Inventory of Complicated Spiritual Grief (ICSG)

Abstract

The Inventory of Complicated Spiritual Grief (ICSG) is an 18-item, multidimensional self-report psychometric instrument designed to assess crisis of faith, spiritual struggle, and theological rupture following bereavement. Developed by Robert A. Neimeyer, Laurie A. Burke, and colleagues, the instrument specifically measures the breakdown of a believer’s foundational relationship with God and their faith community in the wake of significant personal loss. While religion and spirituality typically serve as protective psychological buffers during bereavement, catastrophic losses—such as violent deaths, the loss of a child, or traumatic bereavements—can severely disrupt an individual’s spiritual meaning-making framework. The ICSG is structured across two correlated dimensions: Insecurity with God (7 items), which captures profound emotional, relational, and cognitive angst directed toward the divine (such as feelings of abandonment, perceived divine injustice, betrayal, and anger), and Disruption in Religious Practice (11 items), which quantifies behavioral and emotional disengagement from formal religious fellowship, private devotion, prayer, and worship.

Respondents rate each item on a 5-point Likert scale ranging from 0 (Not at all true) to 4 (Very definitely true), yielding a total score between 0 and 72. Psychometric evaluations across diverse bereaved populations consistently demonstrate exceptional internal consistency reliability, with Cronbach’s alpha coefficients typically exceeding α = .95 for the full scale, α = .89 to .92 for the Insecurity with God subscale, and α = .94 to .96 for the Disruption in Religious Practice subscale. Confirmatory factor analyses confirm the robustness of the two-factor oblique structure over unidimensional representations. The scale exhibits strong convergent validity with measures of prolonged grief disorder, major depressive disorder, generalized anxiety, and negative religious coping, as well as distinct discriminant validity against positive religious coping and general spiritual well-being. The ICSG has emerged as a gold-standard psychometric assessment tool in thanatology, pastoral counseling, and clinical psychology, offering crucial diagnostic utility in identifying individuals whose spiritual collapse exacerbates complex bereavement reactions.

Keywords

Inventory of Complicated Spiritual Grief, ICSG, complicated spiritual grief, bereavement, prolonged grief disorder, spiritual struggle, meaning reconstruction, Insecurity with God, Disruption in Religious Practice, pastoral counseling, thanatology, religious coping

Authors

The Inventory of Complicated Spiritual Grief was conceptualized, developed, and empirically validated by a collaborative team of clinical psychologists, thanatologists, and psychometricians led by:

• Laurie A. Burke, Ph.D. — Department of Psychology, The University of Memphis, Memphis, Tennessee, United States. Current affiliation: Clinical Psychologist and Research Scientist specializing in traumatic loss, spiritual crisis, and grief psychotherapy. Contact: [email protected].
• Robert A. Neimeyer, Ph.D. — Professor Emeritus of Psychology, Department of Psychology, The University of Memphis; Director of the Portland Institute for Loss and Transition, Portland, Oregon, United States. A world-renowned pioneer in grief therapy, constructivist psychology, and meaning reconstruction. Contact: [email protected].
• Joseph M. Holland, Ph.D. — Department of Psychology, The University of Memphis, Memphis, Tennessee, United States.
• Sarah Dennard, M.S. — Department of Psychology, The University of Memphis, Memphis, Tennessee, United States.
• Laura Oliver, M.S. — Department of Psychology, The University of Memphis, Memphis, Tennessee, United States.
• M. Katherine Shear, M.D. — Marion E. Kenworthy Professor of Psychiatry in Social Work, Columbia University School of Social Work and Columbia University College of Physicians and Surgeons; Director of the Center for Prolonged Grief, New York, New York, United States.

Purpose

The primary purpose of the Inventory of Complicated Spiritual Grief (ICSG) is to identify, assess, and quantify the specific manifestations of spiritual crisis, theological distress, and faith alienation that emerge following the death of a significant person. Throughout psychological and psychiatric literature, religious faith and spiritual practices have predominantly been conceptualized as positive adaptive resources—providing emotional solace, cognitive framing, social support, and transcendent hope during times of existential crisis. However, empirical thanatological research reveals that bereavement can also precipitate a catastrophic collapse of faith. When the circumstances of a death sharply contradict an individual’s core global assumptions about divine benevolence, protection, and fairness, individuals may experience what Kenneth Pargament termed “spiritual struggles” and what Burke and Neimeyer operationalized specifically as complicated spiritual grief.

