Inventory of Complicated Spiritual Grief (ICSG)

Abstract

The Inventory of Complicated Spiritual Grief (ICSG) is an 18-item psychometric instrument designed to assess spiritual crisis, existential distress, and spiritual struggle following significant bereavement and loss. Developed by Robert A. Neimeyer, Laurie A. Burke, and colleagues, the ICSG operationalizes spiritual complications that arise when an individual’s spiritual worldview, relationship with God, or religious practices are shattered by the death of a loved one. The instrument measures two interrelated primary dimensions: Insecurity with God (7 items), which captures relational rupture, perceived abandonment, confusion, anger, and loss of perceived safety regarding God; and Disruption in Religious Practice (11 items), which measures behavioral withdrawal from community worship, loss of spiritual comfort, prayer paralysis, and spiritual anhedonia. Respondents rate each item along a 5-point Likert-type scale ranging from 0 (Not at all true) to 4 (Very definitely true), yielding a composite score from 0 to 72 as well as discrete subscale scores. Extensively validated in both clinical and community samples—including highly religious populations and individuals experiencing traumatic bereavement—the ICSG displays exceptional internal consistency (composite Cronbach’s α ≥ .94 to .96; subscale αs ≥ .88 to .94) and robust factorial validity demonstrated via exploratory and confirmatory factor analyses. The scale demonstrates robust convergent and incremental validity, exhibiting strong positive correlations with prolonged grief disorder (PGD), negative religious coping, depressive symptomology, and meaning-making disruption, while establishing discriminant divergence from positive religious coping and general social support. The ICSG serves as an essential tool for clinical psychologists, pastoral counselors, thanatologists, and palliative care researchers seeking to identify and treat multidimensional existential and spiritual suffering in bereavement.

Keywords

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

Authors

The Inventory of Complicated Spiritual Grief was constructed and validated by a multidisciplinary team of clinical psychologists and thanatological researchers:

• Laurie A. Burke, Ph.D. — Department of Psychology, University of Memphis, Memphis, Tennessee, United States; research specialist in spiritual distress, traumatology, and ethnic disparities in bereavement coping. E-mail: [email protected].
• Robert A. Neimeyer, Ph.D. — Director of the Portland Institute for Loss and Transition, Portland, Oregon; Professor Emeritus, Department of Psychology, University of Memphis, Memphis, Tennessee, United States. Renowned theorist in meaning reconstruction in bereavement and grief psychotherapy. E-mail: [email protected].
• Jason M. Holland, Ph.D. — Department of Psychology, University of Memphis; clinical psychologist specializing in traumatic stress, life transitions, and structural equation modeling.
• Sarah Dennard, M.S. — Department of Psychology, University of Memphis, Memphis, Tennessee, United States.
• Liz Oliver, M.S. — Department of Psychology, University of Memphis, Memphis, Tennessee, United States.
• M. Katherine Shear, M.D. — Marion E. Kenworthy Professor of Psychiatry, Columbia University School of Social Work and Columbia University College of Physicians and Surgeons; founding 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 systematically identify, quantify, and conceptualize spiritual crisis and spiritual crisis manifestations that occur in the wake of bereavement. For millions of people globally, spirituality and religious faith serve as paramount resources for resilience, providing an interpretive framework through which catastrophic life events can be comprehended, integrated, and endured. However, when bereavement involves traumatic circumstances (e.g., violent death, suicide, homicide, sudden pediatric loss), or when the death fundamentally violates deeply entrenched assumptions regarding divine benevolence, justice, and protection, religious faith can undergo severe destabilization. Rather than serving as an emotional sanctuary, faith becomes the epicentre of existential crisis, relational turmoil, and intense psychological agony.

