Original Manuscript

OMEGA—Journal of Death and Dying

2022, Vol. 0(0) 1–19
The Impact of Continuing © The Author(s) 2022

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and Their Pets Following the DOI: 10.1177/00302228221125955
journals.sagepub.com/home/ome
Death of Their Pet: A
Systematic Narrative
Synthesis

Ben Hughes1  and Beth Lewis Harkin2

Abstract
When a pet dies, owners can experience similar levels of grief as when a human dies.
Previous research indicates the role of continuing bonds (CB) when a pet is alive. To
understand the impact of these bonds after the pet has died, we conducted a systematic
narrative synthesis according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines (PRISMA). Findings were heterogenous, yet there were
still parallels in the literature. CB can sometimes aggravate and intensify grief expe-
riences, particularly when pet grief is perceived as disenfranchised grief. However,
identifying appropriate bonds can be useful to moderate the intensity of grief and be a
valuable mechanism of support. CB can also help post-traumatic growth of owners.

Keywords
pet loss, grief, continuing bonds, attachment, disenfranchised grief

1
Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
2
School of Nursing, Faculty of Health and Wellbeing, University of Bolton, Bolton, UK

Corresponding Author:
Ben Hughes, Faculty of Health and Wellbeing, University of Bolton, T3-46 Eagle Tower, Deane Road, Bolton
BL3 5AB, UK.
Email: [email protected]
2 OMEGA—Journal of Death and Dying 0(0)

Background
Over half the world’s population own a pet (Growth for Knowledge, 2016b, 2016a) and
pet ownership is increasing (Sabin, 2018). Pets are often considered an important
member of the family (Baydak, 2000; Dale, 2016; Dodgson, 2019; Hess-Holden et al.,
2017; Podrazik et al., 2000; Stokes et al., 2002) and both their loyalty and the emotional
and social support they provide is an integral part of a healthier lifestyle (Allen et al.,
2000; Bradshaw, 2017; Compitus, 2019; Green et al., 2018; PetSecure, 2020; Podrazik
et al., 2000; Waltham Foundation, 2020). This relationship between owners and pets
may be particularly apparent following the Covid-19 pandemic. The first lockdown in
the United Kingdom (UK) in 2020 led to an increase in pet enquiries and ownership
(Battersea, 2020; Fox, 2020; Pets4Home, 2020; Waltham Foundation, 2020). Although
many pets were abandoned or handed back to charities for rehoming, a lot were kept as
loving companions (Battersea, 2020; Pets4Home, 2020; Waltham Foundation, 2020).
Axelrod (2020) recognizes the death of a pet can be painful and cause a range of
emotional responses, such as anxiety, stress, shame, ambiguous grief, complicated
grief, and even traits of psychopathology and trauma (Axelrod, 2020; Compitus, 2019;
Hess-Holden et al., 2017; Sable, 2013; Taniyama et al., 2019). These emotions can lead
to loneliness, isolation, and even suicidal thoughts (Antonacopoulos et al., 2010;
Baydak, 2000; Hess-Holden et al., 2017; Sharkin & Knox, 2003; Taniyama et al.,
2019). Such responses are often attributed to a lack of societal understanding and result
in disenfranchised grief (Baydak, 2000; Chur-Hansen, 2010; Compitus, 2019; Cordaro,
2012; DiNicolantonio et al., 2018; Hess-Holden et al., 2017; Lagoni et al., 1994;
Margolies, 1999; Sharkin & Knox, 2003; Taniyama et al., 2019). The term “disen-
franchised grief” was first coined by Doka to recognize that some grief “is not or cannot
be openly acknowledged, publicly mourned, or socially supported” (Doka, 1989, p. 4).
Research indicates responses to the death of a pet positively correlate with the death of a
human (Archer & Winchester, 1994; Hewson, 2014; Stokes et al., 2002), thereby
signifying the importance of understanding the impact of a pet dying.