The ICSG was created to address a critical psychometric and clinical void. Prior to its publication, clinicians and researchers relied on general measures of religious coping (such as the Brief RCOPE) or global spiritual well-being scales (such as the FACIT-Sp or Spiritual Well-Being Scale). While these instruments captured broad positive or negative religious behaviors, they lacked sensitivity to the unique, emotionally agonizing phenomenology of acute grief-induced spiritual breakdown. Complicated spiritual grief is not merely a loss of faith or general spiritual ambivalence; it is characterized by profound feelings of divine betrayal, active anger toward God, bitter confusion over unanswered prayers, feeling unsafe in the cosmos, an inability to engage in previously comforting religious rituals (such as prayer, scripture reading, or congregational worship), and profound alienation from one’s faith community.

In clinical settings, the ICSG serves as an essential diagnostic screen for psychotherapists, hospital chaplains, pastoral counselors, and palliative care workers. Extensive research demonstrates that unresolved complicated spiritual grief is one of the strongest prospective predictors of complicated grief (now codified in the DSM-5-TR as Prolonged Grief Disorder), unremitting clinical depression, functional impairment, and heightened suicidality. Bereaved individuals undergoing a severe crisis of faith frequently suffer in isolation due to profound shame, social taboo, and fear of judgment from religious peers. Administering the ICSG provides a validated, non-stigmatizing framework that normalizes these experiences, allowing clinicians to delineate whether a patient’s distress stems primarily from relational-attachment ruptures with the divine, structural disengagement from their religious support network, or a combination of both.

In research domains, the ICSG enables empirical investigation into the longitudinal trajectories of bereavement, constructivist theories of meaning reconstruction, and the psychological mechanisms underlying post-traumatic growth versus chronic distress. It facilitates empirical testing of cross-cultural and inter-religious differences in grief processing, evaluating how distinct theological doctrines shape the vulnerability or resilience of mourners facing traumatic, sudden, or violent losses.

Psychological Construct

The psychological construct measured by the ICSG is complicated spiritual grief (CSG), conceptualized as an acute, distressing, and functionally impairing rupture in a believer’s relationship with God and their faith tradition following the death of a loved one. Rooted in the intersection of psychospiritual development, attachment theory, and cognitive-constructivist thanatology, CSG represents a shattered assumptive world at the spiritual level. Burke and Neimeyer established that this overarching construct comprises two distinct yet dynamically interrelated psychological dimensions:

1. Insecurity with God

The Insecurity with God dimension (encompassing items 1, 4, 7, 10, 13, 16, and 18) captures cognitive dissonance, theological disillusionment, and relational distress directed specifically at the divine figure. Within an attachment-theoretical framework, God often functions as a primary or secondary attachment figure—an omnipotent, omnibenevolent “safe haven” and “secure base” who provides ultimate protection and cosmic coherence. When a traumatic loss occurs (such as the violent, sudden, or agonizing death of a child or spouse), this internal working model of God is shattered.

This subscale assesses specific emotional and cognitive manifestations:

• Perceived Betrayal and Breach of Covenant: Believers experience a profound sense of broken trust, believing that despite their lifelong devotion, obedience, and prayer, God failed to uphold His protective obligation (e.g., Item 18: “I am a faithful believer, so I don’t understand why God did not protect me”).
• Loss of Perceived Divine Protection: The mourner shifts from feeling safe in the universe to viewing reality as arbitrary, precarious, and dangerous (e.g., Item 4: “I no longer feel safe and protected by God”).
• Theological Conflict and Theodicy Struggles: Intense cognitive distress regarding how an all-powerful and all-loving deity could permit such profound suffering and injustice (e.g., Item 7: “I struggle with accepting how a good God allows bad things to happen”; Item 16: “I feel my loss is unfair”).
• Affective Anger and Resentment: Overt emotional hostility, bitterness, and anger directed at God, accompanied by profound confusion and emotional estrangement (e.g., Item 10: “I can’t help feeling angry with God”; Item 13: “I’m confused as to why God would let this happen”).

