Loss and Grief in the Context of the COVID-19 Pandemic in Brazil: The Role of Spirituality and Religiosity

Abstract

The COVID-19 pandemic has significantly altered the experience of loss and mourning, potentially increasing distress among bereaved individuals. This study aimed to assess this experience and examine the role of spirituality and religiosity in this context. Using a mixed-methods, cross-sectional design, this research employed a sociodemographic questionnaire, the Inventory of Complicated Grief (ICG), the WHO-5 Well-Being Index, the Burdened by Grief and Loss (BGL) scale, and an open-ended question regarding what participants found helpful in their grieving process. Of the 323 responses eligible for quantitative analysis, 225 participants responded to the open-ended question. Notably, 36.84% of the sample scored above 25 on the ICG, indicating significant grief-related distress. Quantitative findings revealed that individuals with spiritual engagement (religious or not) reported lower levels of grief and higher general well-being scores. Qualitative analysis of the open responses highlighted spirituality as the most prominent source of support in coping with grief during the pandemic. Given Brazil’s high mortality rate, a substantial number of people may be experiencing complications in their grieving processes. Healthcare professionals and spiritual/religious care providers should be equipped to offer appropriate support and foster interdisciplinary dialog to assist those bereaved effectively.

1. Introduction

The rise of the coronavirus (SARS-CoV-2), which causes the COVID-19 disease, to pandemic status on 11 March 2020 presented humanity with a new scenario (OPAS 2020). Globalization, with its ease of transit between the most diverse countries, led us to watch, helpless and perplexed, the advance of contamination and deaths in the world, almost in real time, through electronic panels such as the one developed by the Center for Systems Science and Engineering at Johns Hopkins University in the United States. On 2 January 2023, the dashboard informed the world of the 6,691,521 deaths since the beginning of the pandemic. In Brazil, the panel pointed to a figure of 693,853 (JHU 2023).

According to a publication about the 2022 census by the Brazilian Institute of Geography and Statistics, known as the IBGE (2022a), Brazil’s population was 207,750,291 on 28 December of the same year. It represented 2.6% of the world’s population. Furthermore, 10.4% of all deaths registered in the world were in Brazil, disregarding all the difficulties of measuring the actual number of people who died on Brazilian soil.

By outlining the dimensions and quantitative extent of the impact of deaths caused by the COVID-19 pandemic in Brazil, we can see the importance of studying the process of dealing with loss and mourning caused by disasters of such gigantic proportions as the pandemic. The Brazilian population is considered “highly religious” (Huber and Huber 2012; Esperandio et al. 2019). The latest IBGE (2022b) data shows that nearly 90% of the Brazilian population identifies with a religion, of which 56.7% are Catholics, 26.9% are Evangelicals, 1.8% are Spiritists, 1% belong to Afro Religions, and 4% belong to other faiths. Additionally, 10% reported having no religion, and 1% identified as Atheists.

In 2022, the same institute released data on the number of religious establishments in the country, there being approximately 580,000 (IBGE 2022b). This means that there are more religious institutions than hospitals and schools combined. Given this scenario, one might ask whether spirituality and religiosity play a role in the experience of coping with bereavement in this population context.

The relationship between spirituality and bereavement has been widely studied, highlighting the importance of spiritual beliefs in coping with loss. Spirituality acts as a source of emotional support, helping individuals find meaning and purpose after the death of loved ones (Park 2013). Spiritual practices, such as prayer and meditation, can reduce anxiety and promote acceptance, offering a vision of continuity beyond material life (Koenig 2012). In addition, spiritual and religious beliefs help to reshape the perception of finitude, facilitating emotional adaptation and providing a social support network linked to religious communities (Neimeyer et al. 2010). Religious beliefs are often employed by religious individuals in situations of significant suffering (Pargament et al. 1998), a phenomenon Pargament has termed “religious coping” (Pargament 1997). While religiosity can contribute to the processes of transformation and/or healing, including those involving trauma and grief (Lee et al. 2022; Vis and Boynton 2024), it can also become a source of heightened distress (Pargament and Exline 2020), depending on the type of religious coping employed and the nature of the religious struggle experienced (Desai and Pargament 2015).