Historically, psychological research into bereavement distinguished between normal adaptive grief reactions and prolonged or complicated grief, but predominantly relegated spiritual aspects to brief general coping scales (such as general religious coping measures) or lumped spiritual distress indiscriminately into major depressive disorder or existential anxiety. Pre-existing measures did not adequately capture the distinctive clinical phenomenon wherein an individual experiences simultaneously severe psychological mourning and an acute rupture in their spiritual identity and attachment to the divine. The ICSG was developed precisely to address this diagnostic and psychometric void.

In clinical practice, the ICSG serves critical diagnostic, prognostic, and therapeutic functions:

• Screening for Hidden Spiritual Distress: Many bereaved clients in psychotherapy or pastoral counseling hesitate to voluntarily express anger at God, feelings of spiritual betrayal, or religious apathy due to religious guilt, social stigma, or fear of moral judgment. The ICSG normalizes these experiences within an objective assessment framework.
• Differential Diagnosis and Comorbidity Mapping: The scale enables clinicians to discern whether severe grief reactions are sustained by unresolved spiritual crisis, facilitating the differential diagnosis between unintegrated bereavement, moral injury, prolonged grief disorder (PGD), and major depressive disorder (MDD).
• Treatment Planning and Meaning Reconstruction: Utilizing the ICSG allows clinicians to design targeted therapeutic interventions, such as chair work directed toward God, restorative retelling, therapeutic letter writing to the divine, or cognitive restructuring of maladaptive theodicies.
• Longitudinal Outcome Monitoring: By reassessing individuals over time, clinicians and pastoral care workers can track whether spiritual wounds are resolving into mature, complex faith, or remaining intractable and predisposing the client to chronic psychological morbidity.

In research contexts, the ICSG provides a psychometrically sound, theoretically grounded instrument to examine how spiritual rupture mediates or moderates the relationship between objective trauma parameters (e.g., violent vs. natural death) and mental health outcomes, including suicidality, functional impairment, and post-traumatic stress.

Psychological Construct

The psychological construct assessed by the ICSG is Complicated Spiritual Grief (CSG). Burke, Neimeyer, and colleagues conceptualize CSG as a multidimensional spiritual crisis precipitated by loss, characterized by an ongoing, distressing breakdown in a mourner’s relationship with God and a pervasive disruption of religious activities and community connection. This state is not a benign period of contemplative questioning; rather, it is a debilitating, emotionally agonizing state of spiritual dissonance where faith no longer functions as an effective buffer against despair.

The construct is delineated into two distinct yet strongly correlated dimensions:

1. Insecurity with God

The Insecurity with God dimension (encompassing items 1, 4, 7, 10, 13, 16, and 18) reflects a profound cognitive, affective, and relational fracture between the mourner and the divine. Grounded in attachment theory, this dimension measures the transformation of God from a “safe haven” and “secure base” into a source of perceived threat, abandonment, or injustice. Central psychological elements of this dimension include:

• Relational Betrayal and Confusion: The mourner expresses severe bewilderment regarding divine protection. Having maintained an implicit spiritual contract (“I am a faithful believer, therefore God will shield my loved ones”), the occurrence of death is interpreted as a unilateral breach of trust by God (e.g., Item 18: “I am a faithful believer, so I don’t understand why God did not protect me”).
• Theodicy and Injustice: The loss shatters the individual’s cognitive schema regarding divine benevolence and cosmic fairness (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 Fear: Mourners experience involuntary hostility, resentment, and bitterness toward God alongside the terrifying sensation that divine protection has been permanently revoked (e.g., Item 4: “I no longer feel safe and protected by God”; Item 10: “I can’t help feeling angry with God”).

