“You can’t measure grief,” is something I have heard numerous times as I’ve written about evidence-based bereavement coping strategies. I don’t think these statements mean anything like, “I have studied this matter at length and tried many different methods and I have concluded you can’t measure grief.”
I think it’s more along the lines of, “I haven’t really thought about it before but I can’t see any obvious way to measure grief. It’s not like, say, height and weight. And, besides, I’m a little offended that anyone would presume to say that my deeply personal feelings about loss can be measured like my shoe size.”
With all that in mind and with apologies where appropriate, you can measure grief. Researchers, therapists and others have dozens of tools to evaluate the intensity, duration and nature of grieving symptoms. Some have been around for decades. Some have gone through numerous revisions. They have been translated into many languages. Some have been used in different cultures, with varying outcomes.
What Is a Grief Assessment?
Since it’s not a physical quality, grief is not assessed the way you’d measure, say, your height, with a yardstick. Instead, researchers use written assessments that are filled out by the person being assessed. A question on one of these may ask how often the person feels sadness or yearning. Answers might be “always” and “often” and “rarely” and “never.”
Each answer generally gets a numerical score, typically between 0 and 4. On most assessments, the values of all the answers are added to arrive at a sum that is your score. The score is used to assess the level of grief. Generally there is a cut-off score. If you score above that level, it may indicate you are experiencing complicated or prolonged grief and might want to consider discussing it with a professional.
Subjective self-reports are not considered the best way to measure anything, but it’s hard to measure psychological qualities any other way. There have been a few attempts to use more objective measurements of things like brain activity and facial expressions. These haven’t become widely used, however, so subjective self-reports are what we have for the most part.
It helps that the grief assessments used in research are scientifically validated. This means the tests themselves are tested to see that they consistently and accurately measure symptoms and that the conclusions reflect reality. The process of validating an assessment may result in questions being added or thrown out or changes to the method of scoring.
One important way grief assessments are used is to evaluate the effectiveness of coping strategies. To do this, grievers fill out assessments before and after some kind of intervention, such as writing about the experience of loss. If the grief measurements are significantly lower after the intervention than before, that’s considered evidence that the strategy works.
None of this means these assessments are divinely inspired and can’t produce inaccurate or misleading results. For one thing, they’re only as accurate as the input. If you don’t answer honestly, the assessment may be off target. However, they do measure grief, even if not with immaculate perfection.
None of this means these assessments are divinely inspired and can’t produce inaccurate or misleading results.
Here are some you might consider taking a look at if you want an idea of how you are doing. You might take one of these every few months to see if you are improving, for instance. Or if you are feeling really awful, you could take one to see if consulting a therapist might be a good idea.
Grief Intensity Scale
In the world of grief assessments, the Grief Intensity Scale is about as quick and easy as it gets. In not much more time than it would take you to walk to the bathroom and step on the scale, you could complete this assessment and get an idea of what your grief level is today.
Unlike a lot of these assessments, the Grief Intensity Scale is specifically designed to be used by laypeople. There are 12 questions (plus four on basic information about your lost loved one.) You answer most by sliding a scale to indicate an answer such as “once a week” for how often you experience a feeling such as meaninglessness. It’s an online, interactive assessment. Your score is automatically generated when you click the “submit” button.
My Grief Intensity Scale score was 7. According to this assessment my grief intensity is low and my adjustment appears to be going well. Of course, I don’t feel very well much of the time, but it’s encouraging to know that I appear to be making progress.
Brief Grief Questionnaire
The Brief Grief Questionnaire is a five-question assessment that is intended to indicate whether or not the person being assessed is at risk for complicated grief. It takes literally a minute to complete and scoring won’t require much longer than that.
You answer questions like “How much does your grief still interfere with your life?” with one of three preselected answers. If you say “Not at all” give yourself a 0 on that question. “Somewhat” is worth a 1. “A lot” is good for a 2. If your total score on the questionnaire is 5 or more, you might consider being more fully evaluated by grief therapist.
Personally, I gave myself a 1 on all the questions except the first one for a total of 4. So I’m apparently not at risk for complicated grief.
In the United States, PG-13 is a rating of how violent or smutty a movie is. It’s also the name of a widely used assessment for prolonged grief disorder. The co-developer of this assessment is Holly Prigerson, a professor at the Cornell University medical school who has published many papers on grief and assessment.
The PG-13 consists of 13 questions along the lines of “In the past month, how often have you felt yourself longing or yearning for the person you lost?” Eleven are answered by checking one of five responses such as “Not at all” to “Several times a day.” The third question and the last one call for a yes-or-no response.
Unlike some assessments, you don’t simply total up your scores to measure your grief. Instead, your risk of prolonged grief is indicated by how you answer specific questions. For instance, to use it at all you must answer “yes” to the third one, indicating that it has been at least six months since your loss, because the assessment is intended only for people who are that far down the road of bereavement.
Also to be considered at risk of complicated grief, you must answer the first two questions by saying you experience these feelings at least daily. And you must answer at least five of the fourth through 12th questions by answering at least “once a day” or “quite a bit.”
Based on my self-assessment using the PG-13, I am not at risk of prolonged grief. It has been more than six months since Brady died, so I qualify on that. But I sometimes go a day or more without intense feelings of the sort described in the first two questions. I don’t think could answer at least “once a day” or “quite a bit” to five out of questions four through 12 either.