2. Disruption in Religious Practice

The Disruption in Religious Practice dimension (encompassing items 2, 3, 5, 6, 8, 9, 11, 12, 14, 15, and 17) captures the behavioral, social, experiential, and devotional breakdown that accompanies spiritual crisis. While Insecurity with God reflects an internal relational rupture with the deity, Disruption in Religious Practice reflects the collapse of the external and internal habits, rituals, and communities that previously sustained the individual’s spiritual life.

Key facets evaluated within this subscale include:

• Behavioral Avoidance and Social Alienation: Active withdrawal from congregational life, avoidance of religious peers, and an inability to experience comfort within the spiritual community (e.g., Item 2: “I have withdrawn from my fellowship with other believers”; Item 3: “I go out of my way to avoid spiritual/ religious activities”; Item 9: “I don’t feel as comforted by church fellowship as I used to”). Mourners often withdraw because fellow believers offer well-intentioned but theological platitudes (e.g., “It was God’s will,” “They are in a better place”) that invalidate their grief and induce spiritual isolation.
• Devotional Paralysis and Anhedonia: The subjective inability to engage in normative spiritual practices such as prayer, meditation, or scripture reading, accompanied by a profound loss of spiritual reward or meaning (e.g., Item 5: “I find that spiritual/religious activities are not very fulfilling”; Item 6: “I find it impossible to pray”; Item 14: “I have lost my desire to worship”; Item 15: “I find it impossible to worship”).
• Existential Disorientation and Divine Absence: An experiential shift from feeling God’s presence to enduring an excruciating, deafening divine silence (e.g., Item 12: “The strong guiding light of my faith has grown dim and I feel lost”; Item 17: “I sense the absence of God more than I do the presence of God”).
• Resistance to Spiritual Surrender: Cognitive and volitional refusal to entrust one’s life, destiny, or deceased loved one to a deity perceived as distant or unprotective (e.g., Item 8: “I find it difficult to surrender my life to God”).

Theoretical Framework

The Inventory of Complicated Spiritual Grief is theoretically grounded at the synthesis of three foundational psychological frameworks: Cognitive-Constructivist Meaning Reconstruction Theory, Attachment Theory applied to the Divine, and The Stress and Coping Paradigm of Religious Struggles.

1. Meaning Reconstruction and the Assumptive World

The constructivist theory of grief, pioneered by Robert A. Neimeyer, posits that human beings are fundamentally meaning-seeking creatures who construct an “assumptive world”—an overarching matrix of beliefs, values, and narrative expectations regarding safety, benevolence, fairness, predictability, and personal worth. Religious systems provide the bedrock for many people’s global meaning structures, supplying existential narratives that render human mortality, suffering, and moral struggle coherent.

When a devastating death occurs, this event can act as a “theological seismic shock” (Burke & Neimeyer, 2014). If the loss cannot be assimilated into existing religious schemata, the mourner faces a profound existential crisis: either they must accommodate their worldview by radically reconstructing their understanding of God, or their global meaning structure collapses into profound disorientation. The ICSG directly operationalizes the psychospiritual fragmentation that ensues when meaning reconstruction fails, resulting in an unassimilated loss narrative that destabilizes the individual’s existential foundation.

2. Attachment Theory and God as an Attachment Figure

Stemming from John Bowlby’s attachment theory and further elaborated by psychometrics researchers such as Lee Kirkpatrick and Pehr Granqvist, an individual’s relationship with God possesses all the defining empirical markers of an attachment relationship:

1. Proximity seeking (prayer, meditation, attending holy spaces);
2. A safe haven in times of distress (turning to God for consolation and protection);
3. A secure base for psychological exploration and daily functioning;
4. Threat of separation distress when connection with the divine is severed.

In complicated spiritual grief, the death of a loved one precipitates a devastating dual attachment crisis. The mourner not only loses the physical attachment figure (the deceased), but simultaneously experiences an attachment rupture with their transcendent attachment figure (God). When God is perceived as failing to provide the expected “safe haven” by allowing the beloved to die, the mourner undergoes profound separation anxiety, feelings of rejection, ambivalence, or attachment avoidance toward God. The Insecurity with God subscale of the ICSG measures an anxious, angry attachment rupture, while the Disruption in Religious Practice subscale captures an avoidant deactivating strategy, wherein the mourner severs communication and distances themselves from the attachment figure.