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, and experiential collapse of spiritual engagement. When the internal representation of God becomes fraught with insecurity, external manifestations of faith routinely deteriorate. Key components include:

• Behavioral Avoidance and Withdrawal: Active, deliberate avoidance of religious rituals, scripture reading, personal devotion, and church gatherings (e.g., Item 3: “I go out of my way to avoid spiritual/ religious activities”; Item 2: “I have withdrawn from my fellowship with other believers”).
• Spiritual Anhedonia and Paralysis: Religious activities that formerly elicited profound joy, comfort, or psychological equilibrium become emotionally vacant, irritating, or impossible to perform (e.g., Item 5: “I find that spiritual/religious activities are not very fulfilling”; Item 6: “I find it impossible to pray”; Item 15: “I find it impossible to worship”).
• Social and Existential Alienation: The individual feels estranged from their faith community, unable to participate in corporate worship or find solace in traditional fellowship (e.g., Item 9: “I don’t feel as comforted by church fellowship as I used to”; Item 11: “I don’t feel very much like joining in fellowship to praise God or to glorify Him”).
• Spiritual Desolation and Perceived Divine Absence: An experiential transition from sensing God’s loving immanence to experiencing a cold, hollow absence (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”).

Theoretical Framework

The theoretical architecture of the ICSG synthesizes three foundational paradigms within psychological and thanatological science: Meaning Reconstruction Theory, Attachment Theory applied to Religion, and the Theory of Religious Coping and Spiritual Struggle.

Meaning Reconstruction Theory of Bereavement

Formulated extensively by Robert A. Neimeyer, meaning reconstruction theory posits that human beings possess an intrinsic drive to organize lived experience into coherent narrative structures. Central to this system is the “assumptive world” (a concept pioneered by Ronnie Janoff-Bulman), which consists of foundational presuppositions that the world is meaningful, benevolent, predictable, and fair. A traumatic or untimely bereavement invalidates these overarching cognitive schemas. When individuals operate from a deeply religious frame of reference, their assumptive world is directly anchored in theological assertions: God is sovereign, loving, responsive to prayer, and protective of the righteous. The death of a loved one forces a radical crisis of meaning. If the mourner is unable to assimilate the tragedy into existing theological structures or accommodate their faith to accommodate tragic reality, they enter complicated spiritual grief, experiencing what Neimeyer describes as a narrative collapse.

Attachment Theory Applied to the Divine

Originally articulated by John Bowlby and expanded into religious cognition by Lee Kirkpatrick and Pehr Granqvist, attachment theory suggests that for many believers, God functions as an idealized psychological attachment figure. In healthy spiritual development, God provides a safe haven to which the individual retreats during times of existential terror and a secure base from which they explore and engage the world. Bereavement activates the attachment behavioral system at peak intensity. When mourners reach out to God for rescue, comfort, or preservation of their loved one and the death occurs nonetheless, an attachment crisis ensues. The individual perceives the primary attachment figure as unresponsive, rejecting, or actively punitive. This triggers anxious and avoidant attachment protests toward God, precisely mirrored in the ICSG’s subscales of Insecurity with God (anxious protest, hyperactivating strategies, anger) and Disruption in Religious Practice (deactivating strategies, defensive avoidance, alienation).

Pargament’s Religious Coping and Spiritual Struggle Framework

Kenneth Pargament‘s pioneering work on religious coping establishes that religious engagement during adversity is not uniformly adaptive. While positive religious coping (seeking spiritual support, benevolent religious reframing) promotes post-traumatic growth and resilience, negative religious coping (spiritual struggle involving demonic reappraisals, interpersonal religious conflict, and expressions of divine wrath) strongly predicts worsening depressive symptoms, anxiety, complicated grief, and elevated mortality. The ICSG elaborates directly on Pargament’s concept of spiritual struggle by tailoring it specifically to the unique phenomenological demands of bereavement, separating relational struggles with the divine from ritualistic and behavioral disengagement.

Validity

The psychometric validity of the Inventory of Complicated Spiritual Grief has been rigorously documented across multiple independent studies involving diverse demographic cohorts, distinct religious traditions, and varied bereavement trajectories.

