Bereaved College Students: Social Support,Coping Style,Continuing Bonds,and Social Media Use as Predictors of Complicated Grief and Posttraumatic Growth

Abstract

Many college students experience the death of someone close to them and could be at risk for complicated grieving. Their primary sources of support may be unavailable as family members may live far away and their peers may be unprepared to respond to their grief. In addition, college students are exposed to a variety of stressors that could result in maladaptive coping. Furthermore, although most college-aged students use social media, little is known about its impact on grieving. The purpose of this study was to examine the degree to which social support, coping, continuing bonds, and social media use predicted complicated grief and posttraumatic growth in a sample of college students who had experienced an interpersonal loss. Participants (N = 258; 77.5% female, M age = 19.98, SD = 1.41) completed an online survey assessing the aforementioned constructs using Likert-type scales. Findings from two hierarchical regressions indicated that coping variables accounted for the greatest percentage of variance in grieving outcomes with avoidant-emotional coping being the most robust predictor of complicated grief and problem-focused coping accounting for considerable variance in posttraumatic growth (both were associated positively with the outcomes). As hypothesized, continuing bonds explained variance in both grieving outcomes with externalized continuing bonds and maintaining continuing bonds on social media predicting complicated grief and internalized continuing bonds contributing to posttraumatic growth (also all positively associated). Social support from family also was predictive of posttraumatic growth in the positive direction. Future research directions and implications for practice are discussed with the hope that this research might inform the development of interventions to assist college students who are grieving.

Keywords

grief complicated grief college students posttraumatic growth social media coping/adaptation social support continuing bonds

Throughout their time in college, 40 to 70% of students experience the death of a close friend or relative; 22 to 30% of these students are in their first 12 months of grieving (Balk, 2008; Roberts, 2016). Students’ lack of experience with grief paired with the college atmosphere could result in significant risk to their overall well-being (Servaty-Seib & Hamilton, 2006). Perceived social support, coping style, and continuing bonds (i.e., maintaining an ongoing relationship with the deceased) play a role in the grieving process (Neimeyer et al., 2006; Pillemer & Holtzer, 2015; Schnider et al., 2007). In addition, the use of social networking sites (such as Facebook or Twitter) has become a mechanism for grieving, coping and continuing bonds with the deceased (Fearon, 2018; Rossetto et al., 2015). Thus, the purpose of this study was to examine the degree to which perceived social support, coping style, and continuing bonds predicted complicated grief and posttraumatic growth in a sample of college students. In addition, the contribution of social media use as a mechanism for perceived social support, coping style, and continuing bonds was investigated. Identifying facilitative factors in grieving could be the first step in developing interventions to assist the many students who experience grief in college.

Theoretical Framework for Predicting Grief Outcomes

This study was informed by the Individual Differences Model (Mancini & Bonanno, 2009). This model proposed that most people are resilient when faced with loss and that several constructs contribute to the development of resilience. Specifically, Mancini and Bonanno examined person-centered predictors of resilience and differentiated between several trajectories of bereavement outcomes including chronic grief (lasting struggles with loss and diminished functioning) and resilience (being able to function well while grieving). Among the variables they identified as predictive of resilience were the availability of social resources, coping, quality of the relationship with the deceased, and comfort derived from positive memories of the deceased. This study examined related predictors (i.e., social support, coping, and continuing bonds) and also extended the model to consider a timely potential mechanism for dealing with loss – social media use. Furthermore, two outcome variables were chosen to reflect Mancini and Bonanno’s trajectories of bereavement: complicated grief symptoms (related to chronic grief) and posttraumatic growth (related to resilience).

Bereavement Outcomes

Complicated Grief

Complicated grief can be defined as chronic, intense symptoms of grief that interfere with the ability to function after loss (Shear, 2012). Complicated grief is a risk factor for multiple psychological disorders including depression, anxiety, cardiovascular problems, and substance abuse, and can result in failure to return to pre-loss cognitive performance levels (Maciejewski et al., 2016; Masferrer et al., 2017).

The Individual Differences Model proposed that the effective use of social support may lessen the likelihood of experiencing chronic grief-related symptoms (Mancini & Bonanno, 2009). In fact, perceived social support (defined as the perception that one is cared for and has support when needed) was associated negatively with complicated grief in several studies (Servaty-Seib & Hamilton, 2006; Villacieros et al., 2014). In addition, a systematic review of the literature found that perceived social support was critical after experiencing a death (Lobb et al., 2010).

Similarly, coping mechanisms play a salient role in trajectories of bereavement (Mancini & Bonanno, 2009). Coping style encompasses the processes and strategies used to address the loss of a loved one, and may include problem-focused (e.g., planning), active-emotional (e.g., venting), and avoidant-emotional (e.g., denial) coping strategies (Folkman & Lazarus, 1988). In prior research, avoidant-emotional coping was correlated positively with both complicated grief and psychological distress (Cobb et al., 2015; Schnider et al., 2007).

Another salient factor in bereavement trajectories is the quality of the relationship with the deceased and the degree to which one finds comfort from positive memories of the loved one (Bonanno et al., 2004; Mancini & Bonanno, 2009). Relatedly, continuing bonds or maintenance of bonds with a loved one may relate to positive or negative grief outcomes, depending on how one continues the bond and makes sense of the loss: externalized continuing bonds predicted negative outcomes while internalized continuing bonds predicted positive outcomes (Field & Filanosky, 2010; Stein et al., 2017). Internalized continuing bonds involve keeping the deceased in one’s life through memories and internal reflection while externalized continuing bonds refer more to actions that bring to mind the loved one. Continuing bonds were thought to predict greater levels of complicated grief if the bereaved was unable to make sense of the loss in personal, practical, existential, or spiritual terms (Neimeyer et al., 2006). Moreover, externalized continuing bonds were a risk factor for complicated grief (Field & Filanosky, 2010; Stein et al., 2017).