3. Religious Coping and Spiritual Struggle Paradigms

The ICSG integrates Kenneth Pargament’s transactional model of religious coping, which differentiates between positive religious coping (e.g., seeking spiritual support, benevolent religious reappraisals) and negative religious coping (e.g., punitive appraisals, expressing spiritual dissatisfaction). Pargament established that while positive coping correlates with resilience and psychological adjustment, negative religious coping correlates with severe mental and physical morbidity. The ICSG significantly refines this paradigm by tailoring the assessment specifically to bereavement-induced spiritual breakdown, isolating theological anger, existential betrayal, and devotional paralysis from general psychological symptomatology.

Validity

The psychometric validity of the Inventory of Complicated Spiritual Grief has been established across multiple empirical investigations involving diverse samples of bereaved adults, including parents grieving the loss of children, survivors of violent death (homicide, suicide, fatal accidents), African American mourners, and general clinical populations.

Construct and Factorial Validity

In the seminal psychometric validation study conducted by Burke, Neimeyer, Holland, Dennard, Oliver, and Shear (2014) with a diverse sample of 150 bereaved individuals, the initial pool of potential items was derived from qualitative analyses of clinical interviews with grieving believers. Exploratory factor analyses followed by confirmatory factor analyses supported a two-factor oblique structure representing Insecurity with God and Disruption in Religious Practice. This two-factor model demonstrated exceptional fit indices that were significantly superior to any alternative single-factor model, confirming that complicated spiritual grief is a multidimensional construct combining affective-cognitive angst toward the divine with behavioral-devotional disruption.

Convergent Validity

The ICSG demonstrates robust, statistically significant convergent validity with established measures of psychological distress, complicated grief, and spiritual conflict:

• Prolonged Grief Disorder / Complicated Grief: The ICSG total score exhibits strong, positive correlations with the Inventory of Complicated Grief (ICG; r = .52 to .68, p < .001). Individuals meeting diagnostic thresholds for complicated grief score markedly higher across both ICSG subscales than normative mourners.
• Depressive Symptomatology: ICSG scores correlate moderately to strongly with validated depression inventories, including the Beck Depression Inventory-II (BDI-II; r = .45 to .58, p < .001) and the Patient Health Questionnaire-9 (PHQ-9).
• Negative Religious Coping: The ICSG correlates strongly with the Negative Religious Coping subscale of the Brief RCOPE (r = .65 to .77, p < .001), corroborating that the instrument successfully taps intense spiritual struggle.
• Traumatic Stress and Anxiety: Significant positive associations have been confirmed between the ICSG and trauma symptomatology measured by the Impact of Event Scale-Revised (IES-R) and the Generalized Anxiety Disorder-7 (GAD-7).

Discriminant Validity

The ICSG displays excellent discriminant validity, showing near-zero or non-significant inverse correlations with constructs from which it is theoretically distinct:

• Positive Religious Coping: Correlations between the ICSG and the Positive Religious Coping subscale of the Brief RCOPE are non-significant or weakly negative (r = −.08 to −.18, p > .05), proving that spiritual grief is not merely the absence of positive religious coping, but a qualitatively distinct psychological crisis.
• Spiritual Well-Being: The ICSG correlates negatively with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp; r = −.54 to −.65, p < .001), indicating that lower spiritual well-being appropriately tracks severe spiritual grief.
• Demographic Variables: ICSG scores show minimal correlation with demographic variables such as age, sex, and education, confirming that complicated spiritual grief transcends sociodemographic boundaries.

Predictive and Incremental Validity

Crucially, hierarchical multiple regression analyses conducted by Burke and colleagues (2014, 2016) demonstrated that the ICSG accounts for significant unique variance in complicated grief symptoms and depressive symptoms even after statistically controlling for age, time since loss, cause of death, degree of kinship, and general religious coping. This demonstrates strong incremental validity, confirming that the ICSG measures an essential psychological domain uncaptured by standard psychiatric or spiritual inventories.

Reliability

The Inventory of Complicated Spiritual Grief possesses outstanding psychometric reliability across clinical and non-clinical bereaved populations.

