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Measuring grief: A short version of the Perinatal Grief Scale
Abstract
Despite a considerable number of studies, there are two major drawbacks in the literature on grief and bereavement. One is a lack of adequate and generally agreed upon measures for assessing grief. The second is a lack of ability to predict from existing measures the likelihood of what has been termed chronic or pathological grief reactions. This paper reports the results of the development of a bereavement measure for the study of perinatal loss which attempts to address these gaps. The measure is specific to a pregnancy-related loss, although it has the potential for adaptation to use for other types of loss. Analysis of responses from 138 women has resulted in the reduction of the original measure from 104 to a more manageable and almost equally comprehensive and reliable 33 items. In addition, a factor analysis has produced three factors, two of which indicate the possibility for longer-term and more severe grief reactions. Because of its sound psychometric qualities and interesting factor structure, the measure shows promise of being useful for both research and clinical purposes.
... Therefore, we used the validated short version of the Perinatal Grief Scale (PGS), that consists of 33 items answered on a 5-point Likert scale from Strongly disagree to Strongly agree. The 33-item PGSscale has three identified subscales; Active Grief, Difficulty Coping, and Despair, measuring different dimensions of grief (Potvin et al., 1989). Active Grief measures a "normal" and adaptive grief response. ...
... Active Grief measures a "normal" and adaptive grief response. Difficulty Coping measures depression-like symptoms of withdrawal, and Despair measures feelings of hopelessness and worthlessness and thus potentially more severe reactions to grief (Potvin et al., 1989). The PGS total score ranges from 33 to 165, the subscales from 11 to 55, with higher scores reflecting more intense grief reactions (Potvin et al., 1989). ...
... Difficulty Coping measures depression-like symptoms of withdrawal, and Despair measures feelings of hopelessness and worthlessness and thus potentially more severe reactions to grief (Potvin et al., 1989). The PGS total score ranges from 33 to 165, the subscales from 11 to 55, with higher scores reflecting more intense grief reactions (Potvin et al., 1989). Information on continuing bonds and grief was collected at 4-8 weeks and 13 months after the loss. ...
In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents
experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death.
... To this aim, the Mann-Whitney U test was applied to check gender differences for all items, which showed no significant difference between male and female participants (P>0.05). Similarly, a Kruskal-Wallis test was employed to analyze all the items for different age groups (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), 41-50, >51); accordingly, no significant difference was observed among age groups (P>0.05). Considering these results, the findings of this study can be applicable for any person, irrespective of their age and gender. ...
... To evaluate the intra-rater reliability of the questionnaire, we compared the results of the final questionnaire with those of the Coronavirus Anxiety Scale (CAS) (24), Adjustment Disorder-New Module 20 (25), a short version of the Perinatal Grief Scale (PGS) (26), and Yale-Brown Obsessive Compulsive Scale (YOCS) (27). The individuals' scores in each scale of the questionnaire as well as the standard scores based on CAS, ADNM, PGS, and YOCS were calculated. ...
Background: Considering the scope of the epidemic of the COVID-19 pandemic and the psychological consequences known to be associated with infection, it seems necessary to provide a screening tool for determining the presence of psychological symptoms among the population in the healthcare sector for prevention and timely provision of psychological interventions. Objectives: This study aimed to design and standardize a comprehensive screening test and assess clinical aspects of psychological symptoms associated with COVID-19. Methods: This is a descriptive survey-based study. The study was permitted in two phases. The statistical population included all physicians, nurses, and staff who worked in COVID-19 care wards of hospitals in Ardabil (Iran) in 2021 and were in direct contact with these patients. A total of 200 participants in Phase I and 98 in Phase II were selected via the purposive sampling method. An initial researcher-made questionnaire was used to assess the psychological symptoms of the participants in eight and seven categories in Phase I and Phase II, respectively. The data were analyzed using SPSS26 and R software. Results: Delphi method and second-order confirmatory factor analysis verified the validity of the questionnaire. Findings related to measuring the reliability of the questionnaire in phase I showed that although the questionnaire was reliable based on inter-rater and intra-rater, the test-retest reliability method based on Cohen's kappa coefficients showed no reliability for items 12 and 49-54. In phase II, the unreliable items were removed and the study was permitted to be conducted again with new samples. The results of intra-rater reliability also demonstrated that an intraclass correlation coefficient for each of the seven scales of the questionnaire was greater than 0.75. In addition, the results of inter-rater reliability showed that Cronbach's alpha coefficient for each scale of the questionnaire was greater than 0.70. Furthermore, high amounts of sensitivity and specificity as well as high area under the receiver operating characteristic curve verified the good accuracy of the final questionnaire. Conclusion: Based on the findings, it can be said that the final proposed questionnaire with seven scales (55 items) was a tool with good validity, reliability, and accuracy to assess the psychological symptoms associated with COVID-19. However, since the participants of this study consisted of only medical personnel, the generalization of the results to the general population needs further investigation.
