Assessment of grief-related rumination: validation of the German version of the Utrecht Grief Rumination Scale (UGRS)

Bettina K Doering,Maarten C Eisma,Antonia Barke,Thilo Friehs

doi:10.1186/s12888-018-1630-1

Bettina K Doering, Maarten C Eisma + Show 2 more

Open Access

https://doi.org/10.1186/s12888-018-1630-1

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Abstract

BackgroundBereavement can result in severe mental health problems, including persistent, severe and disabling grief symptoms, termed complicated grief. Grief rumination (i.e., repetitive thought about the causes and consequences of the loss) is a malleable cognitive risk-factor in adjustment to bereavement. The Utrecht Grief Rumination Scale (UGRS) was recently developed to assess grief rumination. The present study aimed to develop and validate a German version of the UGRS.MethodsAn online survey including measures of demographic and loss-related variables, grief rumination (UGRS), depressive rumination (brooding and reflection), and symptoms of depression, anxiety, and complicated grief, was administered online among 159 persons (87% women) who had lost a first-degree relative in the past three years. UGRS item analyses, a confirmatory factor analysis and associations of grief rumination with brooding, reflection and symptom levels were performed.ResultsThe internal consistency of the UGRS was good. The confirmatory factor analysis obtained a good fit for a model with five correlated grief rumination subscales. The UGRS contributed uniquely to the prediction of complicated grief symptoms even when controlling for symptoms of anxiety and depression, brooding, reflection, and demographic and loss-related variables. Discriminant validity of the UGRS was demonstrated by the fact that higher UGRS scores were found in participants with a higher likelihood of receiving a diagnosis of complicated grief (d > 1.60).ConclusionThe translated UGRS showed very good psychometric properties and the correlations with maladaptive ruminative styles and complicated grief symptoms demonstrated the clinical relevance of grief rumination. Limitations concerning generalisability of the results are discussed.

Highlights

Bereavement can result in severe mental health problems, including persistent, severe and disabling grief symptoms, termed complicated grief
Associations between the Utrecht Grief Rumination Scale (UGRS) and symptoms of anxiety and depression, which are often present concurrently in persons who suffer from complicated grief [43], were significant, yet the level of the associations differed significantly: grief rumination was more closely associated with disabling grief than with symptoms of depression or anxiety, providing a first indication of the UGRS’s discriminant validity
Further knowledge about the role of grief rumination may benefit the optimal treatment of patients who suffer from complicated grief: if grief rumination is an avoidance strategy (RAH [10]), psychotherapy should be tailored to address it, for instance by using exposure therapy

Summary

Introduction

Bereavement can result in severe mental health problems, including persistent, severe and disabling grief symptoms, termed complicated grief. A minority of bereaved people, suffer from persistent grief symptoms of clinical relevance that are accompanied by functional impairment. The present article will use the wellestablished term ‘complicated grief ’ to refer to clinically relevant grief symptomatology, since the present assessment of grief symptoms follows the Inventory of Complicated Grief [6]. This allows for drawing on existing research of grief rumination and bereavement outcome

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