Bereavement Assessment Tools

Your client's grief looks severe — but is it clinically severe, or are you witnessing normal acute grief that will self-correct? Your gut feeling won't satisfy a licensing board, an insurance reviewer, or a malpractice attorney. You need validated instruments with published cutoff scores, and you need to know when to use which one.

The Core Assessment Battery

Brief Grief Questionnaire (BGQ). Your intake screener. Five items, two minutes, scored 0–10 on a three-point Likert scale. A score of 4 or above flags the need for a comprehensive assessment. Use this with every grief client at first contact — it costs nothing, takes almost no session time, and creates a documented triage decision.

Inventory of Complicated Grief (ICG). The standard 19-item self-report for clinically significant complicated grief. Each item is rated 0 (never) to 4 (always), with total scores ranging from 0 to 76. A cutoff of 25 or higher suggests clinically significant complicated grief and supports comprehensive assessment; it does not establish PGD by itself. Use the ICG when the intake screen or clinical picture indicates a need for a grief-specific assessment. It measures yearning-focused sorrow, intrusive thoughts, disbelief, anger, and somatic experiences — grief-specific dimensions that depression screeners miss entirely.

Prolonged Grief Disorder-13-Revised (PG-13-R). Aligned directly with DSM-5-TR diagnostic criteria. Thirteen items measuring separation distress, symptom frequency, and functional impairment. A total symptom score of 30 or above, combined with the DSM-5-TR time threshold (at least 12 months for adults, 6 months for minors) and confirmed functional impairment, indicates probable PGD. This is your diagnostic-precision tool — use it when you need a defensible basis for a PGD diagnosis.

Adult Attitude to Grief Scale (AAG). Nine items mapping onto the Range of Response to Loss model, assessing three coping dimensions: Overwhelmed, Controlled, and Resilient. The tool calculates an Index of Vulnerability (IOV) — scores of 20 or below indicate low vulnerability, 21–23 high vulnerability, and 24+ severe vulnerability. Use this to understand your client's coping profile and tailor your therapeutic approach accordingly.

Choosing the Right Tool at the Right Time

The instruments serve different clinical purposes, and timing determines their utility:

At intake (day 1): Administer the BGQ. It takes two minutes; a score of 4 or above indicates the need for a comprehensive assessment, while a lower score does not replace clinical judgment.

At three to six months post-loss: If the BGQ flagged risk, administer the ICG for a comprehensive baseline. Document the score and connect it to your treatment plan.

At follow-up intervals: Re-administer the ICG to track trajectory. A score that's stable or rising signals a grief response that isn't self-correcting.

At twelve months for adults (or six months for minors): If the clinical picture warrants, administer the PG-13-R for formal PGD diagnostic evaluation. This is when the DSM-5-TR temporal threshold opens.

Supplementary Scales Worth Knowing

The core battery above covers screening, severity, and diagnosis. Three supplementary tools address specific clinical questions:

Grief Impairment Scale (GIS) evaluates functional deficits in occupational and social roles — useful when you need to document medical necessity for insurance authorization.

Texas Revised Inventory of Grief (TRIG) contrasts initial post-death reactions with current emotional status, revealing whether the grief response is integrating or freezing.

Grief Support Inventory (GSI) maps the client's natural interpersonal support network, helping identify gaps in available support.

Diagnostic Differentiation: Why It Matters

Assessment tools are only as useful as the diagnostic thinking behind them. PGD, Major Depressive Disorder, and PTSD can co-occur, and each requires different treatment.

The distinguishing feature of PGD is yearning-focused sorrow with loss-specific avoidance. MDD presents with generalized anhedonia and self-critical rumination. PTSD shows threat-based flashbacks and hyperarousal. A client who avoids the cemetery because it triggers intense longing (PGD) needs a different intervention than one who avoids it because it triggers survival-fear flashbacks (PTSD).

PGD is also pharmacologically distinct: core separation distress symptoms are unresponsive to antidepressant monotherapy, unlike MDD. Misdiagnosing PGD as depression can result in months of ineffective medication trials while the grief remains untreated.

Building Assessment into Your Workflow

Add assessment scores to every progress note. "ICG score 34 at baseline (2026-01-15), 29 at 30-day reassessment (2026-02-15), currently 22 at 90-day reassessment (2026-04-15). Downward trend supports continued treatment with CGT Phase III integration work."

This documentation pattern serves three purposes: it guides your clinical decisions, it demonstrates evidence-based practice to insurers and reviewers, and it creates a defensible record if your work is ever audited.

The Therapist's Grief Counseling Framework includes the complete assessment battery structure with scoring guides, administration protocols, and progress note templates that integrate screening results directly into your treatment documentation.