The Traumatic Grief Inventory-Self Report plus (TGI-SR+)

ManualIntroduction
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) persistentcomplex bereavement disorder as described in the DSM-5 (APA, 2013), (ii) prolonged griefdisorder 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 griefdisorder as 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-CA
item

Persistent Complex
Bereavement
Disorder DSM-5(APA, 2013)

ProlongedgriefdisorderDSM-5-TR(APA,2020)

Prolonged griefdisorder ICD-11(WHO, 2018)

Prolonged grief disorder
Prigerson et al. (2009)

1

B3

B2

B2

2

B2

C4*

C13

B1

B1

B1

4C115

C16C67C88C4C4*

C3C59C12C5C10C610C2C6C9C711C10C7B1C1C6C3C2C3C4C812C913D14B4DEE115C316C517C718C919C2C8C2202122C4C5C1C7C8Note. *These symptoms were assessed with two items. Highest score of one of
the two items is used to tap the symptom.

TGI-SR vs. TGI-SR+
This survey was developed in 2019 and based on the 18-item self-report questionnaire theTraumatic Grief Inventory-Self Report (TGI-SR) (Boelen & Smid, 2017; Boelen, Djelantik, deKeijser, Lenferink, & Smid, 2018). The 18 items of the TGI-SR are identical to items 1 through18 of the TGI-SR+. Four items (item 19 through 22) were added to assess symptoms ofprolonged grief disorder according to ICD-11 (WHO, 2018). With the advent of prolonged
grief disorder in the DSM-5-TR (2020), TGI-SR items were mapped 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 firstvalidation 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 apersistent complex bereavement disorder or prolonged grief disorder. A score of 4 or 5 on an
item is indicative of presence of that particular grief symptom.
To meet DSM-5 criteria of persistent complex bereavement disorder at least 1 symptom of
the B criterion, at least 6 symptoms of the C criterion, and the symptom of the D criterion
needs to be present.

2For DSM-5 prolonged grief criteria, the following scoring rule is used: at least one symptom of
the B 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 beapplied; the liberal scoring rule, as mentioned by Killikelly and Maercker (2018), that proposes
the presence of at least 1 symptom of the B criterion, at least 1 symptom of the C criterion,
and the E criterion that suggest presence of prolonged grief disorder or the conservative
scoring rule, as stated by Boelen et al. (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 grief disorder.
To adhere to the criteria for prolonged grief disorder as proposed by Prigerson et al. (2009)
the following scoring rule is used: presence of the B criterion, at least 5 symptoms of the C
criterion, and the E criterion.

References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders(5th ed.). 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 ofpersistent 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 disorder and 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 clinicalutility 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). Validmeasurement of DSM-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 ICD-11. PLOS Medicine 6(8), e1000121.
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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+)
Below several grief reactions are listed. Please indicate how often you have experienced each reaction in thepast month in response to the death of your loved one.
never rarely

sometimes

frequently

always

I had intrusive thoughts or images related to the person who
1 died2 I experienced intense emotional pain, sadness, or pangs of grief
3 I found myself longing or yearning for the person who died
I experienced confusion about my role in life or a diminished4 sense of self
5 I had trouble accepting the loss
I avoided places, objects, or thoughts that reminded me that
6 the person I lost has died
7 It was hard for me to trust others
8 I felt bitterness or anger related to his/her death
I felt that that moving on (e.g., making new friends, pursuing
9 new interests) was difficult for me
10 I felt emotionally numb
11 I felt that life is unfulfilling or meaningless without him/her.
12 I felt stunned, shocked, or dazed by his/her death.
I noticed significant reduction in social, occupational, or otherimportant areas of functioning (e.g., domestic responsibilities)
13 as a result of his/her death
I had intrusive thoughts and images associated with the
14 circumstances of his/her deathI experienced difficulty with positive reminiscing about the lost
15 person
I had negative thoughts about myself in relation to the loss
16 (e.g., thoughts about self-blame)
17 I had a desire to die in order to be with the deceased
18 I felt alone or detached from other individuals.
19 It felt unreal that he/she is dead
20 I put an intense blame on others because of his/her death
21 It felt as if a part of me has died along with the deceased
22 I had difficulties experiencing positive feelings

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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