Attachment Theory, Grief, and Continuing Bonds

The broad framework of Bowlby’s (1969, 1980) attachment theory is useful to un-
derstand grief responses of humans when their pet has died. According to Bowlby,
humans have an innate need for attachment and close proximity to other people for
safety, security, comfort, and support (Bowlby, 1969, 1980; Mikulincer & Shaver,
2022). The death of a loved one can therefore represent the struggle of detaching from
them and the pain bereaved people experience and feel is what we term “grief.”
Consequently, this theory helps understand functions, meaning, and disorders of at-
tachment relationships and the attempt to maintain bonds with the deceased (Margolies,
1999; Sharkin & Knox, 2003). Continuing bonds (CB) are an effort to maintain this
emotional attachment, or connection, following death and therefore represent a con-
tinuation of that attachment and an attempt to manage grief (Habarth et al., 2017;
Hughes and Lewis Harkin 3

Packman et al., 2011). Exploring the role of CB as an ongoing relationship with the
deceased helps understand this connection as either adaptive or maladaptive in the
grieving process (Sirrine et al., 2018).
Previous research has identified that attachment to pets can provide comfort and
reduce feelings of isolation and loneliness during stressful life events such as divorce
and when owners are unwell or isolated (Allen et al., 2000; Sable, 1995, 2013). This
bond also has a positive impact on physical and psychological wellbeing by creating a
significant “other” to share life with (Sable, 2013). The unconditional relationship
offered by pets (Archer, 1997) indicates the positive correlation between strength of
attachment and the level of grief experienced after the pet dies (Antonacopoulos et al.,
2010; Hunt & Padilla, 2006; Joseph et al., 2019; Noonan, 2008). However, there is a
shortage of research exploring CB between pet owners and their dead pets and there is
no consensus about the impact of this attachment after a pet has died (Antonacopoulos
et al., 2010; Joseph et al., 2019). Similarly, there is a lack of research about support
needs for bereaved owners. Therefore, the aim of this review is to identify major themes
in the literature to explore the impact of CB between pet owners and their pets following
the death of the pet and identify mechanisms of support for grieving pet owners. This
synthesis has three key objectives:

1. To identify major themes in the literature to explore the role of CB between a pet
owner and their pet.
2. To investigate what the literature reveals about the impact of CB between a pet
owner and their pet.
3. To utilize the results of the narrative synthesis to understand the support needs of
grieving pet owners.

This is the first-known study to synthesize the literature on this topic. Following the
impact of the Covid lockdowns on pet ownership, it is a timely summary of existing
research to benchmark current understanding of key areas.

Method
The literature search comprised published resources and included the following da-
tabases: CINAHL Complete (Cumulative Index to Nursing and Allied Health Liter-
ature); MEDLINE (Medical Literature Analysis and Retrieval System Online);
PubMed (Public MEDLINE); ProQuest Central, Oxford Reference Online; ProQuest
Ebook Central; Royal College of Nursing Journals; Taylor and Francis Online; Sage
Journals; JSTOR; Wiley Interscience; ScienceDirect; Emerald Journals; and Scopus.
Searches will be run for additional literature on Google Scholar and OpenGrey.
Searches were run in May 2020 and again in October 2020 to check for consistency.
The review of the literature was conducted by both authors, with disagreements
discussed and resolved between them. A third colleague was available to help resolve
any disagreement about the literature but was not needed. There were not any
4 OMEGA—Journal of Death and Dying 0(0)

Table 1. Inclusion and Exclusion Criteria for Study Selection.

