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PG-13-R Prolonged Grief Test (13 items)

Free PG-13-R Prolonged Grief Disorder Inventory. Prigerson 2021 — the instrument used in the DSM-5-TR field trials. 5 minutes, anonymous, answers.

Last updated: Sources verified:

What you are taking

The PG-13-R is the Prolonged Grief Disorder Inventory, revised by Holly Prigerson and colleagues in 2021 to align with the DSM-5-TR criteria added to the manual in 2022. It is the instrument that was used in the field trials that produced the diagnosis. 13 items: two structured gating items about when the loss happened, then eleven Likert-rated symptom items covering the past month. About 5 minutes. Your answers stay in your browser — we never see them. Start the test below.

  • Validated by Prigerson, Boelen, Xu, Smith and Maciejewski (2021, World Psychiatry)
  • Used in DSM-5-TR field trials for Prolonged Grief Disorder (2022)
  • Anchored to ICD-11 code 6B42 (WHO 2019)
  • 5 minutes, 13 items
  • Private — answers never leave your device

How the score is calculated

You answer two structured items first: how many months ago the loss happened, and whether at least 12 months have passed. These do not contribute to the symptom score — they exist because DSM-5-TR only considers PGD when grief has lasted at least 12 months in adults (6 months in children).

You then answer eleven symptom items rated 1 (“Not at all”) to 5 (“Extremely”), covering the past month: yearning, difficulty accepting the death, feeling as if part of you died, avoidance of reminders, intense emotional pain, difficulty re-engaging with life, emotional numbness, life feeling meaningless, intense loneliness, functional impairment, and whether the grief response feels disproportionate to your cultural or community context.

The eleven items sum to a symptom score between 11 and 55.

Symptom scoreBandWhat it usually means
11-29Below clinical thresholdIntegrated grief — the loss is real and painful, but does not look like Prolonged Grief Disorder right now
30-39Sub-threshold prolonged griefSeveral core symptoms are clinically meaningful but not the full disorder; the band where one specialist conversation often changes trajectory
40-55Likely Prolonged Grief DisorderConsistent with DSM-5-TR PGD in the Prigerson 2021 validation samples; specialist evaluation strongly indicated

If you indicate the loss was less than 12 months ago, the calculator surfaces a contextual warning — the symptom score is still meaningful as a snapshot of how heavy grief is feeling now, but the formal DSM-5-TR diagnostic threshold cannot be met before the 12-month mark.

Prolonged Grief Disorder — what the diagnosis names

DSM-5-TR added Prolonged Grief Disorder in 2022 as a new diagnosis because the existing categories — Major Depression, Adjustment Disorder, PTSD — did not capture this specific pattern and were leading to people not getting the right treatment.

The full DSM-5-TR criteria are:

  • Time: at least 12 months since the loss (6 months in children and adolescents)
  • Core symptom: intense yearning or preoccupation with the deceased, almost daily for at least the past month
  • Additional symptoms: at least 3 of 8 — identity disruption (feeling part of oneself died), disbelief about the death, avoidance of reminders, intense emotional pain, difficulty re-integrating, emotional numbness, life feeling meaningless, intense loneliness
  • Impairment: the grief causes clinically significant distress or impairment in social, occupational or other important areas
  • Cultural context: the duration and severity clearly exceed expected social, cultural or religious norms

PGD is not a measure of how much you loved. It names a specific clinical pattern in which grief stops integrating — where the system gets stuck rather than moving over time.

Normal grief vs Prolonged Grief Disorder

Acute grief in the first months after a loss looks remarkably like PGD on the symptom items — that is the point of the 12-month threshold. The differences only become visible over time.

Acute grief (most adults, first 0-12 months): intense waves of pain, intrusive thoughts about the person, longing, sometimes brief moments of disbelief or seeing/hearing the deceased. Functional impairment that gradually softens. Periods of relief, even joy, between waves.

Integrated grief (most adults, 12+ months): the loss is woven into ongoing life. Waves still come — anniversaries, songs, places — but the rest of life has reclaimed shape and meaning. Yearning persists but is no longer daily and disabling.

Prolonged Grief Disorder (roughly 7-10% of bereaved adults, 12+ months post-loss): yearning and preoccupation remain at near-daily intensity. Identity is disrupted (“a part of me died”). Avoidance of reminders is severe enough to constrict life. Re-engagement with friendships, work, future planning is blocked. Cardiovascular and immune correlates have been documented in longitudinal data.

This is a clinical pattern, not a moral category. Treatment works.