Posttraumatic Growth

Posttraumatic growth relates to the resilience trajectory described in the Individual Differences Model (Mancini & Bonanno, 2009) and has been defined as positive emotional, psychological, or behavioral changes that result from a stressful life event, including the death of a loved one (Tedeschi & Calhoun, 1996, 2004). In the Individual Differences model, the use and availability of social resources were hypothesized to relate to positive grieving outcomes. This is consistent with prior research demonstrating that social support was a positive predictor of posttraumatic growth (Sehgal & Sethi, 2016; Wolfe & Ray, 2015). For example, social support explained variance in posttraumatic growth among individuals who experienced the death of a loved one by suicide (Levi-Belz, 2019). Moreover, a systematic literature review identified social support as a key predictor in growth after bereavement (Michael & Cooper, 2013).

In addition, the way in which one copes with loss is hypothesized to relate to resilience (Mancini & Bonanno, 2009) and also may predict posttraumatic growth. Among college students who experienced loss, problem-focused coping was correlated with academic adjustment (Cousins et al., 2017) and active-emotional coping was related to enhanced functioning and well-being (Cobb et al., 2015; Cousins et al., 2017), For example, in a study of bereaved parents, levels of communication about their stress (characterized as active-emotional coping) were associated positively with posttraumatic growth (Albuquerque et al., 2018).

As noted earlier, quality of relationship and comfort from positive memories (two constructs likely related to continuing bonds) likely facilitate positive bereavement trajectories (Mancini & Bonanno, 2009). Similarly, continuing bonds (especially internalized bonds) were hypothesized to be associated positively with adaptive grieving outcomes for some individuals (Klass & Walter, 2001; Stein et al., 2017; Tedeschi et al., 2018). In one study of college students who experienced the death of a close friend, continuing bonds through personal communication, personal change, and homage activities correlated positively with posttraumatic growth (Stein et al., 2017).

Investigating a New Predictor: Social Media Use

For college students, the use of social networking sites (such as Facebook or Twitter) has become an increasingly prominent mechanism for grief expression, virtual support, coping with life events, and connecting with the deceased (Hieftje, 2009; Manago et al., 2012; Rossetto et al., 2015), and may play a salient role in bereavement trajectories. Memorial pages and memorial groups have increased the use of Facebook for grieving (Catania-Opris, 2017) and pages of the deceased are used as a means of venting about anger or sadness since the death (Kern et al., 2013). A recent study of 68 Facebook users noted that 98.5% of respondents recommended using memorial pages as a way of grieving (Fearon, 2018). Others suggested that online memorials provided instant and unlimited connections that can forge bonds among the bereaved and create communities beyond the limitations of geographic location (Carroll & Landry, 2010; Sanderson & Cheong, 2010).

Interestingly, researchers suggested that social media use may present a “coping paradox” as it may be both helpful and problematic with regard to coping with loss (Rossetto et al., 2015). For example, social media offers opportunities for adaptive loss-oriented and restoration-oriented coping, however individuals might spend considerable time on social media and not adapt to a different life without the loved one (Rossetto et al., 2015).

For many, social media can be a mechanism for maintaining continuing bonds as it provides a means for connection to and communication with the deceased (Irwin, 2015; Stein et al., 2017). Continuing bonds through social media has been associated with adaptive grieving outcomes (Rossetto et al., 2015). However, if the bereaved are unable to recognize that their bond differs from when the deceased was alive, using social media might be maladaptive, which could contribute to complicated grief.

Hypotheses

First, we hypothesized that social support, coping styles, continuing bonds, and social media use would account for variance in the prediction of complicated grief. Specifically, social support was expected to relate negatively to complicated grief, and coping strategies and continuing bonds were hypothesized to differentially relate to complicate grief (problem-focused and active-emotional coping would be associated negatively with complicated grief and avoidant-emotional coping would be correlated positively with complicated grief). Internalized continuing bonds were expected to relate negatively (and externalized continuing bonds positively) to complicated grief. Due to a paucity of prior research, no specific hypotheses were made regarding social media use and complicated grief.

Second, we hypothesized that social support, coping styles, continuing bonds, and social media use would account for variance in posttraumatic growth with social support being related positively to posttraumatic growth, and coping strategies and continuing bonds being differentially related to posttraumatic growth. Specifically, problem-focused and active-emotional coping were hypothesized to be associated positively with posttraumatic growth and avoidant-emotional coping negatively with posttraumatic growth. We expected that internalized continuing bonds would relate positively, and externalized continuing bonds would relate negatively to posttraumatic growth. Due to limited prior research, no hypotheses were made regarding social media use and posttraumatic growth.

Method

Procedure

After receiving Institutional Review Board approval, recruitment messages were sent via emails to students enrolled in introductory psychology courses at a large, mideastern public university in the United States and via social media posts using a flyer that asked, “Are you grieving? We want to hear from you.” A link to an online Qualtrics survey was provided in the recruitment emails/flyers. Students who clicked on the link were presented with questions assessing inclusion criteria (i.e., 18 to 24 years old, currently attending a university or college, and experienced the loss of a loved one in the past five years). Those who indicated that they met the criteria received an online consent form. After providing consent, participants accessed the online survey. Those who completed the survey received either class credit or a $5 gift card to a coffee shop. Data were collected over a 3-month period.

Participants

An a priori statistical power analysis, using G*POWER v3 software (Faul et al., 2007) suggested that 119 participants were needed to achieve statistical power of 0.95, a medium effect size (f ²= 0.15), and an overall α = 0.05. The online survey was accessed by 890 people (see Figure 1). Participants who failed to complete at least 85% of the items were eliminated (n = 294). Those who did not answer both of the validity check items correctly (i.e., two items asking participants to endorse a specific response to assess attentiveness to the survey) were deleted (n = 280). Finally, the survey was hacked, and data received during the fraudulent activity were deleted (n = 51). The final sample included 258 participants.