Inclusion criteria Exclusion criteria

• Sources written in English • Sources written in languages other than English

• Studies focused on domesticated pets who • Sources exploring relationships between pet
have died owners and their pets where the pet is still
• Studies focused on the continuing bonds alive
between pet owners and their pets • Studies focused on animals which are not
• Studies focused on the role of continuing domesticated pets, such as wild animals,
bonds/attachment and the grief/ working animals, or agricultural animals
bereavement experiences of pet owners • Studies focused on relationships other than
continuing bonds between pet owners and
their pets
• Studies exploring experiences other than
continuing bonds/attachment and grief/
bereavement experiences

restrictions on the date range of articles published to ensure all relevant literature was
included in the study. The experiences of pet owners and research related to support
needs was reviewed. The synthesis was focused on primary, peer-reviewed research
rather than literature reviews or secondary sources to improve reliability of accurate
findings being included.
An initial search of the literature indicated some key terms used in previous studies
in the broad topic area. These terms were used for this study to ensure relevant and
appropriate literature was included in the search and their synonyms were used to help
identify broader relevant literature. When searching for literature, truncation was added
using an asterisk at the end of words to encompass different spellings or word endings,
such as “bereave*.” Where available, an advanced search strategy was implemented to
allow words to be searched in relation to their proximity to one another. The search
terms used in the literature review were: Pet OR *companion* AND Died OR
continuing bonds OR attach* AND Grie* OR bereave* OR Mourn*. Studies were
selected for review based on clear inclusion and exclusion criteria (see Table 1).
The search strategy was adopted from previous research which included heter-
ogenous studies (Hughes et al., 2018) and adhered to the narrative synthesis guidelines
recommended by Popay et al. (2006). This process ensured consistency, clarity and
transparency within the data extraction and management process. Findings will be
presented thematically in line with previous similar research (Adams et al., 1999;
Baydak, 2000; Dunn et al., 2005; Lavorgna & Hutton, 2019; Packman et al., 2012;
Rémillard et al., 2017).
The synthesis was registered with PROSPERO (PROSPERO registration number:
CRD42020177912). The Preferred Reporting Items for Systematic Reviews and Meta-
Analysis (PRISMA) (Liberati et al., 2009; Stewart et al., 2015) is used to present the
literature search (see Figure 1).
Hughes and Lewis Harkin 5

Figure 1. Summary of the literature search.

Hawker et al.’s (2002) literature assessment framework (Appendix 1) and literature

scoring system (Appendix 2) were used to assess the quality of the studies included in
the synthesis. The assessment framework allows literature to be scored (9 very poor; 36
very good) to indicate the methodological rigor of each study (Hawker et al., 2002).
This scoring process gave a clear indication of the strengths and weaknesses of each
study and so provided clarity, transparency, and rigor in the quality assessment process.
No studies were rejected because of poor methodological quality and all studies were
included in the review.
6 OMEGA—Journal of Death and Dying 0(0)

Findings
Overview of the Studies
A detailed summary of study findings can be found in Appendix 3. Publication dates of
the studies ranged from 1994 to 2020 and the majority were broadly quantitative. The
studies were from various countries across the world but were primarily from the
United States. Studies differed in their reporting of demographic details of participants,
with few or no demographic details were provided in a third of studies. A minority of
studies concentrated on adolescents or young adults, including university students; or
children, or children and their parents. When gender was reported, the majority of
participants were female. When race/ethnicity of participants were identified, the
majority of participants identified as White/Caucasian. A quarter of studies were
focused solely on the death of pet dogs and/or cats, while other studies concentrated on
the death of a pet dog or cat, with the addition of other animals such as birds, rabbits,
guinea pigs, parrot, rat, reptiles, pony, horses, and ferrets.
Due to these reasons, the literature inevitably varied in quality. Factors which
negatively impacted the quality of research included ineffective abstracts (Morris,
2012); a lack of clarity in the aim(s) of the study (Morris, 2012); poor description of
data collection and/or sampling methods (Laing & Maylea, 2018; McCutcheon &
Fleming, 2001; Morris, 2012; Redmalm, 2015; Rémillard et al., 2017; Rujoiu &
Rujoiu, 2015); incomplete data analysis (Dunn et al., 2005; Morris, 2012); poor
consideration of ethical issues and/or potential for bias (Archer & Winchester, 1994;
Dunn et al., 2005; McCutcheon & Fleming, 2001; Morris, 2012; Redmalm, 2015;
Rémillard et al., 2017; Rujoiu & Rujoiu, 2015; Wrobel & Dye, 2003); descriptive
findings which lacked detail (Morris, 2012); or a lack of generalizability and/or dis-
cussion of implications for policy and practice (Archer & Winchester, 1994;
McCutcheon & Fleming, 2001; Redmalm, 2015; Rémillard et al., 2017; Rujoiu &
Rujoiu, 2015). Nevertheless, only a minority of papers (Archer & Winchester, 1994;
Dunn et al., 2005; Laing & Maylea, 2018; McCutcheon & Fleming, 2001; Morris,
2012; Redmalm, 2015; Rémillard et al., 2017; Rujoiu & Rujoiu, 2015; Wrobel & Dye,
2003) were judged as poor in overall quality and none were considered very poor. All
included papers added some valuable information to the synthesis.
Three main themes were identified in the literature from the global theme of
continuing bonds: intensity of grief; support mechanisms and means of coping; and
personal growth. The studies generally covered multiple themes and will be discussed
below. A summary of the themes in the included literature is in Table 2:

