27 PCN Complicated Grief Questionnaire

Likert scale for each question:

• 0: not at all
• 1: somewhat
• 2: a lot

1. How much of the time are you having trouble accepting the death of a loved one?
2. How much does your grief interfere with your life?
3. How much are you having images or thoughts of your loved one when he or she died or other thoughts about the death that really bother you?
4. Are there things that you used to do when your loved one was alive that you don’t feel comfortable doing any more, that you avoid? How much are you avoiding these things?
5. How much are you feeling cut off or distant from other people since your loved one died, even people you used to be close to, like family or friends?

Score of 5 or greater: consider referral/evaluation/intervention

Duration of symptoms 6-12 months after death