A preliminary validation of the traumatic grief inventory-kids-caregiver-report (TGI-K-CR)

Prolonged grief disorder (PGD) is included in the Diagnostic and Statistical Manual of Mental Disorders text-revised fifth edition (DSM-5-TR) and in the International Classification of Diseases Eleventh Edition (ICD-11). While PGD screening instruments exist for adults, these instruments are not applicable to children. Caretakers play a crucial role in screening for PGD in children.

We evaluated the psychometric properties of the Traumatic Grief Inventory-Kids-Caregiver-Report (TGI-K-CR) to screen for DSM-5-TR and ICD-11 PGD in children.

On a website with information about grief, 196 Dutch caregivers (82% woman; Mage = 44) completed questions about their own and their child's (47% girls; Mage = 11; 44% lost a parent) background and loss-related characteristics (77% of deaths resulted from illness). Caregivers completed the TGI-K-CR and a self-report measure about their own PGD intensity. Factor structure and internal consistency of DSM-5-TR and ICD-11 PGD items were examined separately. T-tests and correlation analyses examined whether caregiver-ratings of PGD intensity in children differed as a function of background- and loss-related characteristics. Provisional cut-offs for both criteria sets were determined.

Confirmatory factor analyses showed support for two distinct, but related, factors for DSM-5-TR and ICD-11 PGD items. We found strong internal consistency (ω = .85 for DSM-5-TR; ω = .87 for ICD-11), while some factor loadings were poor. In support of known-groups validity, DSM-5-TR and ICD-11 PGD intensity were higher in children when caregivers reported higher PGD intensity for themselves and when deaths occurred more recently. ROC analyses showed optimal cut-off scores of ≥46 and ≥52 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively, when summing all 16 items.

The psychometric properties of the TGI-K-CR seem promising, but more research among larger samples is needed. This caregiver screening tool for PGD in children (aged 8-18) may advance child bereavement research and care.