Participants ranged in age from 18 to 24 (M = 19.98, SD = 1.41). Most of the participants identified as female (77.5%) and trans female (0.4%), with 19.8% being male, and 0.4% responding “other.” The majority of the sample was White (67.4%) and included Black/Afro-Caribbean/African American (8.5%), Latinx/Hispanic-American (8.5%), Asian/Asian-American/Pacific Islander (10.9%), Native American (0.4%), Biracial/Multiracial (1.9%) and Other (0.4%) participants. They identified as straight (85.7%), bisexual (8.5%), lesbian/gay (1.9%), and other (1.9%).

Most of the sample attended a public four-year institution (93.8%), with 3.1% at a private four-year institution and 1.2% at a community college. The colleges were located in the Mideast (92.6%), Far West (0.8%), Rocky Mountains (0.4%), Plains (0.4%), Great Lakes (1.2%), Southwest (0.4%), and Southeast (0.4%). The most common majors were Psychology (23.64%), Biology (6.6%), and Criminology/Criminal Justice (6.36%).

The sample had experienced the death of a grandparent (50%), good/close friend (14%), distant relative (9.3%), parent (4.7%), best friend (3.9%), romantic/sexual partner (1.2%), sibling (0.4%), or other (14.7%). “Other” included an aunt or uncle, a close family friend, cousin, teacher, or peer. About half of the sample said the death was expected (48.1%), others endorsed unexpected (47.3%), and 2.7% said “other”. Students indicated how much time had passed since their loss: 19% experienced the loss less than 6 months ago, 17.4% said 6 months to 1 year, 33.3% said 1 to 2 years, and 30.2% said within 2 to 5 years.

Measures

Complicated Grief

The 19-item Inventory of Complicated Grief (Prigerson et al., 1995) was used to measure symptoms of complicated grief. Participants indicated how often they were experiencing each of the items on a 5-point Likert scale that ranged from 0 (never) to 4 (always). Example items included: “I feel I cannot accept the death of the person who died,” and “I feel that life is empty without the person who died.” Items were summed, and high scores indicated a high number of grief symptoms. Support for reliability (α = .94) and validity were demonstrated with a sample of college students in a study of coping, complicated grief, and posttraumatic stress disorder (Schnider et al., 2007). In this study, the reliability estimate was .91.

Posttraumatic Growth

The 21-item Post Traumatic Growth Inventory (Tedeschi & Calhoun, 1996) included items assessing growth in relating to others (“I have a greater sense of closeness with others”), new possibilities (“New opportunities are available which wouldn’t have been otherwise”), personal strength (“I have a greater feeling of self-resilience”), spiritual change (“I have a better understanding of spiritual matters”), and appreciation of life (“I can better appreciate each day”). The directions were modified to focus on the degree to which this change occurred as a result of the death of the deceased loved one using a 6-point Likert scale from 0 = I did not experience this change as a result of the death of my loved one to 5 = I experienced this change to a very great degree as a result of the death of my loved one. The average total score was calculated, with high scores indicating high levels of posttraumatic growth. In prior research with college students, the reliability estimate was adequate (α = .90) and support for validity was found as the scale correlated positively with measures of optimism and religiosity (Tedeschi & Calhoun, 1996). In this study, the reliability estimate was .95.

Social Support

The 12-item Multidimensional Scale of Perceived Social Support (Zimet et al., 1990) was used to measure perceived social support from family (4 items; “My family really tries to help me”), friends (4 items; “I can count on my friends when things go wrong”) and significant others (4 items; “There is a special person with whom I can share joys and sorrows”). The instructions were revised to add “since the death of your loved one” (i.e., “We are interested in how you feel about the following statements since the death of your loved one.”). Participants responded using a 7-point Likert scale from 1 (very strongly disagree) to 7 (very strongly agree). Three subscale scores were computed by averaging the responses to items on each subscale. High scores indicated strong levels of perceived social support. Prior research with a large sample of college students found adequate reliability and support for validity (scores were correlated positively with satisfaction with life and negatively with depression and anxiety; Shelton et al., 2017). In the current study, the internal reliability estimates were adequate (family, α = .92; friends, α = .91; significant other, α = .92).

Social Support From Social Media

The Facebook Measure of Social Support (McCloskey et al., 2015) was used to measure social support obtained from using social media. The questionnaire contained 14 items on 4 subscales: perceived support (3 items; “The support I get on Facebook is of practical help to me”), emotional support (4 items; “I’m happy when people comment on my posts”), negative social support (4 items; “I get a lot of negative responses on Facebook”), and informational/instrumental support (3 items; “If I needed information about something, I could post it on Facebook and I’d get the information I need”).

In this study, items were revised so that “Facebook” was replaced with “social media,” and items were specific to grief. For example, one item was changed to “If I needed help with my grief, I could post it on social media and I’d get the help I need.” Participants were asked to indicate the extent to which they have been doing each of these statements since the death of their loved one using a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). After reverse scoring one item, scores on the items on each subscale were summed with high scores indicating strong levels of social support. Support for the reliability of all scales (except for negative social support) and validity of the subscales were demonstrated in prior research (McCloskey et al., 2015). In this study, the perceived (α = .84), emotional (α = .88), and instrumental (α = .79) support subscales had adequate reliability estimates. The negative social support subscale was excluded from further analyses due to low reliability (α = .57).

Coping Style

The Brief COPE Inventory (Carver, 1997) was used to measure coping style. The questionnaire contained 28 items on 14 subscales that were organized into three typologies: problem-focused coping (active coping, planning, instrumental support, and religion scales; e.g., “I’ve been trying to come up with a strategy about what to do”), active-emotional coping (venting, positive reframing, humor, acceptance, and emotional support scales; e.g., “I've been saying things to let my unpleasant feelings escape”), and avoidant-emotional coping (self-distraction, denial, behavioral disengagement, self-blame, and substance use scales; e.g., “I’ve been using alcohol or other drugs to make myself feel better”). Participants responded to each item using a 4-point Likert scale from 0 (I haven’t been doing this at all) to 3 (I’ve been doing this a lot). Items on the three subscales were summed with high scores indicating high levels of each coping style. Prior research demonstrated support for validity and adequate reliability with bereaved individuals (problem-focused, α = .80; active-emotional, α = .81; avoidant-emotional, α = .88; Drapeau et al., 2016). In this study, adequate reliability estimates were found (problem-focused, α = .80; active-emotional, α = .73; avoidant-emotional, α = .80).