Theme 1––Intensity of Grief

The contribution of CB to the intensity of grief was a significant theme identified in the
literature and was identified in 32 sources. This theme is divided into four relevant sub-
themes below:
Hughes and Lewis Harkin 7

Table 2. Summary of the Included Literature.

Theme 1 Theme 2 support mechanisms Theme 3

Paper intensity of grief and means of coping personal growth

(Archer & Winchester, X X

1994)
(Brown et al., 1996) X X
(Brown & Symons, X
2016)
(Bussolari et al., 2018) X X
(Dunn et al., 2005) X
(Eckerd et al., 2016) X
(Field et al., 2009) X X
(Green et al., 2018) X X
(Habarth et al., 2017) X X X
(Hunt et al., 2008) X
(Hunt & Padilla, 2006) X X
(Kaufman & Kaufman, X X
2006)
(King & Werner, 2011) X X
(Krause-Parello & X X
Gulick, 2013)
(Laing & Maylea, 2018) X X
(Lavorgna & Hutton, X X
2019)
(Lee, 2016) X X X
(Lee & Surething, 2013) X X
(Luiz Adrian et al., X X
2009)
(McCutcheon & X X
Fleming, 2001)
(Morris, 2012) X
(Packman et al., 2011) X X
(Packman et al., 2012) X X
(Packman et al., 2014) X X X
(Packman et al., 2017) X X
(Redmalm, 2015) X
(Rémillard et al., 2017) X X X
(Rennard et al., 2019) X X
(Rujoiu & Rujoiu, 2015) X X
(Schmidt et al., 2020) X X
(Testoni et al., 2017) X X
(Tzivian et al., 2014) X X

(continued)
8 OMEGA—Journal of Death and Dying 0(0)

Table 2. (continued)

Theme 1 Theme 2 support mechanisms Theme 3

Paper intensity of grief and means of coping personal growth

(Tzivian et al., 2015) X X

(Wong et al., 2017) X X X
(Wrobel & Dye, 2003) X X
(Zilcha-Mano et al., X
2011)

Grief as a destabilizing emotion. Nearly two thirds of respondents in one study described
their animal as a “baby,” “child,” “best friend,” “companion,” or someone to be “loved”
rather than just a “protector” or a “pet” (Archer & Winchester, 1994). Understandably,
grief is a potentially destabilizing emotion which was exhibited in various behaviors
ranging from numbness and/or disbelief to clinical depression, trauma, and post-
traumatic stress disorder (Archer & Winchester, 1994; Hunt et al., 2008; Hunt &
Padilla, 2006; King & Werner, 2011; Luiz Adrian et al., 2009; Packman et al., 2014;
Redmalm, 2015; Wrobel & Dye, 2003; Zilcha-Mano et al., 2011). These feelings led to
preoccupation with thoughts of the pet, poor concentration, avoidance behavior, loss of
identity, self-reproach, and socialization (Archer & Winchester, 1994; Brown &
Symons, 2016; Hunt et al., 2008; King & Werner, 2011; Krause-Parello & Gulick,
2013; Tzivian et al., 2015; Zilcha-Mano et al., 2011).