Therefore, considering the relationship between spirituality, religiosity, and bereavement, against the backdrop of the Brazilian religious scene and the number of people suffering from the loss of a loved one in times of the COVID-19 pandemic, this study aimed to investigate this experience of loss and bereavement, specifically verifying the place of spirituality and religiosity in this context. The European consensus definition of spirituality published by the European Association for Palliative Care (Nolan et al. 2011, p. 88) is used in this study:

Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred.

The term religiosity can express the individual’s involvement with formal religious practices established by institutionalized religions. In other words, religiosity can be an aspect of the subject’s spirituality since a religious person “assumes certain beliefs, practices and ethical-moral values linked to an established religion” (Esperandio 2014, p. 808). Spirituality may thus refer to religious people within a specific religious faith tradition, or to non-religious people following their own, more open and pluralistic approach to find meaning and hope in life.

The definition of spirituality used in this study could be criticized as a “vague” term “without legitimate value”. As already observed by Swinton and Pattison (2010, p. 226), “this vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless.” However, we follow these authors’ understanding that the vagueness and lack of clarity around the term spirituality is a strength that has powerful political, social, and clinical implications (Swinton and Pattison 2010, p. 226). The study of spirituality as a central human dimension helps us to understand the transformations of subjectivity throughout history. The subjective perception of people who may regard themselves as religious (in terms of a specific faith tradition) or as spiritual (in terms of a more open approach not requiring a church-related faith), whether both or neither, is in the foreground; it was not the intention to control this with external measures, but to take their self-perceptions seriously. Especially in Brazil (one of the countries with the highest number of deaths from COVID-19), the experience of loss and mourning may have led to a transformation in human perception related to spiritual, religious, and existential aspects (of ultimate concern, such as death). As Leget and Guldin (2024) and Guldin and Leget (2025) point out in their analysis of the relationship between mourning and the spiritual and existential dimension, “the spiritual dimension of grief refers to the way we find meaning and transcendence while going through the dying process or after a loss that has affected the global meaning structure that helps us make sense of the world” (Leget and Guldin 2024, p. 368).

In the context of the pandemic in Brazil, death and the experience of mourning suddenly became part of people’s daily lives, both privately and collectively, as the media followed the numbers and statistics that grew daily. The fear of finitude or the loss of loved ones haunted everyone’s reality. Particularly in Brazil, the figures presented in the local context illustrate, quantitatively, a reality that the pandemic soon brought to the forefront and which, in general, is not dealt with recurrently, especially in the Western world: the experience of mourning. This accompanies end-of-life issues.

Bereavement, as a multifactorial and deeply personal experience, has been the focus of numerous theoretical and empirical investigations (Parkes 1998; Neimeyer et al. 2010; Eisma 2023; Gang et al. 2022; Tang and Xiang 2021). Recent approaches, such as those of Leget and Guldin (2024); Guldin and Leget (2025), emphasized the existential and spiritual dimensions of grief, highlighting how individuals navigate meaning-making processes during bereavement. Furthermore, studies specific to the pandemic context (Büssing and Baumann 2023) have underscored the unique challenges posed by the COVID-19 pandemic, including the heightened prevalence of complicated grief. This study draws on these theoretical frameworks and aims to explore the role of spirituality and religiosity in coping with grief during the COVID-19 pandemic.

2. Materials and Methods

The present study represents a subset of a broader investigation on “Loss and Grief in the Context of the COVID-19 Pandemic”. This research adopts a cross-sectional design (capturing a snapshot of participants’ experiences at a single point in time), as well as an exploratory, and descriptive approach, using mixed methods. Data collection included a questionnaire to gather sociodemographic information, an Inventory of Complicated Grief (Prigerson et al. 1995), a scale of perceived stress in the COVID-19 pandemic using the Burdened by Grief and Loss—BGL (Büssing and Baumann 2023), the WHO-5 Well-being Index Scale (Souza and Hidalgo 2012), and a text field with an open-ended question for participants to report coping resources they found helpful in their grieving process.