Construct and Factorial Validity

Construct validity was initially established by Burke et al. (2014) using an initial development sample of 150 bereaved adults and a replication sample of 152 participants. Exploratory Factor Analysis (EFA) and subsequent Confirmatory Factor Analysis (CFA) demonstrated that a two-factor correlated model provided an exceptional fit to empirical data, outperforming alternative single-factor or orthogonal representations. The two factors—Insecurity with God and Disruption in Religious Practice—exhibited strong inter-factor correlations (typically ranging between r = .68 and .76), reflecting distinct but harmoniously integrated components of a higher-order complicated spiritual grief construct.

Convergent Validity

Convergent validity has been repeatedly demonstrated through robust, statistically significant correlations with validated instruments assessing prolonged grief, psychopathology, and spiritual crisis:

• Prolonged Grief Disorder: The ICSG total score exhibits strong, positive associations with the Inventory of Complicated Grief (ICG) (r = .47 to .62, p < .001). Individuals meeting diagnostic thresholds for PGD score significantly higher across both ICSG subscales compared to non-complicated mourners.
• Negative Religious Coping: The ICSG correlates robustly with the Negative Religious Coping subscale of the Brief RCOPE (r = .65 to .78, p < .001), substantiating that the scale accurately captures theological struggles, feeling abandoned by God, and religious questioning.
• Depressive Symptomatology and Psychological Distress: Significant positive correlations have been documented with the Beck Depression Inventory-II (BDI-II) (r = .42 to .55) and the Beck Anxiety Inventory (BAI) (r = .38 to .49), confirming that spiritual collapse co-occurs with systemic emotional dysregulation.
• Sense of Meaninglessness: Strong inverse correlations occur between the ICSG and instruments measuring meaning-making, such as the Integration of Stressful Life Experiences Scale (ISLES) (r = -.55 to -.68, p < .001), corroborating the theoretical postulate that CSG fundamentally involves a failure of existential meaning reconstruction.

Discriminant and Divergent Validity

The ICSG exhibits clear discriminant divergence from constructs with which it should theoretically show weak or non-significant associations:

• Positive Religious Coping: Correlations with the Brief RCOPE Positive Coping subscale are consistently near zero or mildly negative (r = -.05 to -.18, non-significant), demonstrating that the ICSG is not merely measuring general religiosity in reverse, but rather an independent, non-redundant dimension of spiritual pathology.
• Social Support and Demographics: The ICSG exhibits negligible correlations with general perceived social support (outside of religious settings) and general demographic variables such as age, gender, education level, and socioeconomic status.

Incremental and Predictive Validity

Hierarchical multiple regression analyses conducted by Burke, Neimeyer, and colleagues demonstrated that the ICSG accounted for significant, unique variance in complicated grief symptoms and depressive pathology even after statistically controlling for age, time since death, violent cause of death, baseline religiosity, and negative religious coping. Specifically, the ICSG explained an additional 11% to 15% of unique variance in complicated grief severity beyond traditional psychological risk factors, firmly establishing its indispensability in clinical assessment battery designs.

Reliability

The Inventory of Complicated Spiritual Grief has demonstrated exceptional psychometric reliability across diverse empirical investigations, exhibiting high internal consistency, item-total correlations, and temporal stability.

Internal Consistency

The internal consistency of the ICSG composite score and its subscales consistently surpasses standard psychometric benchmarks for both clinical screening and basic research:

• Total Score: The overall 18-item composite yields a Cronbach’s alpha (α) ranging between .94 and .96 across multiple validation samples, reflecting near-optimal homogeneity among items without excessive redundancy. McDonald’s omega (ω) values have mirrored these results (ω = .95).
• Insecurity with God: This 7-item subscale routinely produces Cronbach’s alpha coefficients between .89 and .92. Corrected item-total correlations for these 7 items range from .64 to .81, indicating that every item contributes substantially to measuring relational insecurity with the divine.
• Disruption in Religious Practice: The 11-item subscale yields Cronbach’s alpha coefficients spanning .92 to .94. Corrected item-total correlations range from .61 to .83, confirming high internal cohesiveness regarding the behavioral, ritualistic, and communal collapse of spiritual functioning.