The impact of continuing bonds on grief. The evidence showed CB can intensify the
grieving process by focusing on negative bonds, leading to severe grief (Field et al.,
2009; Lavorgna & Hutton, 2019; Rémillard et al., 2017). In these situations, CB with
the dead pet led to somatizing symptoms of grief similar to those for family members
and friends (King & Werner, 2011; Tzivian et al., 2014). Consequently, the five stages
of grief outlined by Kübler-Ross (1969) are present in the literature about pet death
(Adams et al., 1999; Antonacopoulos et al., 2010; Baydak, 2000; Chur-Hansen, 2010;
Compitus, 2019; Kolodny, 1991; Sharkin & Knox, 2003; Stokes et al., 2002).
Conversely, there is the potential for CB to mitigate the effects of grieving by
decreasing feelings of loneliness. Rituals, memorials, memories, and dreams were
identified as helpful coping mechanisms by continuing levels of attachment and re-
ducing the intensity of grief (Krause-Parello & Gulick, 2013; Packman et al., 2012).

The character of grieving owners. White owners tended to treat their pet more like a
family member than non-white owners and so the bond between them was felt more
strongly when the pet died (Hunt & Padilla, 2006). However, the literature indicated
owners aged 18–35 and over 60 are more likely to experience grief (McCutcheon &
Fleming, 2001). Children and adolescents may also experience more intense grief,
depending on their age, previous experiences of death, and level of attachment to the
Hughes and Lewis Harkin 9

pet (Brown et al., 1996; Schmidt et al., 2020). Most literature indicated females form a
stronger bond with their pet and so do experience grief more intensely than males
(Brown & Symons, 2016; Eckerd et al., 2016; McCutcheon & Fleming, 2001; Testoni
et al., 2017; Wrobel & Dye, 2003). However, the conclusions drawn in the literature
were based on studies in which most participants were White, adult females and
therefore may be the only conclusions to draw. Consequently, there is little under-
standing about the impact of CB on grieving non-White, non-female, younger pet
owners, or bereaved people who have owned pets other than cats or dogs.
Other individual factors were identified as equally important when considering the
role of CB and pet grief. For example, grief intensity was reportedly greater if the death
was sudden and the person lived alone (Archer & Winchester, 1994). There was
disagreement in the literature regarding the length of time attachment continued after
the death of a pet. Periods for the peak of emotions ranged from 2 to 6 months (Krause-
Parello & Gulick, 2013; McCutcheon & Fleming, 2001; Tzivian et al., 2014) and
possibly up to a year after the pet’s death (Tzivian et al., 2014; Wrobel & Dye, 2003).
Other research indicated grief peaked again approximately a year after the pet died, with
up to 20% of pet owners reporting grief symptoms a year after the death (Hunt &
Padilla, 2006; Wrobel & Dye, 2003). Therefore, recognizing the individual’s unique
situation and their bond with the pet is felt important to understand the intensity of grief
and how long it is experienced.

Disenfranchised grief. Grief experiences were further complicated because of disen-