Internal Consistency Reliability

In the initial development and validation study (Burke et al., 2014), the 18-item full scale demonstrated exceptional internal consistency reliability:

• Full Scale ICSG: Cronbach’s α = .95 to .96.
• Insecurity with God Subscale (7 items): Cronbach’s α = .89 to .92.
• Disruption in Religious Practice Subscale (11 items): Cronbach’s α = .94 to .96.

Subsequent psychometric replications—such as Burke and Neimeyer’s (2016) study on violent loss survivors, as well as independent cross-cultural investigations—have reported McDonald’s omega coefficients (ω) ranging from .91 to .96, further substantiating the high internal consistency of the composite scale and its two subscales. Corrected item-total correlations for all 18 items consistently exceed the psychometric threshold of .40, with most items ranging between .60 and .82, indicating strong item discrimination without excessive redundancy.

Test-Retest Reliability and Temporal Stability

In longitudinal evaluations spanning intervals of 6 to 12 weeks among bereaved individuals not receiving active psychotherapy, the ICSG exhibited high temporal stability, with test-retest intraclass correlation coefficients (ICC) ranging between .82 and .88 (p < .001). Importantly, however, in intervention studies where participants received meaning-oriented or constructivist grief therapy, ICSG scores exhibited significant, measurable declines, establishing that while the instrument possesses robust test-retest reliability in the absence of treatment, it remains sensitive to therapeutic change over time.

Factor Analysis

The structural integrity of the ICSG was derived and validated using rigorous exploratory and confirmatory factor analytical techniques across multiple independent samples.

Exploratory Factor Analysis (EFA)

During scale development, Burke et al. (2014) performed an Exploratory Factor Analysis on an initial pool of candidate items utilizing principal axis factoring with promax (oblique) rotation, reflecting the theoretical expectation that dimensions of spiritual distress would be intercorrelated. The analysis of eigenvalues (with initial values > 1.0) in combination with Cattell’s scree plot inspection unequivocally identified two dominant, clean factors accounting for over 65% of the total variance.

Confirmatory Factor Analysis (CFA)

Subsequent Confirmatory Factor Analysis (CFA) was conducted to evaluate the fit of the two-factor model compared to alternative structural models (such as a single unidimensional factor model or an orthogonal two-factor model). The two-factor oblique model demonstrated excellent goodness-of-fit indices:

• Comparative Fit Index (CFI): .96 to .98 (exceeding the standard .95 cutoff for superior fit);
• Tucker-Lewis Index (TLI): .95 to .97;
• Root Mean Square Error of Approximation (RMSEA): .052 to .061 (90% CI [.041, .072]), well below the .08 threshold for acceptable error;
• Standardized Root Mean Square Residual (SRMR): .042 to .051.

In contrast, a one-factor model yielded unacceptable fit indices (CFI < .80, RMSEA > .13), confirming that the cognitive-affective struggles with the divine (Insecurity with God) and the behavioral-communal struggles (Disruption in Religious Practice) constitute distinct, non-interchangeable constructs.

Factor Loadings

Standardized factor loadings for the 18 items are uniformly high and statistically significant (all p < .001):

• Insecurity with God (Items 1, 4, 7, 10, 13, 16, 18): Standardized factor loadings range from .68 to .88. The highest loading items on this factor include Item 4 (“I no longer feel safe and protected by God”, λ = .88) and Item 10 (“I can’t help feeling angry with God”, λ = .84).
• Disruption in Religious Practice (Items 2, 3, 5, 6, 8, 9, 11, 12, 14, 15, 17): Standardized factor loadings range from .65 to .91. The highest loading items on this factor include Item 14 (“I have lost my desire to worship”, λ = .91), Item 15 (“I find it impossible to worship”, λ = .89), and Item 6 (“I find it impossible to pray”, λ = .85).

The correlation between the two latent factors is moderate to high (r ≈ .62 to .68), demonstrating that while these two dimensions frequently co-occur in acute bereavement, they retain substantial unique variance.

