Perinatal Grief Scale (PGS)

Abstract

The Perinatal Grief Scale (PGS) is a robust and widely utilized psychometric instrument designed to quantify the multidimensional experience of grief following a pregnancy loss, stillbirth, or neonatal death. Developed by Potvin, Lasker, and Toedter in the late 1980s, the scale addresses the unique psychological distress associated with perinatal loss, which often goes unrecognized or inadequately assessed by general grief measures. The PGS comprises 33 items rated on a 5-point scale and is structured around three key factors: Active Grief, Difficulty Coping, and Despair, providing clinicians and researchers with a nuanced profile of parental bereavement.

Keywords

Perinatal Grief Scale, PGS, Perinatal loss, Stillbirth, Miscarriage, Parental bereavement, Active Grief, Despair, Psychometric instrument, Neonatal death.

Authors

Potvin, Louise; Lasker, Judith N.; Toedter, Lori J.

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Purpose

The primary purpose of the Perinatal Grief Scale is to provide a standardized, sensitive, and specific measure for assessing the intensity and specific domains of grief experienced by parents following the death of an infant or fetus. Before the PGS, many clinical assessments relied on general instruments that failed to capture the unique features of loss experienced during the perinatal period, such as feelings of self-blame, yearning for the baby, and difficulty integrating the loss into daily life.

By measuring distinct dimensions of the grieving process, the PGS serves as a crucial tool for identifying individuals who may be experiencing complicated or prolonged grief reactions that necessitate professional intervention. It is extensively used in research settings to study the trajectory of bereavement and evaluate the efficacy of support programs designed for bereaved parents.

Construct

The PGS measures the psychological construct of perinatal grief, conceptualized as a distinct multidimensional response encompassing emotional, cognitive, and behavioral reactions to the loss of a pregnancy or newborn. This construct is delineated into three interdependent yet separable factors that together capture the full spectrum of the bereavement experience.

These dimensions—Active Grief, Difficulty Coping, and Despair—reflect different facets of adjustment following the loss. Active Grief focuses on the acute pain and missing of the child, while Difficulty Coping addresses functional impairment and social isolation. Despair captures the more severe, often depressive, elements of the loss, including feelings of worthlessness and hopelessness about the future. The scale’s structure supports the understanding that perinatal bereavement is a complex process that cannot be reduced to a single score.

Validity

The initial validation studies conducted by Toedter, Lasker, and Alhadeff (1988) confirmed the strong content and construct validity of the PGS. The items were derived from extensive clinical interviews with bereaved parents, ensuring that the scale accurately reflects the lived experience of perinatal loss. Subsequent research across various cultures and demographics has consistently supported the scale’s construct validity.

Specifically, the PGS has demonstrated high concurrent validity, showing expected correlations with measures of general psychological distress (such as depression and anxiety), while simultaneously retaining discriminant validity by demonstrating that it measures the specific construct of grief rather than generalized mood disorders. The scale’s ability to differentiate between parents at different stages of bereavement further strengthens its clinical utility and validity.

Reliability

The Perinatal Grief Scale is recognized for its excellent internal consistency. Across numerous studies and languages, the full 33-item scale typically yields high Cronbach’s alpha coefficients, often exceeding 0.90 for the total score, indicating that the items reliably measure the unified construct of grief. The three subscales (Active Grief, Difficulty Coping, and Despair) also exhibit strong internal consistency, demonstrating homogeneity within their respective factors.

Furthermore, test-retest reliability has been established, confirming the stability of the PGS scores over relevant periods, particularly when administered in the months following the loss. This stability is critical for research tracking the natural course of bereavement and assessing therapeutic outcomes.

Factor Analysis

Initial exploratory factor analysis conducted during the development phase identified a stable three-factor structure, which is central to the theoretical model of the PGS. This structure has been largely replicated across international studies, supporting its cross-cultural applicability. The three factors, each comprising 11 items, are:

• Active Grief: This factor measures the immediate, intense emotional and behavioral reactions, including yearning, crying, and preoccupation with thoughts of the baby.
• Difficulty Coping: This factor assesses the parent’s functional impairment, social withdrawal, problems with decision-making, and general difficulty in managing daily responsibilities and relationships.
• Despair: This factor reflects feelings of hopelessness, profound sadness, self-blame, guilt, and symptoms often associated with clinical depression stemming from the loss.

The scoring methodology requires the adjustment of two items (11 and 32) which are reverse-scored to mitigate response bias, ensuring accurate measurement across all three dimensions.