If the PG-13 had suggested I was at risk for prolonged grief, I might head for a capable grief therapist or counselor and ask them to assess me. Self-assessment can be an indicator, but a professional’s expertise and objectivity will give you a more reliable and accurate indicator of what’s going on.
Inventory of Complicated Grief
The Inventory of Complicated Grief or ICG is one of the most widely used assessments in grief research. (The link leads to a document titled “traumatic grief inventory,” but as far as I can tell it is identical to the ICG. This is just the cleanest copy I could find online. To see the original journal article presenting and explaining the ICG, click here.)
The ICG consists of 19 statements along the lines of “I think about this person so much that it’s hard for me to do the things I normally do.” You answer by checking one of five responses from “never” to “always.” Score each answer from 0 (never) to 4 (always) and total the scores for all 19 questions.
This assessment is intended to be used no sooner than six months after loss. If after that point your score is a 25 or more, this could indicate you are at risk for complicated grief. At almost a year since Brady died, I scored a 23. So, could be better, but could be worse.
Yet More Grief Yardsticks
If your appetite for grief assessments is not sated by now, you can find a long list of them here. Others I have seen frequently used in grief research include the Texas Revised Inventory of Grief, the Core Bereavement Items and the Impact of Events Scale-Revised.
There are also assessments for other feelings and symptoms that often go along with bereavement grief.
There are also assessments for other feelings and symptoms that often go along with bereavement grief. For depression, the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) is considered a good one for self-assessment. Here also is an online version of the widely used Beck Depression Inventory that will automatically score and interpret your answers. The Beck Anxiety Inventory is a quick and easy way to evaluate your level of anxiety.
Limits of Assessment
Assessments like these are only as good as the answers you provide. Personally, once I know what the cut-off score is, I involuntarily start adjusting my answers. Gaming the system is part of my nature and, possibly, human nature. If you want an accurate score, answer as honestly as you can.
And remember, these assessments, no matter how carefully constructed and extensively tested, are reflections of reality. They are not reality. If you feel truly awful and an assessment says you’re fine, I’d tend to discount the assessment. If you feel great and the assessment says you don’t, same thing. To me, they are to be used when you’re not sure. They’re just parts of the puzzle, potentially useful tools for understanding and coping with this horrifying, bewildering situation in which we find ourselves.
These assessments, no matter how carefully constructed and extensively tested, are reflections of reality. They are not reality.
Of course, I’m no psychologist, doctor, therapist or counselor. I’m just some guy with an Internet connection. That may be the most important thing of all to keep in mind. Grieve Well is not a source for definitive solutions to your grief problems.
I have no interest in telling anybody how to grieve or how not to grieve. I look through scientific research to identify grief coping strategies that you may not have thought of and that the evidence suggests may be helpful. If you see something that sounds promising, you could give it a try. If not, that’s fine with me. Your mileage may vary.
Thanks for reading, commenting, liking, sharing, reposting and following Grieve Well. I am sorry for the losses that brought you here, and hope you get some peace today.
Five months after writing this post I completed these assessments again, and also did the Impact of Events Scale-Revised assessment. The results on the re-takes were similar although not identical.
On the Grief Intensity Scale, I scored the same, 7. That supposedly means my grief is at a low intensity and my recovery is progressing. Am I still progressing even though my score didn’t change after five months? I’m not sure about that. At least this one didn’t show I’m worse.
Am I still progressing even though my score didn’t change after five months?
On the Brief Grief Questionnaire, on the other hand, I scored a 5 this time, which is one point higher than last time. That’s because I answered the first question, “How much are you having trouble accepting the death of Brady?” with “Somewhat” instead of “Not at all.” This is a judgement call and depends on what you mean by “accepting.” Anyway, a 5 is the threshold score for being “suggestive of the presence of the syndrome of Complicated Grief…” The assessment adds “…but full evaluation by a clinician is necessary to make this diagnosis.” Given that I feel I’m probably not experiencing complicated grief (and the results of the other assessment that I’ll get to in a moment), I don’t think I’ll seek a clinical evaluation and diagnosis right now.
On the PG-13, I again did not meet the criteria for prolonged grief. On items 4-12 I answered all with either the first or second choice. The criteria called for answering at least five of this set at least with the fourth option, “once a day” or “quite a bit.” So I wasn’t even close here, apparently. I also answered “no” to the last question, “Have you experienced a significant reduction in social, occupational, or other important areas of functioning (e.g., domestic responsibilities)?”
On the Inventory of Complicated Grief I scored a 21 this time, a couple of points lower than the 23 I scored months ago. So according to this I am making slow progress, which is what it feels like.
I also took a fourth assessment, the Impact of Events Scale-Revised, that I didn’t take the first time. Here’s a link to a good copy of that assessment. On this assessment I scored a 16, which is well below the cutoff score of 24 for clinical concern about PTSD. According to this assessment, I don’t have PTSD.
It was interesting to go back and take the assessments again after five months. I’d say the results generally fit what I feel. That is, I’m making some slow progress toward recovery and learning to cope in some areas, while in other ways I’m perhaps not moving very well or even at times at least sliding backwards. If you revisit these assessments at some future date, I hope they show you that you are getting better faster. Thanks again for reading, liking, commenting, sharing, reposting and subscribing to Grieve Well.