Instrument / Measurement Tool

The Inventory of Complicated Spiritual Grief is a structured, standardized, 18-item self-report questionnaire designed for clinical and research administration. Below are the operational specifications of the instrument:

• Test Type: Standardized self-report psychometric rating scale.
• Format: Pen-and-paper, computerized assessment, or clinician-assisted interview.
• Item Count: 18 items.
• Response Scale: 5-point Likert rating scale scored from 0 to 4:
  • 0 = Not at all true
  • 1 = A little true
  • 2 = Somewhat true
  • 3 = Mostly true
  • 4 = Very definitely true
• Subscale Breakdown:
  • Insecurity with God (7 items): Items 1, 4, 7, 10, 13, 16, and 18. Evaluates theological anger, shattered trust in God, feelings of abandonment, and existential confusion regarding divine protection. Subscale score range: 0 to 28.
  • Disruption in Religious Practice (11 items): Items 2, 3, 5, 6, 8, 9, 11, 12, 14, 15, and 17. Evaluates behavioral withdrawal from religious community, inability or aversion to pray and worship, emotional emptiness in rituals, and sense of divine absence. Subscale score range: 0 to 44.
• Scoring and Interpretation Procedures:
  • All items are scored in a direct, positive direction; there are no reverse-scored items.
  • Total Score: Calculated by summing the responses across all 18 items. Total score range is 0 to 72. Higher scores indicate greater severity of complicated spiritual grief.
  • Subscale Scores: Calculated by summing the items within each designated factor.
  • Clinical Cutoff Scores: Burke and Neimeyer (2016) identified that a total score of ≥ 28 (or an average item response ≥ 1.55) serves as a sensitive clinical cutoff, indicating significant spiritual distress that strongly correlates with complicated grief and clinical depression, warranting specialized clinical intervention.
• Completion Time: Approximately 5 to 8 minutes.
• Target Population: Bereaved adolescents and adults who previously or currently identify with a religious or spiritual faith tradition (particularly theistic traditions such as Christianity, Judaism, or Islam).

Permissions & Fee and Test Year

The Inventory of Complicated Spiritual Grief was formally published in 2014 by Laurie A. Burke, Robert A. Neimeyer, and colleagues in the journal Death Studies, with further validation and clinical deployment detailed in their 2016 open-access report in Religions and the Routledge therapeutic compendium Techniques of Grief Therapy (2015).

• Copyright Status: The instrument is copyrighted by the authors (Laurie A. Burke and Robert A. Neimeyer).
• Academic & Clinical Use: The authors have made the ICSG freely accessible for non-commercial academic, empirical research, and individual clinical assessment purposes. Researchers and mental health practitioners may administer the scale without licensing fees, provided that proper bibliographic citation is accorded to the original validation publications.
• Commercial Licensing: Commercial distribution, inclusion within proprietary software platforms, or monetization requires formal written permission from the copyright holders. Inquiries regarding permissions and psychometric adaptations may be directed to Robert A. Neimeyer, Ph.D. ([email protected]) or Laurie A. Burke, Ph.D. ([email protected]).

References

• Burke, L. A., Neimeyer, R. A., Holland, J. M., Dennard, S., Oliver, L., & Shear, M. K. (2014). Inventory of complicated spiritual grief: Development and validation of a new measure. Death Studies, 38(4), 239–250. https://doi.org/10.1080/07481187.2013.842344
• Burke, L. A., & Neimeyer, R. A. (2015). Inventory of Complicated Spiritual Grief (ICSG). In R. A. Neimeyer (Ed.), Techniques of grief therapy: Assessment and intervention (pp. 95–98). Routledge. https://doi.org/10.4324/9781315794211
• Burke, L. A., & Neimeyer, R. A. (2016). The Inventory of Complicated Spiritual Grief: Assessing spiritual crisis following loss. Religions, 7(6), 67. https://doi.org/10.3390/rel7060067
• Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: Development of a research program. Death Studies, 43(2), 79–91. https://doi.org/10.1080/07481187.2018.1456620
• Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543. https://doi.org/10.1002/(SICI)1097-4679(200004)56:4<519::AID-JCLP6>3.0.CO;2-1
• Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Rapheal, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., Bonanno, G., Block, S. D., Kissane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLOS Medicine, 6(8), e1000121. https://doi.org/10.1371/journal.pmed.1000121

13. Items of the Scale (Questionnaire)