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Brief Grief Questionnaire

SUMMARY

1. How much are you having trouble accepting the death of ______________?

Not at all............... 0               Somewhat..............1               A lot...................... 2

 

2. How much does your grief still interfere with your life?

Not at all............... 0               Somewhat..............1               A lot...................... 2

 

3. How much are you having images or thoughts of _____________ when s/he died or other thoughts about the death that really bother you?

Not at all............... 0               Somewhat..............1               A lot...................... 2

 

4. Are there things you used to do when ______ was alive that you don’t feel comfortable doing anymore, or that you avoid?  Like going somewhere you went with him/her, or doing things you used to enjoy together?  Or avoiding looking at pictures or talking about _________?  How much are you avoiding these things?

Not at all............... 0               Somewhat..............1               A lot...................... 2

 

5. How much are you feeling cut off or distant from other people since _________ died, even people you used to be close to like family or friends?

Not at all............... 0               Somewhat..............1              A lot...................... 2

 

A score of 4 or more suggests an individual may have complicated grief.

(M.K. Shear, personal communication, January 2014).

Refer the individual to a grief specialist for further evaluation.

 

* Developed by M. Katherine Shear MD and Susan Essock PhD.  Included with permission.



Keywords:
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Doc ID:
150660
Owned by:
Sara A. in Osher Center for Integrative Health
Created:
2025-05-12
Updated:
2025-05-23
Sites:
Osher Center for Integrative Health