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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.