Coping Using Social Media

A revised version of the 44-item Media Use for Coping Scale (Springer, 2018) was used to measure how participants used social media to cope with grief. The original 12 subscales assessed the ways in which widowed individuals used television to cope with their grief. For this study, six of the subscales (23 items) were placed in three categories: problem-focused (planning and instrumental support subscales) active-emotional (emotional support, positive reinterpretation and growth, and acceptance subscales), and avoidant-emotional (escape subscale). In addition, the word “TV” was replaced with “social media”, and “spouse” was replaced with “loved one.” Example items included: Planning (“I use social media to help me make a plan of action to deal with my loss”), instrumental support (“I use social media to help me feel that I am doing something about my grief”), emotional support (“Using social media is similar to getting sympathy and understanding about my grief from someone), positive reframing and growth (“I use social media to find something good in my grieving experience”), acceptance (“I use social media to help me accept my loss cannot be changed”), and escape (“I use social media to forget about the grief I am feeling”).

The items for each of the three coping styles were summed to create three subscales, with high scores indicating high levels of each coping style on social media. The original scale evidenced adequate reliability and validity (Springer, 2018). The reliability estimates for the subscales in this study were adequate (problem-focused, α = .92; active-emotional, α = .93; and avoidant-emotional, α = .87).

Continuing Bonds

Two subscales of the Continuing Bonds Scale (Scholtes & Browne, 2015) were edited (i.e., the word “child” was replaced with “loved one”) and used to assess internalized bonds (11 items; e.g., “I imagine my loved one as watching over me”), and externalized bonds (8 items; e.g., “I visit the cemetery and memorial site to see and be close to my loved one”). Responses were measured on a 5-point Likert-type scale from 1 (never) to 5 (very often). Scores were calculated by summing items on each subscale; high scores indicated strong maintenance of bonds with the deceased. Support for reliability and validity was noted as scores on these scales were related to positive and negative grief status in the expected directions (Scholtes & Browne, 2015). In this study, the reliability estimates were adequate for the internalized bonds (α = .89) and externalized bonds (α = .83) subscales.

Continuing Bonds Using Social Media

The Continuing Bonds on Social Media Scale was developed for this study to measure maintaining an ongoing connection with the deceased on social media. The authors reviewed four studies that included content analyses of Facebook posts and semi-structured interviews (Bouc et al., 2016; DeGroot, 2012; Hieftje, 2009; Rossetto et al., 2015). Seven themes were identified that related to the practice of continuing bonds on social media (i.e., General Activity, Memories, Updates, Appreciation, Ritual, Presence, and Eventual Reunion).

Items were developed for each theme (14 total items) with the expectation that the items collectively represented the overarching construct of using social media to continue bonds with the deceased. Participants rated the extent to which they engaged in each of the items since the death of their loved one. Following are example items for each of the themes: General Activity: “Visit the deceased loved one’s page;” Memories: “Share memories of the deceased on social media;” Updates: “Update the deceased about your shared interests on social media (e.g., “our team won last night”); Appreciation: “Express appreciation to the deceased on social media (e.g., “you made such a difference in my life”); Ritual: “Post messages about the deceased for birthdays, anniversaries, or holidays;” Presence: “Use social media to tell the deceased you feel her or his presence in your life;” and Eventual Reunion: “Use social media to tell the deceased about your desire to reunite (e.g., “I can’t wait to see you again someday.” Responses on the items were summed, and high scores indicated high levels of using social media to maintain continuing bonds. Support for the reliability of this measure was demonstrated in this study (α = 0.91).

Analyses

Data were entered into SPSS 25. Missing data were addressed using the Expectation Maximization algorithm. The means, standard deviations, ranges, and reliabilities of the measures were calculated. Pearson r correlations were computed among all scales and subscales.

Two hierarchical regression analyses were conducted to investigate the contributions of social support (family, friends significant other, and through social media), coping (problem-focused, active-emotional, avoidant-emotional, and social media coping), and continuing bonds (internalized, externalized and through social media) on (1) complicated grief and (2) posttraumatic growth. Hierarchical regression analyses were chosen based on the temporal order of the predictors (i.e., the presence of social support in one’s life likely preceded the need for coping with the loss which occurred prior to engagement in continuing bonds).

Finally, after completion of the aforementioned analyses, we wondered if the findings would differ for the participants who met the diagnostic criteria for complicated grief (n = 56) as defined by Prigerson et al. (1995). Thus, an exploratory post-hoc regression analysis predicting complicated grief was conducted with the subset of the sample who were complicated grievers to determine whether, given the low overall levels of complicated grief among our participants, the finding that coping was important in predicting complicated grief would persist if only those individuals who meet criteria for complicated grief were included in the regression.

Results

The means, standard deviations, ranges, reliabilities, and correlations are reported in Table 1. On average, participants reported low levels of complicated grief (as defined by Prigerson et al., 1995). In addition, low levels of posttraumatic growth were reported (as compared to the average posttraumatic growth total score across 13 studies in a review of positive change following trauma; Linley & Joseph, 2004).

Table 1.

Means, Standard Deviations, Ranges, Reliabilities, and Correlations Among Measures.