The Inventory of Complicated Grief (ICG) aims to identify and measure the maladaptive symptoms of the loss and grieving process. It proposes a cut-off score of ICG > 25 to classify people with more significant impairment in various domains, such as social life, physical and mental health, and bodily pain related to the grieving process. The scale comprises 19 items measured using a Likert scale: never = 0, rarely = 1, sometimes = 2, often = 3, and always = 4. The score is calculated by adding up all the answers on the scale. For the sample, Cronbach’s alpha = 0.930.

The BGL is a 9-item instrument (on a Likert scale, in which 0 = does not apply at all, 1 = does not apply, 2 = neither yes nor no, 3 = applies well, and 4 = definitely applies) and aims to verify how the perception of losing loved ones in a period of restriction such as the COVID-19 pandemic affects the grieving process, making it “heavier.” The score is calculated by adding up all the answers on the scale. A score greater than 29 indicates a greater weight attributed to the stressors of the pandemic period for the elaboration of grief; scores between 7 and 29 display moderate weight; and scores less than 7 have no great relevance. The Exploratory Factor Analysis (EFA) of the BGL showed that the sample was adequate (KMO = 0.914 and Bartlett’s test of sphericity x² = 1861.116 p < 0.001 df = 36). The Maximum Likelihood and Varimax Factor Rotation extraction method was used, suppressing values below 0.30. The results indicate that the instrument is unidimensional, with 61.63% of the variance explained. Cronbach’s alpha was 0.921, without excluding any of the items. These findings support its reliability for analyzing data collected during this extraordinary period.

The WHO-5, or World Health Organization Well-Being Index, was developed from the Psychological General Well-Being Index and the Scales for Anxiety and Depression. The WHO-5 was validated for Brazil by Souza and Hidalgo (2012) and consists of five items: 0 = never, 1 = sometimes, 2 = less than half the time, 3 = more than half the time, 4 = most of the time, and 5 = all the time. The score is calculated by adding up all the answers on the scale. According to the parameters established for the scale, a score of less than 13 (<50%) indicates poor well-being, suggesting that further clinical investigation for depression should be carried out. For the sample, Cronbach’s alpha = 0.926.

The relationship with the dead person was categorized as a father or mother, partner or sibling, child, and friend, relative or other.

The people who took part in the survey were asked to answer two questions about how they experience their religiosity and spirituality: “I feel like I’m a religious person”; “I feel like I’m a spiritual person”. For each question, they answered on a Likert scale where 1 = does not apply at all, 2 = does not apply, 3 = neither yes nor no, 4 = does apply, and 5 = definitely applies. The answers were categorized so that, for the question about self-identification as religious, 1, 2, and 3 = not religious, and 4 and 5 = religious. For the question on self-identification as spiritual, the same criteria were used. These results were grouped into four categories: religious but not spiritual, spiritual but not-religious, both spiritual and religious, and neither spiritual nor religious.

As for the selection of participants, we included people who were at least 18 years old and had lost a person to death, not necessarily from COVID-19, in the period since March 2020. People who did not meet these criteria and did not agree to sign the Informed Consent Form (ICF) were excluded. Participation in the study was voluntary. The study was approved by the Ethics Committee of the Pontifical Catholic University of Paraná—PUCPR (Report no. 5.356.484).

Data was collected through a link created for this purpose, hosted on the Qualtrics Platform. Participants in the study were recruited using an invitation with a link to the online survey, which was sent to target groups and distributed to contacts and social media (Instagram and Facebook). The dissemination also followed a chain referral approach, where initial participants were encouraged to share the link with their contacts. At the start of the online survey, people received information about free consent and clarification about the study.

Thus, this article presents the results of a quantitative and qualitative analysis of data collected on bereavement during the COVID-19 pandemic in Brazil. It specifically seeks to highlight the role of spirituality and religiosity in this context.

The quantitative data was analyzed using descriptive (frequency) and central tendency (mean, standard deviation) analyses. The interest variables ICG, WHO-5, BGL, religiosity, and spirituality were correlated. Matching tests were applied between groups according to the characteristics of the sample. As the matched groups are non-proportional, non-parametric tests were carried out (Kruskal–Wallis and Mann–Whitney U). IBM SPSS v.20 (Statistical Package for the Social Science) software was used. The significance level adopted was 5% (α = 0.05).