Test-Retest Stability

In longitudinal cohort assessments tracking bereaved individuals over a 6-to-10-week interval without intervening psychotherapy, the ICSG demonstrated high test-retest reliability, with intraclass correlation coefficients (ICC) and Pearson correlation coefficients exceeding r = .82 (p < .001). Concurrently, in clinical outcome studies evaluating targeted meaning-reconstruction grief therapy, the ICSG showed robust sensitivity to therapeutic change, exhibiting statistically significant reductions in scores that paralleled declines in complicated grief symptoms.

Factor Analysis

The structural dimensionality of the ICSG was developed and verified through rigorous exploratory and confirmatory factor analytical protocols.

Exploratory Factor Analysis (EFA)

In the initial instrument development study by Burke et al. (2014), an initial pool of 28 candidate items was administered to an ethnically diverse sample of bereaved adults. Principal Axis Factoring (PAF) accompanied by oblique rotation (Promax, κ = 4) was selected due to the theoretical expectation that sub-dimensions of spiritual grief would correlate moderately to highly with one another.

Examination of eigenvalues, Cattell’s scree plot, and parallel analysis definitively converged on a robust two-factor solution accounting for over 61% of the total variance. Items with factor loadings below .50, cross-loadings greater than .30, or poor conceptual clarity were systematically eliminated, winnowing the final scale to 18 highly cohesive items:

• Factor 1: Disruption in Religious Practice (11 items): Eigenvalue = 9.42; accounted for 47.1% of the common variance. Salient pattern loadings ranged from .60 to .87. This factor assembled all behavioral disengagements, ritual paralysis, church alienation, and loss of devotional desire.
• Factor 2: Insecurity with God (7 items): Eigenvalue = 2.14; accounted for 14.1% of the common variance. Salient pattern loadings ranged from .62 to .85. This factor gathered items tapping perceived divine betrayal, anger, existential injustice, and perceived abandonment.

Confirmatory Factor Analysis (CFA)

Confirmatory factor analysis conducted on an independent replication cohort confirmed that the hypothesized two-factor correlated model provided an exemplary fit to the empirical data, significantly outperforming alternative unidimensional and orthogonal models:

• Model Fit Indices:
  • Comparative Fit Index (CFI) = .96 (threshold ≥ .95 indicates superior fit)
  • Tucker-Lewis Index (TLI) = .95 (threshold ≥ .95 indicates superior fit)
  • Root Mean Square Error of Approximation (RMSEA) = .054 (90% CI: [.041, .067]; values ≤ .06 indicate close fit)
  • Standardized Root Mean Square Residual (SRMR) = .046 (values ≤ .08 indicate good fit)
  • Chi-Square to Degrees of Freedom Ratio (χ²/df) = 1.48 (values < 2.0 indicate excellent fit)

All standardized factor loadings in the CFA exceeded .62 (p < .001), indicating that every designated item serves as an exceptional indicator of its assigned latent factor. The latent inter-factor correlation was estimated at r = .71, confirming that while the two dimensions represent related facets of spiritual distress, they retain sufficient independent variance to warrant separate subscale scores.

Instrument / Measurement Tool

Below is a comprehensive technical breakdown of the Inventory of Complicated Spiritual Grief as a formal clinical and psychometric assessment instrument:

• Instrument Name: Inventory of Complicated Spiritual Grief (ICSG)
• Authors: Laurie A. Burke, Ph.D., Robert A. Neimeyer, Ph.D., Jason M. Holland, Ph.D., Sarah Dennard, M.S., Liz Oliver, M.S., and M. Katherine Shear, M.D.
• Year of Development: 2014; expanded in 2015 and 2016.
• Instrument Type: Self-report psychometric rating scale / clinical inventory.
• Target Population: Bereaved adolescents and adults who have experienced the death of a family member, partner, or close friend, specifically applicable to individuals from theistic, monotheistic, or spiritual backgrounds (e.g., Christian, Jewish, Islamic, or non-denominational theistic faiths).
• Number of Items: 18 items total.
• Response Scale: 5-point Likert-type scale scored as follows:
  • 0 = Not at all true
  • 1 = A little true
  • 2 = Somewhat true
  • 3 = Mostly true
  • 4 = Very definitely true
• Subscale Composition:
  • Insecurity with God: 7 items (Items 1, 4, 7, 10, 13, 16, 18). Subscale score range: 0 to 28.
  • Disruption in Religious Practice: 11 items (Items 2, 3, 5, 6, 8, 9, 11, 12, 14, 15, 17). Subscale score range: 0 to 44.
• Scoring and Interpretation Procedures:
  • Reverse Scored Items: None. All 18 items are positively keyed toward spiritual distress.
  • Total Score Calculation: Sum the numerical responses across all 18 items. Total composite score ranges from 0 to 72. Higher scores correspond to more profound spiritual crisis, existential despair, and spiritual grief complication.
  • Subscale Scores: Computed by summing the respective item scores for each factor.
  • Clinical Cutoff Guidelines: While clinical discernment must always accompany psychometric cutoffs, empirical studies (Burke & Neimeyer, 2014, 2016) suggest that a total score of ≥ 28 indicates clinically significant complicated spiritual grief that warrants targeted therapeutic intervention. Scores between 0 and 15 reflect mild or normative existential grief; scores from 16 to 27 reflect moderate spiritual struggle; and scores of 28 or above indicate severe, debilitating spiritual crisis.
• Administration Time: Approximately 5 to 10 minutes.

Permissions & Fee and Test Year

The Inventory of Complicated Spiritual Grief was formally established and psychometrically validated in 2014, with further theoretical and brief validation models released in 2015 and 2016. The instrument is copyright © 2014 by Laurie A. Burke and Robert A. Neimeyer.

The ICSG is considered an open-access psychometric instrument for academic research, educational instruction, and individual clinical practice. Clinicians and researchers are permitted to utilize, administer, and reproduce the inventory without financial cost or royalty fees, provided that appropriate academic attribution is maintained and the scale is cited accurately according to scientific conventions. For commercial application, integration into proprietary digital health systems, or mass translation initiatives, formal permission must be sought directly from the lead authors:

• Robert A. Neimeyer, Ph.D. — Portland Institute for Loss and Transition: [email protected]
• Laurie A. Burke, Ph.D. — University of Memphis: [email protected]

References

• Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. Basic Books.
• Burke, L. A., & Neimeyer, R. A. (2014). Complicated spiritual grief: When faith fails in the wake of loss. In R. A. Neimeyer (Ed.), Grief and the expressive arts: Practices for creating meaning (pp. 264–268). Routledge. https://doi.org/10.4324/9780203761984
• 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. 95–99). Routledge. https://doi.org/10.4324/9781315795416
• 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
• 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/10.1080/07481187.2013.841197
• Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2006). Sense-making, grief, and the reconstructing of meaning: A test of a mediational model. Journal of Loss and Trauma, 11(3), 235–259. https://doi.org/10.1080/15325020500407989
• Exline, J. J., Park, C. L., Smyth, J. M., & Carey, D. A. (2011). Anger toward God: Social-cognitive predictors, prevalence, and links with suffering. Journal of Personality and Social Psychology, 100(1), 129–148. https://doi.org/10.1037/a0021716
• Granqvist, P., & Kirkpatrick, L. A. (2013). Religion, spirituality, and attachment. In K. I. Pargament, J. J. Exline, & J. W. Jones (Eds.), APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research (pp. 139–155). American Psychological Association. https://doi.org/10.1037/14045-007
• Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. Free Press.
• 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., Feuille, M., & Burdzy, D. (2011). The Brief RCOPE: Current psychometric status of a short measure of religious coping. Religions, 2(1), 51–76. https://doi.org/10.3390/rel2010051
• Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1-2), 65–79. https://doi.org/10.1016/0165-1781(95)02757-2

Items of the Scale