... A equipe do Núcleo de Estudos em Desenvolvimento e Saúde (NEEDS) da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) realizou pequenos ajustes para o português brasileiro. 3. Escala de Luto Perinatal (ELP; Perinatal Grief Scale -PGS) (Potvin et al., 1989), adaptada para o português brasileiro por Rocha (2004): avalia a sintomatologia de luto perinatal através de 33 itens (escala Likert de 5 pontos, variando de 1 = "concordo totalmente" a 5 = "discordo totalmente"), distribuídos em três subescalas que avaliam pensamentos, sentimentos atuais e sintomatologia de adaptação da perda. O escore total (soma total) varia de 33 a 165 pontos e, em cada subescala, de 11 a 55 pontos. ...
A perda gestacional (PG) é um evento complexo e potencialmente traumático, muitas vezes invisibilizado socialmente. A escassez de estudos sobre aspectos psicológicos relacionados à PG pela perspectiva masculina aponta a necessidade de ampliar a compreensão do tema. Este estudo objetivou conhecer as repercussões e o processo de luto decorrente de uma PG, assim como as diferenças entre as experiências de homens e mulheres que compartilharam esta perda, com base em um estudo de casos múltiplos (Yin, 2005), qualitativo e transversal, com três casais. Foram aplicados Ficha de Dados Sócio-Demográficos e Clínicos, Brief Symptom Inventory, Escala de Luto Perinatal e uma entrevista individual sobre a experiência de PG ocorrida nos últimos 12 meses. A análise dos dados revelou que a forma como o parto foi vivido, incluindo o manejo e cuidado das equipes, pode ser atenuante ou complicadora do processo de luto. A presença de rituais de despedida e ações de simbolização da perda, o sentir-se mãe/pai mesmo na ausência do filho e a flexibilização do papel de apoio entre o casal também repercutiram no processo de luto. A vivência corporal da gestação e da PG na mulher mostrou-se um importante demarcador da experiência feminina e masculina, tanto pela singularidade do processo psíquico que acarreta, quanto pela compreensão social de maior sofrimento feminino nessa situação, o que reforça a importância de dar visibilidade às dores de ambos.
... The Perinatal Grief Scale (PGS) (Potvin et al., 1989) consists of 16 items with a response range of 1 (I strongly disagree) to 5 (I strongly agree) designed to assess the intensity and impact of grief following a perinatal loss. An example of an item on this scale is "I very much miss the baby". ...
The death of a baby in the perinatal period is considered a disenfranchised grief that can be a source of significant symptoms of guilt, shame, and stigma. There is a lack of validated instruments for assessing the stigma associated with perinatal grief. The aim of this study was to examine the psychometric properties (factor structure, reliability, and validity) of the Spanish version of the Stillbirth Stigma Scale (SSS) in parents who have experienced a perinatal loss. A total of 291 participants (mostly mothers) completed an online questionnaire that included the SSS and other measures. The best-fitting factor structure was a second-order model with four dimensions and adequate reliability values. In terms of validity, we found statistically significant relationships between the SSS scores and the variables of self-esteem, complicated grief, event centrality, depression, and anxiety. In conclusion, the Spanish adaptation of the SSS is deemed to have adequate psychometric properties.
... -report scale with items equally divided among three subscales: Active Grief, Difficulty Coping, and Despair. Each subscale has a scoring range from 11 to 55 with higher scores demonstrating more grief, greater difficulty coping, and deeper despair. Although reliability (internal = .95, test-retest = .59 to .66) and validity have been demonstrated (Potvin, Lasker. & Toedter, 1989), this scale was slightly altered for use in this study (for example, one item was deleted and we introduced minor word changes appropriate to our sample of postabortion men). The psychometric properties of the altered scale were unknown prior to this study. ...