franchised grief. Although memorialization and rituals helped reduced the intensity of
grief and stimulated personal growth, pet death was widely recognized as disen-
franchised grief which had implications for both level of support and access to available
support (Archer & Winchester, 1994; Lavorgna & Hutton, 2019; Packman et al., 2012;
Rémillard et al., 2017; Tzivian et al., 2014, 2015). The understanding of pet be-
reavement was generally poorer and more trivialized in affluent societies, where grief
was also linked to a hierarchy of animals (Laing & Maylea, 2018; Wong et al., 2017).
This hierarchy has sometimes recognized the loss of dogs and cats as significant but the
loss of other animals, such as fish and rats, has not received the same validation (Laing
& Maylea, 2018). Some bereaved pet owners have described a “double disenfran-
chisement” whereby their feelings of grief for the pet have not been widely recognized
by society and, in addition, their emotional connection to an animal considered lower
down the hierarchy is considered abnormal (Laing & Maylea, 2018). Therefore, the
literature indicates grieving owners should be supported by recognizing their unique
needs and understanding that CB can intensify grief in some situations while alleviating
it in other circumstances.
10 OMEGA—Journal of Death and Dying 0(0)

Theme 2––Means of Coping and Support Mechanisms

As with Theme 1, the recognition of support and coping was a comprehensive theme
identified in the literature and was covered by 33 of the eligible studies. Two sub-
themes are outlined below:

Continuing bonds and religion as means of coping. Some owners maintained bonds with a
dead pet through an existing or new pet (Redmalm, 2015; Wong et al., 2017). However,
there was no conclusive evidence to indicate whether this reduced grief or simply
delayed its onset. If the owner views their pet as a family member, replacement of one
pet with another is also not as simple or as viable as it sounds. Focusing on “replanning”
following the death of a pet was sometimes negative because of the permanent and
inescapable nature of death (Green et al., 2018). Instead, owners who were oriented
toward using CB as a method of self-compassion reported less intense grief, less
frequent dismissive or negative social interactions, and better psychosocial functioning
(Bussolari et al., 2018).
Evidence also suggested that grieving owners needed someone to talk to and a
means to express their grief (Brown et al., 1996). Many owners sought to maintain CB
by incorporating their dead pet into religious belief (Testoni et al., 2017). In this way,
owners discovered positive expressions of religious coping to deal with their loss
through seeking God’s love and care (Lee, 2016). Belief in an afterlife for people and
animals was associated with stronger attachment and improved grief response because
of a communal sharing of the relationship; conversely, belief in an afterlife for only
people led to more intense grief and was considered a less effective coping mechanism
(Testoni et al., 2017). Other owners believed their pet’s soul was in a worse place, such
as hell, and so they engaged in negative forms of religious coping because they felt
punished by God (Lee, 2016; Lee & Surething, 2013). Therefore, religion was
sometimes associated with feelings of guilt or comfort, depending on whether the
owner felt punished or sought God’s love (Lee, 2016; Lee & Surething, 2013; Testoni
et al., 2017). Overall, evidence suggested owners who drew on both positive and
negative aspects of religion coped with grief more effectively because of their search for
meaning (Lee, 2016). For this reason, spirituality, or a more subjective process of
searching for connectedness and contextualizing one’s own existence, was helpful to
cope more effectively (Lee & Surething, 2013).

Social and professional support as a support mechanism. Social support was also identified
as an important mechanism in which to share CB and maintain the owner’s quality of
life following the death of their pet and validate emotions (Field et al., 2009; Packman
et al., 2012, 2017; Tzivian et al., 2015). The greater the perceived levels of social
support, the lower the reports of attachment anxiety and attachment avoidance, and vice
versa (Field et al., 2009; King & Werner, 2011). Social support was particularly
important for people living alone (Archer & Winchester, 1994; Hunt & Padilla, 2006);
Hughes and Lewis Harkin 11