An open-ended question, “what helped you most in your grieving process?”, was analyzed using the Content Analysis methodology proposed by Mayring (2000, 2014). According to this approach, after formulating the research question, the sample material is determined, a system of categories is established based on theoretical foundations relevant to the research question, the categories are defined, possibly with examples, and the units of analysis and the units of classification (or categories) are determined. In this study, the analysis was conducted deductively, guided by the conceptual framework of spirituality and religiosity outlined in the Introduction (Nolan et al. 2011; Pargament 1997; Esperandio 2014; Pargament and Exline 2020), and complemented by thematic analysis to identify patterns and insights across the data (Mayring 2014, p. 104).

As part of the analysis process, two authors independently coded the data, identifying themes by examining the frequency and presence of textual elements in each category. They then discussed their findings to resolve discrepancies and synthesize the final categories. To ensure accuracy, a third author reviewed the categorization process, confirming and validating the results. This collaborative effort enhanced the reliability of the qualitative analysis, adhering to Mayring’s (2000, 2014) methodology. The use of Atlas.Ti 24 software streamlined the systematic management of the substantial textual data, enabling the use of a rigorous approach to organizing and coding responses. All responses to the open-ended question were analyzed comprehensively, without selective sampling, capturing the full range of perspectives. This methodology, consistent with Mayring’s principles, also reported response frequencies, providing a thorough overview of participants’ coping mechanisms.

3. Results

Data was collected between September 2022 and February 2023. A total of 499 bereaved people answered the questionnaire, and 323 (64.73%) were qualified for statistical analysis. Most participants were female (75.23%), with an average age of 42.59 ± 14.39 [18–80] years. The majority declared themselves Catholic (44.89%), with access to education, a post-graduate degree or higher, and a high average household income, representing a specific section of the Brazilian population considered “middle class.” Most of the people who died were friends, relatives, and others (60.68%), followed by parents (26.93%). The average time of bereavement during the survey was 18.69 ± 8.46 months (

Table 1. Description of study sample.

Sociodemographics	%	Mean ± SD
Gender
Female	75.23
Male	21.05
Other	3.72
Skin color
White	83.80
Black	2.20
Brown	9.20
Asian	3.80
Indigenous	0.50
Other	0.50
Region of the country
Northeast	12.20
Midwest	1.60
Southeast	21.00
South	65.20
Relationship with the deceased
Father or mother	26.93
Sibling or spouse	9.60
Child	2.79
Friend, relative, or other	60.68
Self-report “religious” and “spiritual”
Neither spiritual nor religious	13.31
Spiritual but not religious	20.43
Religious but not spiritual	6.19
Spiritual and religious	60.06
Religious affiliation
Catholic	44.89
I believe in God. but I have no religion	20.12
Evangelical	13.93
Spiritist	9.60
Afro-Brazilian religions	4.02
I don’t believe in God and have no religion	4.02
Other	3.41
Age (in years)		42.59 ± 14.39
Time of bereavement (in months)		18.69 ± 8.46

).

3.1. Indicators of Bereavement, Well-Being, and Burdened by Grief and Loss

For the sample, the average ICG was 21.69 ± 15.54 [0–76], and 36.84% had a score > 25, indicating intense suffering directly related to grief, with an indication of complicated grief. For the BGL, the overall average was 18.76 ± 9.95 [0–36], and 11.15% had a low grief burden (scores < 7), 72.45% had a moderate grief burden (scores 7–29), and 16.40% had a high grief burden (scores > 29). For the WHO-5, the overall average was 13.09 ± 6.03 [0–25], and 45.20% had a score < 13, indicating low well-being.

The ICG, BGL, WHO-5, religiosity, and spirituality variables of interest were correlated to see if there was a statistically significant relationship between grief intensity, well-being, and the participants’ self-reported spiritual and religious engagement. As shown in

Table 2. Correlation among ICG, WHO, BGL, and self-reported “religious” and “spiritual”.

