Validation of the Ukrainian Prolonged Grief Assessment for Children (PGA-C) in a Wartime Context

Prolonged grief reactions in children and adolescents are linked to marked emotional distress, social withdrawal, academic disruption, and impaired daily functioning. These difficulties may be intensified in contexts of chronic threat and instability, such as the ongoing war in Ukraine, where bereavement is widespread and support systems are disrupted. Valid, culturally adapted assessment tools are essential for identifying youth experiencing clinically significant grief responses. This study aimed to adapt and validate the Ukrainian version of the Prolonged Grief Assessment for Children (PGA-C) in a sample of bereaved young people living under wartime conditions.

A total of 129 bereaved children and adolescents (63.6% female; M age = 12.1, SD = 3.14) completed structured interviews. Analyses included descriptive statistics, internal consistency (Cronbach's α), test-retest reliability over 4-5 weeks (ICC), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity testing, and regression analyses. Convergent/divergent validity was examined through associations with PTSD symptoms (CRIES-8), anxiety and depression (RCADS-25), and health-related quality of life (KIDSCREEN-27).

Internal consistency was excellent for the total PGA-C scale (α = 0.92) and strong for both identified factors (α = 0.89 and 0.88). Test-retest reliability was high (ICC = 0.88, 95% CI [0.82-0.91], p < 0.001). PGA-C scores showed strong negative associations with quality of life (r = -0.622, 95% CI [- 0.729, -0.488]) and positive associations with depression (r = 0.480, 95% CI [0.330-0.620]) and PTSD symptoms (r = 0.438, 95% CI [0.273-0.585]). Correlations of PTSD (r = -0.333, 95% CI [-0.483, -0.162]) and depression (r = -0.350, 95% CI [-0.500, -0.190]) with components of quality of life were clearly weaker than those of PGA-C. No significant differences in PGA-C scores were found for sex, age, relationship to the deceased, or cause of death. EFA of the PGA-C supported a two-factor structure - Detachment/Avoidance and Yearning/Disbelief, yet CFA of the PGA-C showed limited fit of the data to this model (CFI < 0.90, RMSEA > 0.10). Strong internal consistency of the total scale and its concurrent/divergent validity support the use of the PGA-C total score.

The Ukrainian PGA-C demonstrates excellent internal consistency, strong test-retest reliability, and robust convergent and divergent validity. Findings support its use as a reliable tool for assessing prolonged grief among bereaved children and adolescents living in high-adversity wartime contexts.