White Orchids

This study aims to understand stress, coping strategies, and wellbeing of last responders across the US during COVID-19 and to use that knowledge to guide the development of supportive interventions to promote wellbeing among these workers.

Team members:

  • UIowa: Rima Afifi (lead), Daniel Sewell, Mark Vander Weg
  • PRC-RH Students: Jorge Calderon, Libby Fry, Natalie Peters, Hahn Pham, Jasinaremi Robledo, Sydney Zarate-Sada
  • Partners: Peter Teahen (funeral director); Suzanne Gebel (Iowa Funeral Directors Association); Deana Gillespie (National Funeral Directors Association); Hari Close (National Funeral Directors and Morticians Association); Claire Pritchard (Johnson Consulting); Rachel Kaul (US Department of Health and Human Services); Nancy Weil (Order of the Golden Rule); Leili McMurrough (Worsham College of Mortuary Science); Mary Schoenfeldt (Green Cross Academy)

Project dates: 2020-present

Funding sources: UI PRC-RH, Funeral Services Foundation, UI College of Public Health

Project tags: Mental health, COVID-19, Community engagement

Details

 

Description

Last responders constitute an occupational category that includes all those involved in the postmortem care of deceased persons and their families. Last responders are exposed to several work-related stressors affecting their health and well-being. COVID-19 exacerbated these stressors, as last responders were at the front lines of the pandemic. Yet, last responders have generally been ignored in the COVID-19 pandemic, and not prioritized for PPE, nor for vaccines despite their clear exposure.

One of the clear stressors is the discrimination/ stigma towards last responders. In the US, the topic of death remains taboo and stigmatized. To date, there has been very little research to understand the consequences of COVID-19 on last responders. Without this knowledge, intervention programs to support them cannot be developed.

The purpose of our mixed-methods research is to (1) understand stress, coping strategies, and wellbeing of last responders across the US during COVID-19 and (2) use that knowledge to guide the development of supportive interventions to promote wellbeing among these workers. An advisory board of last responders has guided this research.

In a survey of 535 last responders in 2020, we found that last responders had increased stress, anxiety, and feelings of discrimination during the pandemic; many were feeling burned out, and many had experienced secondary traumatic trauma.  Younger and female last responders had worse outcomes.

We conducted interviews (Fall 2021/Spring 2022) to better understand their experiences and uplift their stories. Prominent themes from preliminary analysis include lack of perceived control (over stressors) resulting from communal and political factors; the critical importance of peer social support in coping with stressors; the strong commitment of last responders to serving families despite the difficult restrictions imposed by COVID-19; and significant experiences of stigmatization.

 

Resources, Media, & Publications

Media:

Publications:

  • Kibbi R, Afifi RA, Pham H, Sewell DK, Teahen PP, Vander Weg MW. The "dirty work" of last responders: Occupational stigma risk and protective factors. J Occup Environ Hyg. 2024 Feb 16:1-7. doi: 10.1080/15459624.2024.2302481. Epub ahead of print. PMID: 38363742.
  • Afifi RA, Calderon JL, Pham H, Teahen P, Zarate-Sada S, Sewell DK, Vander Weg MW. Ignored and distressed: a cross-sectional study of the impact of COVID-19 on last responders. BMC Public Health. 2023 Aug 26;23(1):1637. doi: 10.1186/s12889-023-16565-z. PMID: 37633898; PMCID: PMC10463888.

Presentations:

  • Calderon J, Teahen P, Pham H, Sewell D, Vander Weg M, Zarate-Sada S, Afifi R. Fatalities management workers COVID-19 related stress, coping, and wellbeing. American Public Health Association annual conference. Oct. 22, 2021
  • Teahen P, Afifi R. Fatalities Management Workers COVID-19 related stress, coping and wellbeing. International Critical Incident Stress Foundation. World Congress. May, 2021  
  • Afifi R, Teahen P. Fatalities Management Workers COVID-19 related stress, coping and wellbeing: Results of a National survey. Iowa Funeral Directors Association Meeting. Des Moines, IA. May, 2021
  • Afifi, R., Zarate-Sada, S., Calderon, J., Teahen, P., Vander Weg, M., Fry, L., Peters, N., Robledo, J., Pham, H., Sewell, D. We were the forgotten ones - Stigma, stress, coping and wellbeing among the last responders during the COVID-19 pandemic. American Public Health Association annual conference. October, 2022