	ICG	WHO-5	BGL	Religious	Spiritual
ICG	1
WHO-5	−0.586 **	1
	0.000
BGL	0.527 **	−0.376 **	1
	0.000	0.000
Religious	−0.093	0.122 *	−0.113 *	1
	0.094	0.028	0.043
Spiritual	−0.192 **	0.164 **	−0.117 *	0.537 **	1
	0.001	0.003	0.036	0.000

** correlation is significant at the 0.01 level. * correlation is significant at the 0.05 level.

, the indicator spirituality demonstrated a significant negative correlation with ICG and BGL (p < 0.05) and a positive correlation with WHO-5 (p < 0.01). These correlations indicate that self-assessment as spiritual is associated with lower grief intensity and burden and higher well-being (Table 2). The indicator religiosity, however, only showed a significant positive correlation with WHO-5 (p < 0.05) and a negative correlation with BGL (p < 0.05), but no significant correlation with ICG (Table 2).

To assess differences in the three indicators—grief (ICG), well-being (WHO-5), and Burdened by Grief and Loss (BGL)—across demographic and self-reported spirituality/religiosity groups, the Kruskal–Wallis was used to analyze overall group differences (

Table 3. Indicators of bereavement, well-being, and Burdened by Grief and Loss.

	ICG	WHO-5	BGL
Total sample	21.69 ± 15.54	13.09 ± 6.03	18.76 ± 9.95
Gender
Female	24.08 ± 15.69	13.16 ± 5.90	19.77 ± 9.72
Male	14.76 ± 12.97	15.68 ± 5.56	15.04 ± 9.89
Other	12.50 ± 10.87	17.17 ± 5.70	19.33 ± 10.79
x2-value	26.664	23.167	11.416
p-value	<0.001	<0.001	0.003
Relationship with the deceased person
Father or mother	24.17 ± 16.77	12.65 ± 6.68	18.68 ± 11.19
Sibling or partner	32.03 ± 19.68	11.58 ± 6.94	20.35 ± 9.80
Child	41.22 ± 13.58	5.89 ± 4.25	24.44 ± 12.48
Friend, relative, or other	18.06 ± 12.53	13.85 ± 5.37	18.28 ± 9.22
x2-value	30.715	15.976	4.319
p-value	<0.001	0.001	n.s.
Self-report: “religious” and “spiritual”
Neither spiritual nor religious	28.12 ± 17.80	10.44 ± 6.31	21.05 ± 11.37
Spiritual but not religious	20.64 ± 14.23	13.11 ± 5.68	19.54 ± 10.12
Religious but not spiritual	25.10 ± 14.77	12.35 ± 5.69	20.20 ± 7.80
Spiritual and religious	20.27 ± 15.22	13.74 ± 6.00	17.83 ± 9.70
x2-value	10.02	11.683	5.036
p-value	0.018	0.009	n.s.

Note: n.s. = not statistically significant.

). For pairwise subgroup comparisons, the Mann–Whitney U test was applied.

Significant differences were found between women and men for the means of the ICG (U = 5177.500 p < 0.001), WHO-5 (U = 5424.500 p < 0.001), and BGL (U = 6053.500 p = 0.001). Regarding the relationship with the deceased, the loss of a child or spouse/brother or sister elicited high ICG and low WHO-5 responses but no significant differences for BGL (Table 3).

For those self-reporting as “religious” and/or “spiritual”, as shown in Table 3, there were statistically significant differences in the ICG means between those who declared themselves “religious and spiritual” and those who declared themselves “neither spiritual nor religious” (U = 3032.000 p = 0.005) and for those who declared themselves “spiritual but not religious” and those who declared themselves “neither spiritual nor religious” (U = 1034.500 p = 0.017), but there were no differences between the other comparisons (other p > 0.116). For the WHO-5, statistically significant differences were also found between those who declared themselves “spiritual and religious” and those who declared themselves “neither spiritual nor religious” (U = 2807.000 p = 0.001) and between those who declared themselves “spiritual but not religious” and those who declared themselves “neither spiritual nor religious” (U = 1040.5000 p = 0.019), but there were no significant differences in the other comparisons (others p > 0.231). For BGL, there were no differences between the groups.