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
Support
1. Family	–
2. Friends	.50***	–
3. Sig Oth	.46***	.45***	–
4. SM perc	.13*	.03	.10	–
5. SM info	.09	.08	.15*	.57***	–
6. SM emo	.09	.02	.12	.71***	.54***	–
Coping
7. Prob	.19**	.15*	.10	.21**	.08	.18**	–
8. Act	.16**	.21**	.21**	.12	.09	.13*	.64***	–
9. Avo	−.20**	−.13*	−.18**	.16*	.12	.16**	.41***	.34***	–
10. SM prob	.08	.03	.03	.55***	.39***	.40***	.33***	.23***	.27***	–
11. SM act	.06	−.03	.02	.58***	.44***	.48***	.33***	.29***	.33***	.84***	–
12. SM avo	−.12*	−.06	−.00	.19**	.25***	.20**	.16*	.21**	.42***	.40***	.49***	–
Bonds
13. Ext	.19**	.17**	.21**	.21**	.13*	.27***	.46***	.37***	.37***	.27***	.27***	.26***	–
14. Int	.15*	.15*	.22***	.25***	.15*	.24***	.43***	.35***	.30***	.26***	.25***	.15*	.84***	–
15. SM	.02	−.04	.02	.52***	.37***	.50***	.37***	.24***	.42***	.61***	.61***	.31***	.41***	.40***	–
16. CG	−.09	−.07	−.07	.26***	.17**	.25***	.34***	.16*	.68***	.38***	.38***	.41***	.53***	.47***	.51***	–
17. PTG	.29***	.21**	.18**	.29***	.13*	.22**	.65***	.46***	.35***	.32***	.33***	.16*	.58***	.59***	.36***	.39***	1
Mean (SD)	5.63(1.29)	5.75(1.12)	5.83(1.24)	7.78(3.78)	8.51(3.45)	10.14(4.86)	8.97(5.11)	12.38(4.62)	7.00(5.02)	10.90(4.27)	17.80(6.96)	5.18(2.50)	22.28(6.62)	28.55(8.47)	21.72(8.51)	18.23(11.77)	2.26(1.13)
Actual range	1.25–7	1–7	1–7	3–18	3–18	4–26.85	0–24	0–30	0–27	8–32	12–48	3–12	8–40	10–50	14–70	0–55.9	0–4.76
Possible range	1–7	1–7	1–7	3–18	3–18	4–24	0–24	0–30	0–30	8–32	12–48	3–12	8–40	10–50	14–70	0–76	0–5
Cronbach’s alpha	.92	.91	.92	.84	.79	.88	.80	.73	.80	.92	.93	.87	.83	.89	.91	.91	.95

*Correlation is significant at p < .05.

**Correlation is significant at p < .01.

***Correlation is significant at p < .001.

PSS: Perceived Social Support; Sig Oth: Significant Other; SM perc: Perceived Social support on Social Media; SM inst: Informational/Instrumental Support on Social Media; SM emo: Emotional Support on Social Media; COPE: Coping Style; Prob: Problem-Focused; Act: Active-Emotional; Avo: Avoidant-Emotional; SM: social media; CB: Continuing Bonds; Ext: Externalizing; Int: Internalizing; CG: Complicated Grief; PTG: Posttraumatic Growth.

Regression Analyses

The assumptions for conducting multiple regressions were examined (i.e., linearity, multicollinearity, residual independence, homoscedasticity, and influential cases biasing our model); only multicollinearity was found (the correlation between internalizing and externalizing bonds was .84). Given that this relationship was expected, the regressions were conducted.

Collectively, the hypothesized variables accounted for 63% of the variance in complicated grief, with social support contributing 9%, coping adding 45% after the contribution from social support, and continuing bonds explaining an additional 8% over and above the contributions of social support and coping (see Table 2). When all of the variables were entered into the equation, avoidant-emotional coping, avoidant-emotional coping on social media, externalized continuing bonds, and continuing bonds on social media accounted for variance and were positively associated with complicated grief. Active-emotional coping also explained variance and was related inversely to complicated grief.

Table 2.

Hierarchical Regression Analysis Predicting Complicated Grief (N = 258).

Variable	B	SE B	$β$	t	df	R	R²	ΔR²	F	ΔF
Step 1:					6	.31	.09	.09***	4.34***	4.34***
Fam SS	−.80	.67	−.09	−1.19
Friend SS	−.05	.76	−.01	−.06
Sig Oth SS	−.63	.68	−.07	−.93
SM Perc SS	.50	.28	.16	1.76
SM Info SS	.08	.26	.02	.29
SM Emo SS	.35	.21	.15	1.65
Step 2:					12	.74	.54	.45***	24.02***	39.69***
Fam SS	.21	.50	.02	.42
Friend SS	−.03	.56	.00	−.05
Sig Oth SS	.45	.50	.05	.89
SM Perc SS	.08	.22	.03	.37
SM Info SS	−.11	.19	−.03	−.57
SM Emo SS	.20	.16	.08	1.27
Prob Cope	.31	.14	.13	2.15*
Act Cope	−.53	.15	−.21	−3.5**
Avo Cope	1.45	.13	.62	11.23***
Prob Cope SM	.54	.23	.20	2.37*
Act Cope SM	−.13	.15	−.08	−.83
Avo Cope SM	.55	.25	.12	2.16*
Step 3:					15	.79	.63	.08***	26.84***	18.05***
Fam SS	.03	.46	.00	.06
Friend SS	−.06	.51	−.01	−.12
Sig Oth SS	−.13	.46	−.01	−.27
SM Perc SS	.03	.20	.01	.16
SM Info SS	−.07	.18	−.02	−.40
SM Emo SS	.01	.15	.01	.09
Prob Coping	.08	.13	.03	.57
Act Coping	−.55	.14	−.22	−3.99***
Avo Coping	1.20	.12	.51	9.66***
Prob Cope SM	.32	.21	.12	1.51
Act Cope SM	−.09	.14	−.05	−.66
Avo Cope SM	.48	.24	.10	2.04*
Ext CB	.34	.14	.19	2.40*
Int CB	.19	.11	.14	1.80
Cb on Media	.19	.08	.13	2.27*

Note: *p < .05, **p < .01, ***p < .001; Fam SS: Perceived Social Support, Family; Friend SS: Perceived Social Support, Friends; Sig Oth SS: Perceived Social Support, Significant Other; SM Perc SS: Perceived Social Support on Social Media; SM Emo SS: Emotional Support on Social Media; SM Info SS: Informational/Instrumental Support on Social Media; Prob Cope: Problem-Focused Coping; Act Cope: Active-Emotional Coping; Avo Cope: Avoidant-Emotional Coping; Prob Cope SM: Problem-Focused Coping on Social Media; Act Cope SM: Active-Emotional Coping on Social Media; Avo Cope SM: Avoidant-Emotional Coping on Social Media; Ext CB: Externalized Continuing Bonds; Int CB: Internalized Continuing Bonds; CB Media: Continuing Bonds on Social Media; ΔR² = change in R² and ΔF = change in F.