those with family or friends unable to offer support (Tzivian et al., 2015); and for
children (Kaufman & Kaufman, 2006; Schmidt et al., 2020).
Other literature indicated that social networks were was less important in pet death
than in human death (Field et al., 2009; Green et al., 2018), suggesting not all pet
owners have the same level of attachment to their pet, feel the same intensity of grief, or
benefit from the same support. Yet there were situations when grieving individuals were
shown to have benefitted from professional support and treatment (Luiz Adrian et al.,
2009).
Although many vets shared similar emotions to grieving owners (Rujoiu & Rujoiu,
2015), perceived reactions of vets to the existence of CB further negatively impacted
grief (Rémillard et al., 2017). Vets were often the initial contact for owners and lit-
erature indicated they should be available to help owners self-manage their emotions, as
well provide initial support and contacts, make phone calls the day after the death, and
send a condolence letter (Morris, 2012; Rémillard et al., 2017; Tzivian et al., 2014,
2015). Social workers may provide additional support as a conduit between vets and
owners (Dunn et al., 2005). However, evidence suggested a barrier to accessing support
was created because healthcare professionals did not always accept the death of a pet
family member in the same way they accepted the death of human family member
(Wrobel & Dye, 2003). Consequently, professionals can sometimes reduce intensity of
grief by recognizing CB and facilitating access to support. Conversely, they may
amplify grief and create an obstacle to support by failing to understand the role of CB in
pet bereavement.

Theme 3––Personal Growth

Personal growth was identified as a relatively small but important theme in eight
studies. Two sub-themes are outlined below:

Religion and spirituality. Appreciation for life was also reflected in psychological or
spiritual growth. Bereavement highlighted the owner’s personal strength and so
provided a meaning to life (Packman et al., 2017). Although the death was painful,
facing difficult decisions around euthanasia or discovering coping mechanisms for the
death helped some owners identify resilience they did not realize they had. Pet death
encouraged other owners to channel their energies into being creative or productive and
so helped refocus their attention. Coming to terms with death enabled the grieving to
offer support and information to other people or volunteer to work with animals
(Packman et al., 2014, 2017; Wong et al., 2017). Some owners also reported the death
of a pet led to a strengthening of bonds with existing pets (Wong et al., 2017).
The multifaceted positive layers of religion and spirituality helped the search for
meaning and validated feelings of purpose, although religious faith itself did not seem
to be strengthened (Lee, 2016; Packman et al., 2017; Wong et al., 2017). Yet reflections
on life and death provided meaning and inspiration to cherish what life still had to offer.
12 OMEGA—Journal of Death and Dying 0(0)

For example, a strong bond with a pet helped bring some owners closer to other family
members after the pet died (Packman et al., 2017; Wong et al., 2017).

Continuing bonds, attachment, and growth. Despite previous research indicating the
negative impact of pet bereavement, evidence suggested CB might be beneficial for
encouraging post-traumatic growth. CB helped the bereaved find value in the death of a
pet and, in doing so, facilitated the search for comfort (Habarth et al., 2017; Packman
et al., 2011; 2017). In this sense, CB acted as a regulating and adapting process
(Packman et al., 2011).
A strong bond with a pet was a considerable factor in other aspects of personal
growth. Using a range of positive CB associations was shown to have an impact on
wider aspects of health, wellbeing, and relationships with the wider world (Habarth
et al., 2017). Growth was reported in the expression of emotions such as empowerment,
happiness, love, positive thinking, and coping behaviors (Rémillard et al., 2017; Wong
et al., 2017). Higher levels of post-traumatic growth were also associated with lower
levels of somatization and functional impairment (Habarth et al., 2017).
The bereaved also expressed meaning through verbal discussions and poetry
(Kaufman & Kaufman, 2006), writing a eulogy (Rennard et al., 2019); and engaging in
pet loss support groups and counseling (Dunn et al., 2005; Laing & Maylea, 2018;
Lavorgna & Hutton, 2019; Rujoiu & Rujoiu, 2015; Tzivian et al., 2014; Wong et al.,
2017). The strength of attachment to the pet reflected these expressions and fostered
empathy and compassion for other people, as well as recognition and acceptance of the
sympathy that was offered in the period after the pet had died (Packman et al., 2017).
Validating expressions of CB also helped minimize symptoms of grief and their
duration (Kaufman & Kaufman, 2006).