3.2. Content Analysis of the Open Question

The open-ended question about “what helped the bereaved person most in their grieving process” was optional. Of the 323 participants in the study, 225 answered this question, and all of them were analyzed. Based on the method proposed by Mayring (2000, 2014), the analysis identified the units of meaning and categories shown in

Table 4. Qualitative analysis of what helped most in bereavement process.

Units of Meaning	Categories	Expressions of Category	Citations	Occurrence (%)
Spiritual dimension	Spirituality as a source of strength, meaning, and connection	Connection with oneself, the other, the moment, nature, the significant, and/or the sacred (sense of total presence).	“Contact with nature, God and music”; “Understanding what death and spirituality are. Looking at death within us. Without fear or anger, psychotherapy and meditation were essential pillars”; “Spiritual practices”; “My spirituality”.	36
			“Being present during the dying process, caring, giving affection, praying and singing.”
			“Spirituality and family support”; “Important friends who are present daily helped in this process”; “My animals”.
Religious dimension	Public practice	Involvement in faith community activities	“The church without a doubt”; “Working in the church”; “Listening to testimonies, talking about loss…”; “Being a Spiritist”; “Knowing that those in Christ have eternal life. They don’t die!”; “Knowledge of spiritist doctrine”; “Belief in the resurrection after death”; “Being Catholic, deepened in the faith”.	12.90
	Private practice	Religious beliefs, reading religious texts	“Having faith in the continuity of life in the Spirit”; “My faith in the certainty that God is in control of everything and that nothing happens by chance. Everything has a purpose. Everything has its time. Time to be born and time to die”; “Reading the Bible, praying”; “Believing in God, talking to God.”
Acceptance of the situation	Acceptance of death as a natural phenomenon of life	Resignification of the event; rationalization of the experience; relief through the cessation of suffering	“What comforted me the most was knowing that my brother would no longer need to take medication for his illness, schizophrenia, and that he would stop hearing voices due to this illness”; ‘Rational, everyone will go through this’; “Accepting what had happened and that I could do nothing to change it”; “Knowing that my father was calm at the time of his hospitalization and that he trusted in God’s plans, that everything has its time. As he always said, ‘nobody dies the day before.’”	24.44
	Good memories of the deceased and feeling of gratitude	“Comfort and gratitude for the legacy left behind and the positive memories lived.”	“I had the privilege of having the best mother in the world, and the best sister God could give me; I have three children who give me strength”; “Remembering the life we had together”; “Thinking about the good things she left me”; “Remembering the positive moments with the person.”
Expressions of care	Care from health professionals	Quality of care the deceased received from health professionals, including pain control.	“The care of the doctor and nursing staff”; “Knowing that my grandmother died painlessly.”	8.89
	Psychological care	Individual psychotherapy, psychoanalysis, mutual help groups	“I had strong psychological and therapeutic support”; “The psychoanalytic process”; “Participating in a bereavement group, where I realized that I wasn’t the only one suffering from the death of my beloved son”; “Anonymous Brotherhoods of Anonymous (12 Steps—Neurotics Anonymous) and Mourners Anonymous.”
	Pastoral care	Support from the faith community; assistance from religious leaders	“The priest’s words, his speech at the time,”; “Support from the friars, church members”; “The presence of the Christian community (prayer from pastors, and friends of the church)”; “Support from the church and colleagues in the ministry.”
mental and physical occupation	Labor occupation	More intense work involvement	“What helped the most was maintaining the work routine,” focusing on work, and “Going back to work and doing church work.”	4.44
	Mental occupation	Occupy your thoughts with basic and/or work activities	“What helped me was to keep working and have things to occupy my mind. Basic, manual tasks.”
Participation in farewell rituals	Participation in funerals and virtual celebrations	The need for a farewell ritual shared with the affective group.	“For me, being able to see him and accompany his funeral, although very painful, was very important to thank him for everything and to realize that he had gone in peace”; “Having participated in the funeral and burial, where I met supportive family members”; “I did an Online Posthumous Ceremony for my family using the Zoom app. I gathered photos, posted poetry, and my relatives were able to open up and share their grief for my uncle.”	4.00
Difficulties in experiencing bereavement.	Avoidance Attitude	Suppression of the suffering arising from the loss; hope that time alone will help the grieving process.	“Time”; “This feeling should stay for a long time’”; “Nothing. I still haven’t gotten over it, and many, many times I’ve wished for death…”	9.33
	Paralysis and rumination	Anger: feeling that nothing can help	“Getting angry and wanting to kill someone, that is what keeps me from killing myself”; “ Nothing helped”; “I still do not know… I am still in deep mourning”; “ Without help.”