With regard to posttraumatic growth, the variables collectively explained 58% of the variance in this bereavement outcome. Specifically, social support accounted for 16% of the variance, coping explained 34% after the contribution from social support, and continuing bonds contributed 9% after accounting for the variance explained by social support and coping (see Table 3). When all of the variables were entered in the regression equation, only problem-focused coping, internalized continuing bonds and family social support explained posttraumatic growth (all were positively associated).

Table 3.

Hierarchical Regression Predicting Posttraumatic Growth (N = 258).

Variable	B	SE B	$β$	t	df	R	R²	ΔR²	F	ΔF
Step 1:					6	.40	.16	.16***	7.95***	7.95***
Fam SS	.17	.06	.20	2.81**
Friend SS	.10	.07	.10	1.40
Sig Oth SS	.02	.06	.02	.33
SM Perc SS	.08	.03	.28	3.18**
SM Info SS	−.03	.02	−.09	−1.17
SM Emo SS	.01	.02	.04	.49
Step 2:					12	.70	.50	.34***	20.04***	27.16***
Fam SS	.14	.05	.16	2.78**
Friend SS	.05	.06	.05	.80
Sig Oth SS	.05	.05	.05	.98
SM Perc SS	.05	.02	.15	2.02*
SM Info SS	−.02	.02	−.05	−.90
SM Emo SS	−.01	.02	−.03	−.42
Prob Cope	.11	.01	.48	7.4***
Act Cope	.01	.02	.04	.56
Avo Cope	.04	.01	.16	2.77**
Prob Cope SM	.00	.02	.01	.13
Act Cope SM	.01	.02	.05	.48
Avo Cope SM	.00	.03	.01	−.10
Step 3:					15	.76	.58	.09***	22.40***	16.58***
Fam SS	.13	.05	.14	2.70**
Friend SS	.03	.05	.03	.65
Sig Oth SS	−.01	.05	−.01	−.14
SM Perc SS	.04	.02	.13	1.87
SM Info SS	−.01	.02	−.04	−.75
SM Emo SS	−.01	.02	−.06	−.91
Prob Coping	.09	.01	.39	6.42***
Act Coping	.00	.01	.01	.17
Avo Coping	.02	.01	.09	1.63
Prob Cope SM	−.01	.02	−.02	−.26
Act Cope SM	.02	.01	.09	1.02
Avo Cope SM	−.01	.02	−.02	−.33
Ext CB	.02	.01	.10	1.2
Int CB	.04	.01	.27	3.34**
Cb on Media	−.01	.01	−.04	−.62

Given that the participants, on average, experienced low levels of complicated grief symptomatology, we conducted an exploratory post-hoc regression analysis predicting complicated grief symptoms with the small number of participants who met criteria for complicated grief (i.e., the 56 participants who scored 25 or above on the scale and experienced the death at least 6 months ago). Social support, coping and continuing bonds collectively explained 51% of the variance in this bereavement outcome (see Table 4). When all of the variables were entered in the regression equation, only avoidant-emotional coping predicted complicated grief.

Table 4.

Hierarchical Regression Predicting Complicated Grief for Complicated Grievers (n = 56).

Variable	B	SE B	$β$	t	df	R	R²	ΔR²	F	ΔF
Step 1:					6	.41	.17	.17	1.62	1.62
Fam SS	.33	1.04	.07	.32
Friend SS	.04	1.22	.01	.03
Sig Oth SS	−1.30	.92	−.26	−1.42
SM Perc SS	−.49	.33	−.28	−1.46
SM Info SS	.28	.34	.14	.82
SM Emo SS	.56	.24	.45	2.35*
Step 2:					12	.65	.43	.26**	2.69**	3.30**
Fam SS	−.41	.99	−.08	−.41
Friend SS	.44	1.20	.08	.37
Sig Oth SS	−.32	.86	−.06	−.37
SM Perc SS	−.63	.34	−.36	−1.84
SM Info SS	.10	.34	.05	.29
SM Emo SS	.45	.22	.36	2.03*
Prob Cope	.33	.25	.24	1.33
Act Cope	−.22	.30	−.13	−.73
Avo Cope	.56	.18	.45	3.16**
Prob Cope SM	.33	.32	.29	1.02
Act Cope SM	−.01	.22	−.02	−.05
Avo Cope SM	−.16	.36	−.06	−.43
Step 3:					15	.71	.51	.08	2.73**	2.08
Fam SS	−.08	1.04	−.02	−.08
Friend SS	.27	1.22	.05	.22
Sig Oth SS	−.75	.87	−.15	−.87
SM Perc SS	−.53	.34	−.31	−1.60
SM Info SS	.05	.35	.02	.13
SM Emo SS	.29	.25	.23	1.18
Prob Coping	.12	.27	.09	.45
Act Coping	−.26	.29	−.16	−.89
Avo Coping	.53	.18	.42	2.93**
Prob Cope SM	.38	.34	.34	1.10
Act Cope SM	.08	.22	.10	.36
Avo Cope SM	−.26	.37	−.11	−.70
Ext CB	.40	.24	.32	1.64
Int CB	.08	.21	.08	.38
Cb on Media	−.07	.14	−.11	−.48

Note: *p < .05, **p < .01, ***p < .001; Complicated grievers were respondents who scored >25 on the Inventory of Complicated Grief and for whom at least 6 months had passed since the loss of their loved one (Prigerson et al., 1995); ΔR² = change in R² and ΔF = change in F.