When this test is most useful — and when it isn’t

Useful for:

  • Adults 12+ months past a significant loss who are not sure whether grief is integrating
  • People in the sub-threshold band who want a structured reason to talk to a clinician
  • Repeat measurement over months to see whether grief is moving
  • A document to bring to a GP or therapist visit to give the conversation a starting point

Less useful for:

  • The first year of grief — the symptom items are valid, but the DSM-5-TR threshold does not apply
  • Children under 18 — DSM-5-TR uses a 6-month threshold and PGD presents differently; the PG-13-R was validated in adults
  • Sole reliance for a diagnosis — PG-13-R is a screener; clinical interview is required for a diagnostic decision
  • Cultures with extended formal mourning periods longer than 12 months — interpretation requires context (item 13 helps but does not replace clinical judgement)

Treatments that actually work for PGD

The evidence base for grief-specific treatment is unusually consistent:

  • Complicated Grief Therapy (CGT, Shear) — 16-session protocol combining CBT, interpersonal therapy and prolonged exposure elements. Response rates around 60-70% in randomised trials. The Shear 2016 trial directly compared CGT, citalopram and combined therapy — CGT was the active ingredient.
  • Prolonged Grief Disorder Therapy (PGDT) — closely related to CGT, also 16 sessions, structured around the core PGD criteria.
  • Internet-delivered cognitive behavioural therapy for grief (Boelen / Lenferink, “Grief-Help”) — RCT evidence of meaningful effect. A real option when in-person therapy is not accessible.
  • Bereavement support groups — not therapy, but consistently associated with better adjustment, especially in the sub-threshold band.

Antidepressants alone do not move grief-specific symptoms in trials. If depression is co-occurring (PHQ-9 in the moderate or severe range), the depression component may respond, but the grief work still needs to happen.

If you are in crisis tonight

PGD elevates suicide risk specifically — this is in the longitudinal literature and it is treatable. If thoughts of self-harm or suicide are present, treat them as the priority.

You do not need to be in immediate danger to call. Grief-related suicidal thoughts are exactly what these lines are for.

Sources, verified 2026-05-18

  • Prigerson HG, Boelen PA, Xu J, Smith KV, Maciejewski PK. Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry 2021;20(1):96-106. (PMID 33432758)
  • American Psychiatric Association. DSM-5-TR: Prolonged Grief Disorder. 2022.
  • World Health Organization. ICD-11 6B42 Prolonged grief disorder. 2019.
  • Shear K, Frank E, Houck PR, Reynolds CF. Treatment of complicated grief: a randomized controlled trial. JAMA 2005;293(21):2601-2608. (PMID 15928281)
  • American Foundation for Suicide Prevention. Grief and loss support resources. afsp.org.

Privacy

The PG-13-R calculator runs entirely in your browser. Your answers and the calculated band never leave your device. We send one anonymous event to a privacy-respecting analytics service: your locale code and the band string (e.g. pg13r_below, pg13r_sub, pg13r_likely). No raw answers, no per-item data, no identifier of any kind.

