Traumatic Grief Inventory-Self Report plus (TGI-SR+)
Introduction
The Traumatic Grief Inventory-Self Report plus (TGI-SR+) consists of 22 statements about grief
reactions, hereafter referred to as items. These items are similar to symptoms of(i) persistent complex bereavement disorder as described in the DSM-5 (APA, 2013),(ii) prolonged grief disorder as described in the revision of the fifth edition of the DSM (DSM-5-TR;
APA, 2020),(iii) prolonged grief disorder as included in the ICD-11 (WHO, 2018), and (iv) prolonged grief disorderas proposed by Prigerson et al. (2009).
See Table 1 for an overview of the relation between the TGI-SR+ items and these symptoms.
Table 1. Similarities between TGI-CA items and symptoms of disturbed grief.
TGI- Persistent Complex
SR+ Bereavement Disorder
item DSM-5 (APA, 2013)

Prolonged griefdisorder DSM-5-TR(APA, 2020)

Prolonged griefdisorder ICD-11(WHO, 2018)

1B3

B2

B2

2

B2

C4*

C13

B1

B1

B1

4C115C16C67C88C4C4*

C3C59C12C5C10C610C2C6C9C711C10C7C6C3C2C3C4C8C913D14B415C316C517C718C9DEEC2C8C22021

B1C11219

Prolonged griefdisorder Prigerson etal. (2009)

C4C5C1C722C8Note. *These symptoms were assessed with two items. Highest score of one of the two items is used
to tap the symptom.

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TGI-SR vs. TGI-SR+
This survey was developed in 2019 and based on the 18-item self-report questionnaire the Traumatic
Grief Inventory-Self Report (TGI-SR) (Boelen & Smid, 2017; Boelen, Djelantik, de Keijser, Lenferink, &Smid, 2018). The 18 items of the TGI-SR are identical to items 1 through 18 of the TGI-SR+. Four items(item 19 through 22) were added to assess symptoms of prolonged grief disorder according to ICD-11(WHO, 2018). With the advent of prolonged grief disorder in the DSM-5-TR (2020), TGI-SR items weremapped on these new symptoms.
The participant is asked to rate to what extent each TGI-CA items applies to the participant during
the last month on an answer scale with 1 = never, 2 = seldom, 3 = sometime, 4 = often, 5 = always.

Scoring
Summing up the scores on the 22 items results in a total score for disturbed grief. A first validation
study indicated that a cut-off score of ≥71 can be used to distinguish disturbed from non-disturbed
grief (Lenferink et al., 2022).
Diagnostic scoring rules are helpful to determine whether a person meets criteria for a persistentcomplex bereavement disorder or prolonged grief disorder. A score of 4 or 5 on an item is indicativeof presence of that particular grief symptom.
To meet DSM-5 criteria of persistent complex bereavement disorder at least 1 symptom of the Bcriterion, at least 6 symptoms of the C criterion, and the symptom of the D criterion needs to bepresent.
For DSM-5-TR prolonged grief criteria, the following scoring rule is used: at least one symptom of theB Criterion and at least 3 out of the 8 symptoms of the C Criterion, and the D Criterion symptom
should be endorsed.
To fulfill ICD-11 criteria for prolonged grief disorder the following two scoring rules could be applied;
the liberal scoring rule, as mentioned by Killikelly and Maercker (2018), that proposes the presenceof at least 1 symptom of the B criterion, at least 1 symptom of the C criterion, and the E criterion thatsuggest presence of prolonged grief disorder or the conservative scoring rule, as stated by Boelen etal. (2019), that advocates that the presence of at least 1 symptom of the B criterion, at least 5
symptoms of the C criterion, and the symptom of the E criterion are indicative of prolonged griefdisorder.
To adhere to the criteria for prolonged grief disorder as proposed by Prigerson et al. (2009) thefollowing scoring rule is used: presence of the B criterion, at least 5 symptoms of the C criterion, andthe E criterion.

Citation TGI-SR+:
Lenferink, L.I.M., Eisma, M.C., Smid, G.E., de Keijser, J., & Boelen, P.A. (2022). Valid measurement ofDSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder:
The Traumatic Grief Inventory-Self Report Plus (TGI-SR+). Comprehensive Psychiatry, 112, 152281.
https://doi.org/10.1016/j.comppsych.2021.152281