.

4. Discussion

The sample in this study mostly comprises white people who live in the South and Southeast regions and have higher purchasing power than most of the Brazilian population. In this sense, it constitutes the group with the best access to healthcare, both for the deceased and for self-care, differing from most of the Brazilian population. This reflects the non-probabilistic sampling method employed, which inherently limits the representativeness of the results. The use of online surveys further excludes individuals without internet access or digital literacy, contributing to the overrepresentation of educated and middle-class participants. Nonetheless, online data collection proved to be a valuable tool during the pandemic, as it enabled access to participants across diverse locations while reducing logistical and financial barriers (Salvador et al. 2020). The results of this study offer valuable insights into how spirituality and religiosity—as a self-assessment and thus the perception of an attitude—were experienced in this demographic, suggesting a possible shift in societal understanding regarding the meanings of spirituality and religiosity used as a resource. These findings make evident the importance of distinguishing these two concepts, which often overlap but remain distinct in how individuals identify themselves as ‘spiritual’ or ‘religious.’ In future studies, this nuanced understanding may be crucial to exploring how these dimensions shape the grieving process and coping mechanisms. A “spiritual” person would be someone who places greater value on personal beliefs, grounded in values that emerge from their own subjectivities rather than from religious traditions. In general, they find themselves disengaged from their old bonds and religious traditions. Those who identify themselves as both “spiritual and religious” are individuals who develop their spirituality in an integrated manner within the religion they embrace. In this sense, they embody what Allport and Ross (1967) describe as intrinsic religiosity. Although they are distinct notions, spirituality and religiosity can overlap, with the latter being an expression of the former.

The results suggest that the sample reflects an evolving societal understanding of the differences between these two terms. The findings highlight how participants relate to spirituality and religiosity in the context of bereavement. However, as the data is self-reported, it may reflect participants’ perceptions, or perhaps social desirability, rather than standardized and objectifying measures of conceptual understanding.

The data indicates that a significant proportion of the sample shows signs of complicated mourning, demonstrating that they are in pain, which can lead to a deterioration in their health.

The results show that those who identify themselves as “spiritual” or “spiritual and religious” seem to be better equipped with internal and external resources to deal with bereavement, resulting in feelings of greater well-being. The qualitative analysis not only corroborates all these findings but also provides additional context, particularly regarding the spontaneous emphasis participants placed on spirituality and religiosity as coping mechanisms. By analyzing all the open-ended responses without selective sampling, the study highlights the importance of these dimensions across a diverse range of perspectives, offering a richer understanding of the grieving process. The integration of quantitative and qualitative data allowed for a deeper understanding of the role of spirituality and religiosity in coping with bereavement.

It is worth noting that the perception of being religious is related to greater well-being when associated with the spiritual dimension, i.e., as an expression of spirituality. The Units of Meaning express two types of patterns used in coping with bereavement: “inward” and “outward.” The following units characterize an “inward” pattern: spiritual dimension and the acceptance of the situation. The categories of these units show that how the individuals deal with the loss internally is predominantly based on the search for meaning and comfort in personal, spiritual, or emotional aspects. These categories indicate a way of processing grief that does not depend directly on interactions with the external world.

The “outward” pattern can be characterized by the following units: religious dimension, care given to the deceased, participation in farewell rituals, and physical and mental occupation. The categories representing these Units of Meaning involve interactions with the external environment, through which the individual seeks and receives support. Quantitative statistical analysis, combined with qualitative analysis, indicates that spirituality plays a relevant role in the experience of complicated bereavement. It can even be inferred that this dimension supports greater acceptance of the situation, as it contributes to the experience of loss with coping resources.

