Perinatal Grief Scale (PGS)

Abstract

The Perinatal Grief Scale (PGS) is a widely utilized psychological instrument designed to quantitatively measure the intensity and specific dimensions of grief experienced by parents following a perinatal loss, such as miscarriage, stillbirth, or neonatal death. Developed by Toedter, Lasker, and Alhadeff in 1988, the original scale comprises 33 items rated on a 5-point Likert scale. It provides a robust measure of the multifaceted nature of grief, typically yielding scores across three primary factors: Active Grief, Difficulty Coping, and Despair. The PGS has been instrumental in clinical practice and research globally, facilitating the study of maternal and paternal bereavement processes.

Keywords

Perinatal Grief Scale, PGS, perinatal loss, pregnancy loss, stillbirth, miscarriage, grief, bereavement, psychological assessment, neonatal death.

Authors

L. J. Toedter, J. N. Lasker, J. M. Alhadeff, L. Potvin.

[quads id=5]

Purpose

The primary purpose of the Perinatal Grief Scale (PGS) is to provide researchers and clinicians with a reliable and valid tool for assessing the severity and manifestation of grief reactions specific to the experience of perinatal or neonatal death. It helps differentiate typical grief responses from more complex or pathological reactions that may require intervention, thereby guiding clinical support strategies.

By quantifying the dimensions of bereavement, the PGS allows for longitudinal studies of the grieving process, comparison of grief responses between mothers and fathers, and evaluation of the effectiveness of support interventions aimed at bereaved parents. Its structured format ensures consistency in data collection across various clinical and research settings focused on perinatal loss.

Construct

The PGS is designed to measure the psychological construct of perinatal grief, which is understood as a multidimensional reaction to the loss of a pregnancy or newborn child. The full 33-item scale operationalizes this construct through three empirically derived subscales, reflecting distinct aspects of the bereavement experience:

• Active Grief: This factor measures the acute emotional pain, preoccupation with the loss, and the intense yearning or missing of the baby.
• Difficulty Coping: This factor assesses functional impairment, disruption of daily activities, challenges in interpersonal relationships, and the general inability to manage the overwhelming stressor of the loss.
• Despair: This factor captures severe emotional distress, including feelings of hopelessness, guilt, worthlessness, self-blame, existential fears, and pronounced depressive symptoms associated with the death.

Validity

Initial validation studies conducted by Toedter, Lasker, and Alhadeff (1988) demonstrated strong evidence for the construct validity of the PGS, confirming that the scale accurately measures the intended dimensions of perinatal grief. The establishment of the three-factor structure (Active Grief, Difficulty Coping, Despair) supports its theoretical foundation regarding the complexity of grief.

The scale has also shown high concurrent validity, correlating significantly with other established measures of depression and general psychological distress among bereaved populations. Furthermore, the PGS exhibits good discriminant validity, successfully distinguishing between parents who have experienced perinatal loss and non-bereaved control groups, confirming its ability to measure the specific phenomenon of grief following infant death.

Reliability

The Perinatal Grief Scale demonstrates excellent internal consistency, a key measure of reliability. Across numerous studies and international comparisons, the overall scale typically yields high Cronbach’s alpha coefficients, often exceeding 0.90, indicating that the items cohesively measure a unified construct of grief.

The individual subscales—Active Grief, Difficulty Coping, and Despair—also show strong internal consistency, confirming their distinct yet reliable measurement properties. Test-retest reliability has generally been found to be adequate, suggesting stability of measurement over time, particularly when administered consistently within the initial period of bereavement.

Factor Analysis

Exploratory factor analysis (EFA) performed during the scale’s development identified a robust three-factor structure, which accounts for a significant portion of the variance in reported grief symptoms. These factors are consistently identified as Active Grief, Difficulty Coping, and Despair. This structure is crucial for clinical interpretation, allowing practitioners to identify which specific aspect of grief is most prominent for the individual parent.

The factor structure has been replicated across various cultures and different types of pregnancy loss, confirming its cross-cultural stability and utility in research. The assignment of specific items to these factors (e.g., feelings of guilt loading onto Despair, and difficulty maintaining routine activities loading onto Difficulty Coping) provides a clear, empirically supported framework for understanding the multidimensional nature of perinatal loss.

Instrument

Test Type: Self-report psychometric scale.

Format: 33 items (long version) or 17 items (short version). Responses utilize a 5-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree).

Language Available: English, with validated translations widely available for international research.

Population Group: Parents (both maternal and paternal) who have experienced perinatal loss or neonatal death.

Age Group: Adults (typically reproductive age parents).

Population Details: Specifically designed for individuals coping with the loss of a baby through miscarriage, stillbirth, or death shortly after birth.

Test Methodology: Administration is typically via paper-and-pencil or digital self-administration. Scoring involves summing item responses, with items 11 and 32 being reverse-scored. Higher total scores indicate greater intensity of grief.

Keywords

Active Grief, Difficulty Coping, Despair, Toedter, Lasker, stillbirth, infant loss, psychological measurement, bereavement.

[quads id=5]

Authors

Author ORCID Identifier: N/A (Information not provided in source material).

Affiliation Email addresses: N/A (Information not provided in source material).

Correspondence Address: N/A (Information not provided in source material).

Permissions & Fee and Test Year

The Perinatal Grief Scale (PGS) was originally published and validated in 1988. While the scale is frequently used in academic research and published freely in various sourcebooks, specific permissions and associated fees for commercial or large-scale clinical use should be sought directly from the primary authors (L. J. Toedter or J. N. Lasker) or the journal publisher. The instrument is highly accessible for non-commercial research purposes.

Reference’s

The original instrument details can be found in academic sourcebooks and journals. The ResearchGate publication link is provided here for reference:

https://www.researchgate.net/publication/227027205

• Fischer, Joel, & Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY: Oxford University Press. Vol. 1, Page(s): 405-406.
• 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.
• 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 Press. Vol. 1, Page(s): 405-406.
• 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.
• 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.

[quads id=5]

Items of the Perinatal Grief Scale (PGS)

Scoring Range: 1= Strongly Disagree, 2= Disagree, 3= Neither Agree nor Disagree, 4=Agree, 5= Strongly Agree

The 33 items of the Perinatal Grief Scale are as follows:

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
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 Breakdown:

• 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.