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References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5thed.). Arlington, VA: American Psychiatric Publishing.
American Psychiatric Association (2020). Board Approves New Prolonged Grief Disorder for DSM.
Accessed on December 29, 2020 via: https://doi.org/10.1176/appi.pn.2020.11a12
Boelen, P. A., Djelantik, A. A. A. M. J., de Keijser, J., Lenferink, L. I. M., & Smid, G. E. (2018). Further
validation of the traumatic grief inventory-self report (TGI-SR): A measure of persistent complex
bereavement disorder and prolonged grief disorder. Death Studies.
doi:10.1080/07481187.2018.1480546
Boelen, P. A., Lenferink, L. I. M., & Smid, G. E. (2019). Further evaluation of the factor structure,prevalence, and concurrent validity of DSM-5 criteria for persistent complex bereavement disorderand ICD-11 criteria for prolonged grief disorder. Psychiatry Research, 3, 206-210. doi:
10.1016/j.psychres.2019.01.006
Boelen, P. A., & Smid, G. E. (2017). The traumatic grief inventory self -report version (TGI-SR):
Introduction and preliminary psychometric evaluation. Journal of Loss and Trauma, 22, 196– 212.
doi:10.1080/15325024.2017.1284488
Killikelly, C., & Maercker, A. (2018). Prolonged grief disorder for ICD-11: The primacy of clinical utility
and international applicability. European Journal of Psychotraumatology, 8(sup6). doi:
10.1080/20008198.2018.1476441
Lenferink, L.I.M., Eisma, M.C., Smid, G.E., de Keijser, J., & Boelen, P.A. (2022). Valid measurement ofDSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder:
The Traumatic Grief Inventory-Self Report Plus (TGI-SR+). Comprehensive Psychiatry, 112, 152281.
https://doi.org/10.1016/j.comppsych.2021.152281
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K,. . . Maciejewski, P.
K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD11. PLOS Medicine 6(8), e1000121.
WHO (2018). ICD-11. Prolonged Grief Disorder Criteria. Accessed on October 2, 2019 via:
https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314

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Traumatic Grief Inventory – Self Report Plus (TGI-SR+)
Instruction:

This questionnaire contains two parts. In Part 1, you are asked about the losses of loved ones you
have been confronted with. Part 2 asks you to what extent you experience grief reactions related tothe most distressing loss you have experienced.

Part 1:In this part you are asked to:1)
Indicate whether or not you have experienced the death of the person mentioned.
2)
Write down the date of the day that the deceased persons died.
3)
Indicate if these persons died to violent causes (by which we mean death due to homicide,suicide, or some unnatural cause).
(1) I have been confronted
with the death of:(2) Date ofdeath:(Name)(3) Death was due toa violent cause:
Yes

Partner 1
Partner 2
Child 1Child 2Child 3
FatherMother
Brother 1
Brother 2
Brother 3
Sister 1
Sister 2
Sister 3
Friend/ acquaintance 1, namely…
Friend/ acquaintance 2, namely…
Friend/ acquaintance 3, namely…
Other relative 1, namely …
Other relative 1, namely …
Other relative 1, namely …

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5Part 2In this part you are asked to do the following two things:
1. From the persons who died, listed in Part 1, please select one person whose death iscurrently mostly on your mind or is currently most distressing you. Write down the nameof this person:
The loss that is currently mostly on my mind/distressing, is the death of:__________________________________________________________________
2. Below, several grief-reactions are listed. Please indicate how often you have experienced
each reaction in the past month, in response to the death of this person.
Never(1)12345678910111213141516Seldomly(20Sometimes(3)

Frequently(4)

All thetime(5)

I had intrusive thoughts or images
related to the person who died.
I experienced intense emotional pain,sadness, or pangs of grief.
I found myself longing or yearning for theperson who died.
I experienced confusion about my role inlife or a diminished sense of self.
I had trouble accepting the loss.
I avoided places, objects, or thoughtsthat reminded me that the person I losthas died.
It was hard for me to trust others.
I felt bitterness or anger related to
his/her death.
I felt that that moving on (e.g., making
new friends, pursuing new interests) wasdifficult for me.
I felt emotionally numb.
I felt that life is unfulfilling or
meaningless without him/her.
I felt stunned, shocked, or dazed by
his/her death.
I noticed significant reduction in social,occupational, or other important areas offunctioning (e.g., domesticresponsibilities) as a result of his/herdeath.
I had intrusive thoughts and images
associated with the circumstances ofhis/her death.
I experienced difficulty with positive
reminiscing about the lost person.
I had negative thoughts about myself inrelation to the loss (e.g., thoughts aboutself-blame).

561718
1920
21
22

I had a desire to die in order to be withthe deceased
I felt alone or detached from otherindividuals.
It felt unreal that he/she is deadI put an intense blame on others becauseof his/her death
It felt as if a part of me has died alongwith the deceased
I had difficulties experiencing positive
feelings
SomeAll theFrequently
times
time
(4)
(3)
(5)
© Paul A. Boelen, Geert E. Smid & Lonneke I.M. Lenferink, 2019
Never
(1)

Seldomly(206