An intervention designed to foster forgiveness was implemented with postabortion men. Participants were randomly assigned to either the treatment or the control (wait list) condition, which received treatment after a 12-week waiting period. Following treatment, the participants demonstrated a significant gain in forgiveness and significant reductions in anxiety, anger, and grief as compared with controls. Similar significant findings were evident among control participants after they participated in the treatment. Maintenance of psychological benefits among the 1st set of participants was demonstrated at a 3-month follow-up.
... This instrument has been validated worldwide for different types of pregnancy losses, showing high internal consistency (56)(57)(58). Its Portuguese version has also been validated with good levels of reliability (57). ...
Introduction
Worldwide, up to a quarter of all recognized pregnancies result in Early Pregnancy Loss (EPL), also known as miscarriage. For many women, this is a traumatic experience that leads to persistent negative mental health responses. The most common morbidity reported in studies from different countries is complicated grief, usually comorbid with depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). To our best knowledge, no studies characterizing the psychological impact of EPL have been made in Portugal.
Methods
An online survey was conducted to evaluate clinical symptoms of perinatal grief, anxiety, depression, and PTSD in women who suffered a spontaneous loss within 20 weeks of gestation. Out of 1,015 women who answered this survey, 873 were considered eligible, and subsequently distributed in 7 groups according to the time passed between their loss and their participation in the study.
Results
The proportion of women showing symptoms of all comorbidities was greater in those whose loss had happened within a month, and there was a significant gradual decrease over time in scores and proportions of clinical perinatal grief and PTSD. In terms of depression symptoms, scores dropped significantly in the group whose loss occurred 13–24 months before their participation but proportions oscillated without great changes in the other groups. Regarding anxiety, there were small oscillations, but there was no significant decrease of symptoms over time.
Discussion
Overall, despite a general drop in scores for most morbidities over time, substantial proportions of women showed persistent symptoms of clinical morbidities 3 years or more after the loss. Therefore, it is essential to promote monitoring of possible complicated responses to the event, to provide appropriate and timely intervention to those women in need.
Background and Aims
Perinatal grief have a significant influence on maternal mental health, hence appropriate tools for assessment are necessary. In this study, we translated and validated the Perinatal Grief Scale in Urdu (PGS‐Urdu) for use in Pakistan, therefore filling the gap in validated tools.
Methods
Data was collected from 165 women using consecutive sampling. Initially, “forward/backward” translation was used. For validity, content validity index and confirmatory factor analysis (CFA) were used respectively, and “Cronbach's‐Alpha” for reliability. In the validity stage, items 8, 11, 23, and 32 of the original scale were eliminated based on feedback from the target groups and the expert panel. For data‐analysis, SPSS 26 and Amos 26 were used.
Results
In analyzing the “Confirmatory factor analysis”, the “all‐fitness indicators” validated the three‐factor structure of 29‐item main scale. Cronbach alpha value was 0.83 for the entire scale The CFA results showed that all fitness indicators, with the exception of four, had loadings greater than 0.20, supporting the main scale's three‐factor structure. With a Cronbach's Alpha value of 0.83 for overall reliability, and varied from 0.81 to 0.87 for the PGS‐U variables. the PGS‐U exhibits an acceptable level of internal consistency.
Conclusion
The PGS‐U identifies women in perinatal grief for medical and social care. This research supports using the Urdu perinatal grief scale in obstetrics and bereavement counseling to reduce maternal mental health issues.
Aims/Background: Assessing the intensity of perinatal grief is very important for identifying the more complex cases in mothers and fathers. Despite this, there are few assessment tools available. The aim of this study was to analyze the psychometric properties (factorial structure, reliability, and validity) of the Spanish version of the Perinatal Grief Intensity Scale (PGIS). Design/Methods: An online survey was completed by 291 mothers and fathers who had suffered perinatal loss in the previous six years. Results: The results showed adequate fit indexes for the three-factor model of the PGIS: reality, confront others, and congruence. Reliability values for the overall scale and subscales were adequate. Finally, with regard to validity, significant (p < .05) and positive relationships were found with levels of complicated grief, event centrality, guilt, anxiety, and depression. There were also differences depending on whether participants exhibited high or low levels of complicated grief, and on the number of weeks of pregnancy at the time of the loss. Conclusion: In conclusion, the Spanish adaptation of the PGIS has adequate reliability and validity scores and a factorial structure consistent with the original version.