Instrument

Test Type: Self-report psychometric scale.

Format: 33 items utilizing a 5-point Likert scale, ranging from 1= Strongly Disagree to 5= Strongly Agree. There is also a validated short version available (Potvin, Lasker, Toedter, 1989).

Language Available: English (original), French, Dutch, Spanish, and numerous other translations used in international studies.

Population Group: Bereaved parents (Mothers and Fathers).

Age Group: Adults (typically reproductive age).

Population Details: Individuals who have experienced fetal death, stillbirth, miscarriage, or neonatal loss.

Test Methodology: Administration is typically via paper-and-pencil or electronically. Scoring involves summing the responses for all 33 items (after reversing items 11 and 32) to obtain a total grief score, as well as calculating separate scores for the Active Grief, Difficulty Coping, and Despair subscales.

Keywords

Psychological assessment, Bereavement, Neonatal death, Stillbirth, Active Grief, Difficulty Coping, Despair, Potvin, Lasker, Toedter, Likert scale.

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Authors

Author ORCID Identifier: Information not provided in the source material.

Affiliation Email addresses: Information not provided in the source material.

Correspondence Address: Correspondence regarding the scale is typically directed toward the primary authors, Judith N. Lasker (Lehigh University) or Lori J. Toedter (Moravian College), or via the journal publishing the original articles.

Permissions & Fee and Test Year

The Perinatal Grief Scale was initially published in 1988 (validation) and 1989 (short version). While often used freely for non-commercial academic research, users requiring formal clinical application or large-scale studies are advised to contact the original authors or the publishers of the relevant journal articles (e.g., American Journal of Orthopsychiatry or Journal of Psychopathology and Behavioral Assessment) for explicit permissions and fee structures, if applicable. The instrument documentation is accessible through academic repositories.

Reference’s

The instrument documentation referenced in the source content can be found here: https://www.researchgate.net/publication/227027205

• Toedter, L. J., Lasker, J. N., & Alhadeff, J. M. (1988). The Perinatal Grief Scale: Development and initial validation. American Journal of Orthopsychiatry, 58(3), 435-449.
• Potvin, Louise., Lasker, Judith., Toedter, Lori. (1989). Measuring grief: A short version of the perinatal grief scale. Journal of Psychopathology and Behavioral Assessment, 11(1), 29–45.
• Toedter, L. J., Lasker, J. N., & Janssen, E. M. (2001). International comparison of studies the perinatal grief scale: A decade of research on pregnancy loss. Death Studies, 25(3), 205-228.
• Potvin, Laskar, Toediter. (1989). Perinatal Grief Scale (PGS). In Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page (s): 405-406.

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Items of the Perinatal Grief Scale (PGS)

Instructions: Respondents rate their agreement using a 5-point scale where 1= Strongly Disagree, 2= Disagree, 3= Neither Agree nor Disagree, 4=Agree, 5= Strongly Agree.

1. I feel depressed
2. I find it hard to get along with certain people
3. I take medicine for my nerves
4. I feel empty inside
5. I can’t keep up with my usual activities
6. I feel guilty when I think about the baby
7. I feel a need to talk about the baby
8. I have considered suicide since the loss
9. I feel physically ill when I think about the baby
10. I am grieving for the baby
11. I have considered suicide since the loss (Note: This item is duplicated in the source content.)
12. I feel unprotected in a dangerous world since he/she died
13. I am frightened
14. I have let people down since the baby died
15. I try to laugh but nothing seems funny anymore
16. I very much miss the baby
17. I get cross at my friends & relatives more than I should
18. The best part of me died with the baby
19. It is painful to recall memories of the loss
20. Sometimes I feel like I need a professional counselor to help me get my life together again
21. I blame myself for the baby’s death
22. I get upset when I think about the baby
23. I feel as though I am just existing and not really living since he/she died
24. I feel worthless since he/she died
25. I cry when I think about him/her
26. I feel somewhat apart and remote even among friends
27. It is safer not to love
28. Time passes so slowly since the baby died
29. I find it difficult to make decisions since the baby died
30. I worry about what my future will be
31. I feel so lonely since he/she died
32. It feels great to be alive
33. Being a bereaved parent means being a second class citizen

Subscale Item Distribution:

• Active Grief items: 1, 4, 7, 10, 13, 16, 19, 22, 25, 28, and 31
• Difficulty coping items: 2, 5, 8, 11, 14, 17, 20, 23, 26, 29, and 32
• Despair items: 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, and 33
• Reverse-scored items: 11 & 32