Frequently asked questions

What does a PG-13-R score of 35 mean?
35 sits in the sub-threshold band (30-39). Several core symptoms of Prolonged Grief Disorder are present at a level Prigerson 2021 described as clinically meaningful, but the picture is not yet the full disorder. Roughly half of people in this band move down to integrated grief within 6-12 months; the other half drift upward. This is exactly the band where one conversation with a bereavement-trained clinician most often changes the trajectory.
From what score is it Prolonged Grief Disorder?
40-55 is the band consistent with DSM-5-TR Prolonged Grief Disorder in the Prigerson 2021 validation samples. But the score alone is not the diagnosis — DSM-5-TR also requires that the loss was at least 12 months ago (6 months for children), that yearning or preoccupation has been present almost daily for more than a month, and that grief is causing real functional impairment. The score is a strong signal worth bringing to a clinician, not a verdict.
Why does PG-13-R require at least 12 months since the loss?
Because grief in the first year — even when it is intense, disabling and frightening — usually does not predict whether someone will develop the chronic disorder. Prigerson and colleagues studied trajectories over years and found that the 12-month mark (6 months in children) is when persistent, non-remitting grief reliably separates from acute grief that will eventually integrate. The threshold is conservative on purpose — to avoid medicalising normal early grief.
Does normal grief last a year?
Normal grief does not have a fixed length. Most adults move from acute grief (waves of intense pain, disbelief, preoccupation) toward integrated grief (the loss is woven into life, with smaller waves on anniversaries and triggers) somewhere in the first 12-24 months. Many people carry threads of grief for the rest of their lives. PGD is diagnosed not by length alone but by intensity, daily presence, and functional impairment past the 12-month line.
Sub-threshold (30-39) — what now?
Three things, in this order. First, look at items 6 (avoidance) and 12 (functional impairment) — if those two are high, the case for structured help is stronger. Second, consider a bereavement-trained therapist, especially someone offering Complicated Grief Therapy (CGT, Shear) or Prolonged Grief Disorder Therapy (PGDT) — both are 16-session protocols with the best trial evidence. Third, if therapy is not accessible, an evidence-based grief workbook plus a bereavement support group is a real starting point.
What is Complicated Grief Therapy (CGT)?
CGT is a 16-session protocol developed by Katherine Shear (Shear 2005, JAMA) that combines elements of CBT, interpersonal therapy and prolonged exposure, specifically tailored to grief. It works on the bond with the deceased, on stuck points (avoidance, idealisation, anger), and on gradual re-engagement with life. Response rates in randomised trials are around 60-70% — substantially better than general counselling for this specific syndrome. Ask for it by name.
Do antidepressants help in grief?
For Prolonged Grief Disorder, the trial evidence says no — antidepressants do not move grief-specific symptoms when used alone. If depression also developed (PHQ-9 in the moderate or severe range), the depression component may respond to SSRIs, but the grief-specific symptoms typically need a grief-targeted therapy to shift. The Shear 2016 trial directly compared CGT, citalopram, and the combination — CGT was the active ingredient.
Loss of a partner vs loss of a child — is there a difference?
Yes, in risk. Loss of a child is the single strongest demographic predictor of developing PGD — roughly twice the baseline risk in cohort studies. Sudden, violent or unexpected death (suicide, accident, homicide) also doubles risk. Older bereaved spouses are at elevated risk for the first 6-12 months. PGD itself looks similar across loss types; what differs is the probability of developing it.
PGD or post-loss depression?
They overlap heavily and often co-occur, but they are distinct. Grief is loss-focused — yearning, longing, preoccupation with the person. Depression is self-focused — worthlessness, guilt, anhedonia across the board. The PHQ-9 captures depression; the PG-13-R captures grief. The cleanest signal that grief is the primary process: yearning (item 3) is high, and feelings improve in moments of connection with reminders of the person rather than getting worse.
PGD or PTSD?
Both can follow loss, especially traumatic loss, and they often co-occur. PTSD centres on the threat and the trauma memory — intrusions, hyperarousal, avoidance of trauma cues. PGD centres on the bond and the absence — yearning, preoccupation with the person, identity disruption. When the death was traumatic, PTSD-focused therapy may need to come first (to address the trauma memory), then grief-focused therapy. Combined approaches exist.
Does grief have to end? Is that not anti-religious?
No, grief does not have to end, and treating PGD is not about ending grief. The goal of evidence-based grief therapy is functional reintegration — that you can hold the loss, honour the relationship, and still live a life that has meaning, contact and forward motion. Many religious and cultural traditions (Catholic month's mind, Jewish shloshim, Hindu shraddha, Islamic 40-day mourning) explicitly recognise an extended mourning period — what PGD names is the failure of grief to integrate, not the persistence of mourning itself.
What if I have suicidal thoughts?
Treat that as the priority above the test. PGD elevates suicide risk specifically — this is in the longitudinal data and it is treatable. In the US, call or text 988 (Suicide & Crisis Lifeline). In the UK, Samaritans 116 123, free, 24/7. Tell someone today — a partner, a friend, your GP, or the line. The shame around grief-related suicidal thoughts is itself a reason the literature says to lower the bar for calling, not raise it.
When should I see a therapist?
Three signals, any one is enough: (1) it has been more than 12 months and yearning/preoccupation are still daily and disabling, (2) grief is significantly impairing work, relationships or self-care, (3) suicidal thoughts. You do not need a high score to see a therapist for grief — you need it to feel like the right step. Most bereavement therapists will tell you in the first session whether structured grief therapy is indicated.
Can the test be wrong?
The PG-13-R is a screener, not a diagnostic interview. False positives happen around anniversaries or shortly after additional losses. False negatives happen when someone has emotionally numbed and stopped registering the symptoms. The test also does not capture culturally normative extended mourning — item 13 partly accounts for this, but a clinician's interpretation of context matters. Retake the inventory in 4-8 weeks if the result feels off.
Is the data private?
Yes. The PG-13-R calculator runs entirely in your browser. Your answers and the calculated band never leave your device. We send one anonymous event to a privacy-respecting analytics service: your locale code and the band string (e.g. `pg13r_below`, `pg13r_sub`, `pg13r_likely`). No raw answers, no per-item data, no identifier of any kind.

Sources

  1. Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale — Prigerson HG, Boelen PA, Xu J, Smith KV, Maciejewski PK — World Psychiatry (2021) (peer reviewed, retrieved 2026-05-18)
  2. Prolonged Grief Disorder — DSM-5-TR — American Psychiatric Association (2022) (guideline, retrieved 2026-05-18)
  3. ICD-11 6B42 Prolonged grief disorder — World Health Organization (2019) (guideline, retrieved 2026-05-18)
  4. Treatment of complicated grief: a randomized controlled trial — Shear K, Frank E, Houck PR, Reynolds CF — JAMA (2005) (peer reviewed, retrieved 2026-05-18)
  5. American Foundation for Suicide Prevention — grief and loss support resources — AFSP (medical society, retrieved 2026-05-18)