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    • Our Therapists
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  • Resources for Parents/
    • Death of a child due to an accident
    • Stillbirth or loss of a pregnancy
    • Miscarriage and Unsuccessful IVF
    • Death of a child due to illness
    • Death of a child as a result of suicide
    • Men and Grief
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    • For Referrers
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Penthos

Growth Through Grief

Screener

Penthos
  • HOME/
  • About/
    • The Penthos Program
    • Our Therapists
    • Program Team
    • The Board
  • Resources for Parents/
    • Death of a child due to an accident
    • Stillbirth or loss of a pregnancy
    • Miscarriage and Unsuccessful IVF
    • Death of a child due to illness
    • Death of a child as a result of suicide
    • Men and Grief
  • How to Access Therapy/
    • For Couples
    • For Referrers
  • Donate/
  • Contact/

Prolonged Grief Disorder (PG - 13)

Holly G. Prigerson, Ph.D., Paul K. Maciejewski, Ph.D.
Copyright - not to be reproduced without the permission of the authors

Option 1: Complete the online questionnaire below and submit. You will receive an email with the score within 2 business days.

Option 2: Click here for the printable PDF of the questionnaire. Once complete, access ‘How To Score’ information via the following password protected link. If you don’t already have the password, contact susie@penthos.org.au.

 
Name *
PART 1
For each item, place a check mark to indicate your answer.
1. In the past month, how often have you felt yourself longing or yearning for the person you lost? *
2. In the past month, how often have you had intense feelings of emotional pain, sorrow, or pangs of grief related to the lost relationship? *
3. For questions 1 or 2 above, have you experienced either of these symptoms at least daily and after 6 months have elapsed since the loss? *
4. In the past month, how often have you tried to avoid reminders that the person you lost is gone? *
5. In the past month, how often have you felt stunned, shocked, or dazed by your loss? *
PART 2
For each item, please indicate how you currently feel. Select the number to indicate your answer.
6. Do you feel confused about your role in life or feel like you don't know who you are (i.e., feeling that a part of yourself has died)? *
7. Have you had trouble accepting the loss? *
8. Has it been hard for you to trust others since your loss? *
9. Do you feel bitter over your loss? *
10. Do you feel that moving on (e.g. making new friends, pursuing new interests) would be difficult for you now? *
11. Do you feel emotionally numb since your loss? *
12. Do you feel that life is unfulfilling, empty, or meaningless since your loss? *
PART 3
Place a check mark to indicate your answer below.
13. Have you experienced a significant reduction in social, occupational, or other important areas of functioning (e.g., domestic responsibilities) *

Thank you for completing the questionnaire. Penthos will contact you within 2 business days.

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