Background
Post-traumatic stress response reactions are prevalent mental phenomenon in perinatal loss women due to high grief, high perinatal depression and anxiety or low social support. Although post-traumatic stress reactions are known to have serious negative implications for perinatal loss women, families and society, the mechanism through which it functions is less clear.
Methods
This study was a multicentre cross-sectional survey conducted from December 2021 to October 2022, involving 346 perinatal loss women as participants. The Pearson’s correlation analysis, the PROCESS Macro Model 4 and Model 14 on SPSS (version 26) were used to analyse the available data.
Results
Perinatal grief positively predicted post-traumatic stress reactions among perinatal loss women. Perinatal depression and anxiety mediated the relationship between perinatal grief and post-traumatic stress reactions. Meanwhile, this process was moderated by social support.
Conclusions
The higher the level of grief among perinatal loss women, the more likely post-traumatic stress reactions. As a mediating mechanism with moderating, social support and perinatal depression and anxiety further explained how perinatal grief affected the post-traumatic stress reactions. In the higher social support, there was a weaker positive relationship between perinatal depression and anxiety, and post-traumatic stress reactions, compared to situations with lower social support. Nurses and midwives can help reduce the post-traumatic stress reactions among perinatal loss women by alleviating their perinatal depression and anxiety, and perinatal grief and by providing adequate medical and emotional support.
Termination of pregnancy for fetal anomaly (TOPFA) represents a uniquely distressing and challenging situation for women and their partners. Having appropriate screening tools that best highlight the psychological symptoms experienced by women and their partners is important to be able to guide care. Many validated screening tools for pregnancy and psychological distress exist, with variation in the ease of application and the domains addressed in each. We undertook a scoping review of tools used to assess psychological symptoms in women and/or partners after TOPFA. Of 909 studies, 93 studies including 6248 women and 885 partners were included. Most of the included studies assessed symptoms within six months of TOPFA and highlighted high rates of distress, grief and trauma symptoms. There was broad variation in the tools used between studies and the timing of their implementation. Focusing the care of women and families who undergo TOPFA to validated, broadly available and easily applied screening tools that assess a range of psychological symptoms is key in being able to identify the potential interventions that may be of benefit.
The prevalent approach to understanding of and clinical intervention in the process of mourning employs a model based on stages of bereavement. This paper suggests a theoretical conception that is not tied to a fixed order of emotional states. Two dimensions--closeness of relationship and mourner's perception of preventability of the death--are identified as prime predictors of the intensity and duration of bereavement.
We determined the grief response to neonatal death of 50 mother-father pairs by administering a queastionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parentinfant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving.
Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decisions, even when death results, and adjust to their loss with healthy grieving.
We determined the grief response to neonatal death of 50 mother-father pairs by administering a questionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P less than .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parent-infant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving. Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decision, even when death results, and adjust to their loss with healthy grieving.
Epidemiological literature revealing excess mortality in the newly widowed is reviewed. The risk varies by age and sex. Younger persons and men are at higher risk. There are manifold specific causes of death characterized by conditions manifest in middle and late life. Cause specificity also varies by sex. Methodological problems in this literature are mitigated by application of varied methodology and replication of basic findings. Socioeconomic status and "social" stress are not well controlled as independent variables. Nevertheless, they probably do not explain the large relative risk of mortality among the bereaved. Pathogenetic mechanisms resulting from a loss are probably twofold: physiologic changes associated with the loss response and behavioral changes that comprise health maintenance or chronic disease management. Because of its important as a health problems, as a fundamental human reaction, and as a research strategy for the basic psychosomatic hypothesis, bereavement is a prime target of investigation.
Investigated the effects of preventive intervention that followed the life crisis of sudden death in the family. Two bereaved groups of families (one of which received preventive intervention service) and one non-bereaved group were compared in an outcome design and were assessed for indices of illness, psycho-social disturbance, and general quality of life. The results revealed that sudden death has a two-stage impact upon family survivors and that subsequent adjustment can be predicted from a knowledge of facts at the time of death. A preventive intervention service had little or no impact and may have been harmful. Discussion centered on possible intervention strategies with a focus upon the complex determinants of environmental stresses and family/individual variables.