Discussion
As far as it is known, this is the first systematic review to understand the impact of CB
between pet owners and their pets following the death of the pet. Using a valid, reliable,
and rigorous approach to searching for and analyzing the literature, three themes were
identified.
In relation to the study’s first objective, the synthesis identified that the strength of
the bond with a pet and the resulting impact of grief relates to pets being seen as family
members. In relation to the study’s second objective, CB can make negative and
positive impacts on the grieving experience. A strong bond with a pet can lead to a
range of emotional responses and informal and formal social support can help maintain
positive bonds and mitigate the effects of grief. The type and strength of impact is
influenced by various factors, such as age, gender, previous grieving experiences, and
the strength of the bond with the pet. At their extreme, owners can be debilitated and
would benefit from professional support. Stereotypical ideations of owners and grief
experiences are not particularly useful and have implications for the coping mecha-
nisms available for grieving owners. Conclusions based on these findings reflect that
Hughes and Lewis Harkin 13

most research has been conducted with participants who are predominantly White,
female adults. Therefore, the current understanding about the impact of CB between a
pet owner and a pet is based on a narrow population sample. The perspectives of
different ethnicities and genders are not often included in previous research and so
current literature is not representative of every pet owner. This is important because
mechanisms of support depend on wider societal and professional attitudes. In relation
to objective three of the study, informal support and some aspects of spirituality can
identify and maintain positive aspects of CB. This basis can provide a foundation for
finding value, creating meaning, strengthening relationships, or personal growth.
Overall, evidence suggests grieving owners would benefit from empathetic com-
munication to validate and legitimize their feelings and so provide effective support
(Rennard et al., 2019; Wong et al., 2017; Wrobel & Dye, 2003). This approach ne-
cessitates support from someone they trust to listen, understand, and validate their
experiences, and help them develop coping mechanisms (Wong et al., 2017). The
availability and quality of support provision depends in part on the attitudes of society
and professionals. Opportunities to access appropriate external support are partially
dependent on perceptions of disenfranchised grief. These perceptions are a barrier to
seeking support as well as being a potential barrier to providing support.
Further research is needed to better understand the impact of CB on males, non-
white populations, and different age groups following the death of a pet. Finally,
amplifying discussions around pet grief will help to franchise grief experiences and
create safe spaces to open conversations with those around us.

Limitations and Strengths

There are several limitations to this review. A narrative synthesis aims to, and supports,
the synthesis of heterogeneous studies, but the varied nature of the studies creates a
potential for bias. Variation in terminology used to refer to pets was a challenge when
searching for articles and discussing the impact of CB.
Despite the limitations above, the included studies and synthesis approach satis-
factorily answer the review question. The design of the synthesis reduced the potential
for bias and ensured the review was conducted rigorously and is replicable. Even with
the heterogeneous nature of the studies, the findings appear similar and are applicable to
a variety of owners and settings.

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) received no financial support for the research, authorship, and/or publication of this
article.
14 OMEGA—Journal of Death and Dying 0(0)

ORCID iD
Ben Hughes  https://orcid.org/0000-0002-1173-4312

Supplemental Material
Supplemental material for this article is available online.

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Author Biographies
Ben Hughes has worked in education for over 20 years and, as part of his work in
higher education, has written and developed programmes of study and taught a range of
subjects, such as philosophy, social work, education, English, Nursing, Health and
Social Care, and Criminology. Ben teaches full-time at the University of Bolton on
postgraduate courses, which includes supervising dissertation and PhD students. He
also contributes to modules in Death, Dying and Bereavement as well as Health and
Social Care, and the Access programme at the Open University. He has a multi-
disciplinary approach to teaching and research and involved in work which explores
and informs policy around vulnerable groups, marginalised populations, young people,
health, and education.

Beth Lewis Harkin qualified nurse over 8 years ago and has a number of years’
experience as a theatre practitioner in Lancashire Teaching Hospitals NHS Foundation
Trust. She currently works as a full-time lecturer at the University of Bolton, where she
has taught on different modules. She is also a personal tutor and assessor for Nursing
students and has been involved in developing assessments for students.