Discussion

This study contributed to our understanding of complicated grief and posttraumatic growth in a sample of college students who experienced the death of a loved one. Our hypotheses that social support, coping styles, continuing bonds, and social media use would account for variance in the prediction of complicated grief and posttraumatic growth were partially confirmed. Moreover, our findings were consistent with the Individual Differences Model (Mancini & Bonanno, 2009) as several of the hypothesized predictors of bereavement trajectories accounted for variance in complicated grief and posttraumatic growth.

Specifically, the coping variables accounted for the greatest percentage of variance in grieving outcomes with avoidant-emotional coping being the most robust predictor of complicated grief (in the positive direction) and problem-focused coping accounting for considerable variance in posttraumatic growth (also positively related). As hypothesized, continuing bonds explained variance in both grieving outcomes with externalized continuing bonds and maintaining continuing bonds on social media predicting complicated grief and internalized continuing bonds contributing to posttraumatic growth (all were positively associated). Social support from family also was predictive of (and positively correlated with) posttraumatic growth. With regard to social media use, avoidant coping on social media was predictive of complicated grief in the positive direction and maintaining continuing bonds on social media was related positively to complicated grief symptoms.

Coping as a Powerful Predictor of Bereavement Outcomes

Our most salient finding was that coping strategies were strongly related to both complicated grief and posttraumatic growth, with avoidant-emotional coping being related positively to complicated grief, active-emotional coping being associated negatively with complicated grief, and problem-focused coping being related positively to posttraumatic growth.

With regard to complicated grief, our findings make sense as college students who used avoidant-emotional coping strategies in person or on social media (e.g., refusing to accept that the death occurred, blaming or distracting oneself, giving up dealing with the loss, or using alcohol or drugs to cope) also reported experiencing symptoms of complicated grief. Avoidant-emotional coping strategies could be associated with challenges in engaging in or finding purpose in one’s life, isolation from others, and acceptance of the loss – all symptoms of complicated grieving. Moreover, this finding replicated prior research with college students who experienced a traumatic loss; for this sample, avoidant-emotional coping also was an important predictor of complicated grief (Schnider et al., 2007). It is important to note that although avoidant-emotional coping strategies were associated with complicated grief, given the correlational nature of this study, it also is possible that students who were struggling with their loss were more likely to engage in unhealthy coping strategies.

As hypothesized, students who coped by using positive reframing, emotional support, acceptance, humor, and venting were less likely to exhibit complicated grief. This may occur because framing one’s loss in a positive manner or moving toward acceptance may help make sense of the loss and lessen the chance of rumination or depressive feelings. Similarly, obtaining emotional support, venting one’s feelings, and laughing with others might lessen isolation or enhance feelings of being understood and cared for when grieving. These positive outcomes may mitigate the development of complicated grief.

For posttraumatic growth, problem-focused coping strategies were predictive of greater growth (e.g., creating a strategy for how to cope, seeking help and advice from others, taking action to improve the situation, and planning, and finding comfort in spiritual beliefs). This finding was consistent with our hypothesis and with prior research indicating that using strategies to address how one was feeling after a traumatic event was associated with growth after loss (Albuquerque et al., 2018). Interestingly, active-emotional coping did not account for variance in posttraumatic growth. Mancini and Bonanno (2009) suggested that short-term emotion-focused strategies might not as effective as long-term problem-focused strategies for coping with grief.

Continuing Bonds Contribute Differentially to Grief Outcomes

Interesting patterns emerged in how continuing bonds related to bereavement outcomes. Both externalized bonds and continuing bonds on social media were associated positively with complicated grief, which was supported by the literature that identified externalized bonds as a risk factor for complicated grief (Field & Filanosky, 2010). Externalized continuing bonds included activities that typically happen more regularly at the beginning of the grieving process, such as engaging in rituals to remember the deceased, visiting the cemetery or memorial site, keeping objects that belonged to the deceased, and posting messages or photos online (Scholtes & Browne, 2015). It is possible that continued engagement in externalized bonds over time could maintain feelings of intense emotions and longing for the deceased. Alternatively, the strong feelings associated with grief could lead to maintaining bonds through externalized activities, both in person and online.

As predicted, internalized continuing bonds positively predicted posttraumatic growth, which was consistent with prior research that found maintaining a connection with a deceased loved one through memories, feeling their presence, and believing that the loved one had a positive influence on their life could facilitate growth (Stein et al., 2017). The Individual Differences Model (Mancini & Bonanno, 2009) highlighted the importance of obtaining comfort from memories of the deceased with regard to resilience to loss, i.e., “internalized representation of the deceased continues to serve adaptive ends” (p. 11). It also is possible that those highest in posttraumatic growth are most able to engage in the development and maintenance of internalized mechanisms to remember their loved one.

Social Support Less Predictive of Bereavement Outcomes

Social support did not contribute to bereavement outcomes as was expected when coping strategies, continuing bonds, and social media use were included in the model. Only family support was positively predictive of posttraumatic growth; friend support and significant other support did not account for variance in either bereavement trajectory. In the Individual Differences Model, effective use of social support leads to effective coping, which in turn predicts resilience (Mancini & Bonanno, 2009). Family support may have been most salient for our sample as the majority of students lost a grandparent, so they may have processed their grief primarily through family interactions rather than friendships. Relatedly, it is possible that peers and romantic partners fail to support grieving friends because they are not certain about how to respond. In fact, bereaved students reported that their peers seemed uncomfortable when discussing death (Bergene, 2013).