As bereavement is a multifactorial process, many variables are synergistically involved in our understanding of this issue. The research results demonstrate the interaction of the spiritual dimension in the grieving process in situations of significant disasters and show that this dimension cannot be neglected in care proposals. People seem to turn more to this dimension in search of meaning and connection with what they perceive as sacred, even if that sacredness is their family, a pet, nature, or transcendence. It is worth remembering that pointing out indications of complicated grief is not intended to “pathologize grief.” Colin Parkes says, “The pain of bereavement is as much a part of life as the joy of living; it is perhaps the price we pay for love, the price of commitment” (Parkes 1998, p. 21). It is necessary to legitimize the pain and the need for adequate care. The components of the concept of spirituality assumed in this study support the creation of proposals for caring for bereaved people.

The results of this study suggest a change in the understanding and experience of spirituality in the Brazilian context. This inference should be confirmed in the future by the publication of the results on the new religious map in Brazil (survey led by IBGE) and new research studies (based on standardized assessment) focusing on how spirituality is experienced in the country.

Considering the number of deaths in Brazil during the COVID-19 pandemic, public policies in mental health should consider the role of spirituality in caring for bereaved people. In Brazil, psychology professionals find it challenging to integrate issues related to the spiritual dimension into the psychotherapy clinic. In the same way, religious leaders who provide spiritual care to the faithful who are going through the experience of bereavement could integrate the spiritual dimension into their care through questions such as, “How is this loss changing your understanding of life? How can you find meaning again? What are your revised goals in life?”, as suggested by Leget and Guldin (2024, p. 370).

The results presented here should not only serve as strong hints to integrate the spiritual dimension into care. They reveal that spirituality may transform the human way of being in the world. This is also a dimension that provides positive strategies (in general) for coping with suffering, especially bereavement. Research in theology, psychology, and public health, along with transdisciplinary dialog, is needed to provide theoretical and practical support for public policies and to propose new psychotherapeutic and pastoral interventions in Brazil.

5. Conclusions

The findings of this study align with the broader bereavement literature, which highlights the interplay of psychological, social, and existential dimensions in coping with grief (Neimeyer et al. 2010; Lee et al. 2022; Guldin and Leget 2025). By focusing on the role of spirituality and religiosity, this research contributes to a nuanced understanding of how individuals navigate loss, particularly in the extraordinary context of the COVID-19 pandemic. These results underscore the need for integrative approaches in bereavement care that consider spiritual and existential dimensions alongside mental health interventions.

Understanding the complexity of the bereavement experience, a multifactorial phenomenon, requires various efforts. The study’s findings point to the fact that losing someone in an exceptional context, such as the global COVID-19 pandemic, can cause a significant proportion of bereaved people to experience intense suffering directly related to grief.

The research also draws attention to the role of spirituality in its various forms of manifestation, including religiosity, as an essential dimension in giving meaning and support to bereavement. The results highlight the importance of improving and training health professionals in general, mental health professionals, and people who provide spiritual and/or religious assistance to promote transdisciplinary dialog in the care of bereaved people.

One of the limitations of this study concerns the sample’s characteristics, which do not reflect the reality of most of the Brazilian population. According to the information presented, the sample can be characterized as WEIRD (an acronym for Western, Educated, Industrialized, Rich, Democratic). Despite the efforts made during the research process, the institutional environment of the researchers may have influenced participant accessibility and engagement. These and other methodological limitations, including the non-probabilistic sampling method and the constraints of online data collection, were explicitly addressed in the Discussion section. Future studies should prioritize a more diverse sample composition to ensure broader generalizability and deepen the understanding of these phenomena across different social and cultural contexts.

Finally, these findings provide compelling evidence of a shift in how the Brazilian population conceptualizes spirituality and religiosity, with important implications for understanding their roles in coping with profound suffering, such as bereavement. Notably, the study highlights that elements characterizing spirituality, distinct from its religious expressions, have a more significant impact on fostering resilience and well-being during grief. This distinction underscores the need for researchers and practitioners to consider these evolving perspectives in future investigations and interventions. By addressing the nuanced interplay between these dimensions, this study contributes to a deeper understanding of their relevance in navigating loss and suffering, especially within the context of significant global crises such as the COVID-19 pandemic.