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This questionnaire is for people who have experienced the death of a loved one. Please answer each question referring to the past month, considering the loss happened at least 6 months ago.
1.How often have you felt yourself longing or yearning for the person you lost?
2.How often have you had intense feelings of emotional pain, sorrow, or pangs of grief?
3.How often have you tried to avoid reminders that the person is gone?
4.How often have you felt stunned, shocked, or dazed by your loss?
5.Do you feel confused about your role in life or feel like you don't know who you are?
6.Have you had trouble accepting the loss?
7.Have you had trouble trusting others since your loss?
8.Do you feel bitter over your loss?
9.Do you feel that moving on (e.g., making new friends, pursuing new interests) would be difficult now?
10.Do you feel emotionally numb since the loss?
11.Do you feel that life is unfulfilling, empty, or meaningless since your loss?
12.Do you feel dazed or stunned by your loss?
13.Has your grief significantly impaired your social, occupational, or other important areas of functioning?
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