Social Media Use

This study sought to advance knowledge regarding the role of social media use in bereavement outcomes. Overall, this sample reported low levels of obtaining social support on social media, using social media to cope with their grieving, and maintaining continuing bonds on social media. This may have occurred due to methological limitations in measurement of the social media variables or because of the length of time since the loss – over 60% of the sample experienced their loss one to five years ago.

Interestingly, avoidant coping on social media was predictive of complicated grief, supporting the finding that avoidant coping generally was a problematic strategy to deal with the loss of a loved one. Moreover, maintaining continuing bonds on social media was positively related to complicated grief symptoms, suggesting that individuals who were struggling with their grief may have used social media to connect with deceased loved ones. Given the ubiquitous nature of social media, continuing bonds online may be an additional mechanism for rumination, isolation or expression of the intense longing associated with complicated grief.

Limitations and Implications for Future Research

Several limitations of this study related to sample characteristics limit the generalizability of our findings. Specifically, most students were female, White, straight students who attended a public university in the Mideast. Although the demographic characteristics of this sample were similar to those of undergraduates in postsecondary institutions (mostly White and female; National Center for Education Statistics, 2019), the experiences of students of color, LGBTQIA individuals, men, and gender non-binary people may not be reflected in our findings. In addition, the sample included college students who were willing to participate in a study about grief and share their grief experiences. Individuals who were uncomfortable with thinking about their grief or remembering their loss likely would not participate in this investigation (which may partially explain the low levels of complicated grief reported for most of the sample). In addition, the majority of participants had experienced the death of a grandparent, thus this sample was not representative of students whose parents or friends died. Given that our participants had both low levels of complicated grief and posttraumatic growth, our findings also cannot be generalized to students who are struggling severely with their grief or experiencing high levels of posttraumatic growth.

Another limitation of the study was the self-reported nature of the data - some studies found a discrepancy in actual posttraumatic growth and perceived growth (Frazier et al., 2009). In addition, the scale that measured continuing bonds on social media was created and used for the first time in this study. Also, this study examined two of the three grief trajectories based in the Individual Differences Model (complicated grief and posttraumatic growth) and did not include recovery as an outcome variable. Finally, the correlational nature of this research did not allow for the examination of causality among the variables in this study.

Thus, future research should examine the predictors of all three bereavement trajectories in the Individual Differences Model with diverse samples that experienced the death of a parent, sibling or friend. Future research on bereavement also should address the roles that culture, religion/spirituality, race, and gender play in the ways that grievers cope, use support systems, and continue bonds with their loved ones. Finally, future studies should examine additional predictors of grief oucomes described in the Individual Differences Model, such as attachment style and identity continuity and complexity.

Longitudinal studies should be conducted to study predictors of grieving outcomes over time, the mechanisms by which these predictors influence grief trajectories, and how we can best intervene during the ongoing process of grieving. Some college students initially may choose unhealthy coping mechanisms that momentarily reduce pain and are readily available in the college environment (e.g., distraction, substance use, risky sexual behaviors). These coping mechanisms may change as students age and leave the college environment. Ideally, a series of interventions could be evaluated empirically to enhance healthy coping, reduce complicated grief and encourage posttraumatic growth among college students.

The role that social media plays in bereavement also should continue to be examined. Instruments to assess social media variables related to grieving should be developed and tested to ensure adequacy of their psychometric properties. Should social media use prove helpful in bereavement, interventions could be developed (and evaluated) to enable grieving college students to participate in online grief support groups or to connect with family members who live far away. Since continuing bonds are now accepted as an important component of grieving, future research may study the ways in which college students could maintain continuing bonds online.

Implications for Practice

Overwhelming, our findings point to the importance of coping in bereavement trajectories. Thus, should our findings be replicated, college counselors, teachers, advisors, and students could be educated about healthy coping mechanisms and their relationship to complicated grief and posttraumatic growth. Active-coping and problem-focused coping could be taught to college students and professors and advisors could model these strategies by assisting students in planning for the semesters during which the student is grieving (e.g., obtaining extensions on coursework, taking fewer courses, participating in grief groups or individual counseling; Masferrer et al., 2017; Russel et al., 2017). Similarly, college students could be taught about the negative impact that maladaptive coping strategies (e.g., substance use, avoidance of emotions, and self-blame) can have on their functioning. Furthermore, the process of maintaining internalized continuing bonds could be normalized and encouraged in this training. This education could extend to families at parent orientation sessions; they also could be educated about the importance of providing support should their child experience a death in college.

In addition, future research might investigate how peers can be sources of support for bereaved college students. Recently, researchers developed an online intervention to educate college students about how to communicate in person and over text with friends who experienced the death of someone close to them (Hill & O’Brien, 2019). If efficacious, this intervention might be implemented with college students to provide another mechanism for resilience to loss (as suggested by the Individual Differences Model; Mancini & Bonanno, 2009).

To conclude, this study highlighted the importance of coping strategies, social support, and continuing bonds in predicting bereavement outcomes among college students. Also, knowledge regarding the role of social media use in grieving was advanced. It is our hope that this work may inform the development of interventions to reduce complicated grief and enhance posttraumatic growth among grieving college students.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was received from the University of Maryland College of Behavioral and Social Sciences Summer Scholars Program.

ORCID iD

Natania S. Lipp

Author Biographies

Natania S. Lipp is a graduate student in the Counseling Psychology PhD program at Lehigh University. She received her Bachelor of Science from the University of Maryland, where she completed this study as her Undergraduate Honors Thesis. Her current research is dedicated to prevention of gender-based violence (e.g., sexual violence, intimate partner violence, and lgbtq+ violence) reproductive health and agency, and improving trauma-informed service provision in medical, school, and legal systems.

Karen M. O’Brien, PhD is a professor and associate chair for Undergraduate Studies in the Department of Psychology at the University of Maryland. She studies factors related to successful management of work and family, end-of-life issues and dating violence. She completed a graduate certificate program in Applied Thanatology: Death, Dying and Grieving at the University of Maryland, Baltimore. She is a volunteer with Caring Matters and she maintains a small psychotherapy practice.

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