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Trauma, Bereavement and Grief

Topic leader: Geert Smid

Please contact the topic leader if you would like to initiate new projects or have other ideas about global collaboration related to this topic. You can also directly submit your project proposal here.


Trauma, Bereavement and Grief Network

Project leader: Geert Smid, University of Humanistic Studies, Utrecht, and ARQ National Psychotrauma Centre, Diemen, the Netherlands

Project group: Geert E. Smid, University of Humanistic Studies, Utrecht, and ARQ National Psychotrauma Centre, Diemen, the Netherlands

Paul A. Boelen, Utrecht University, Utrecht, and ARQ National Psychotrauma Centre, Diemen, the Netherlands

Hannah Comtesse, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany

Simon Groen, De Evenaar, GGZ Drenthe, The Netherlands

Lonneke I.M. Lenferink, University of Twente, University of Groningen, and Utrecht University

Clare Killikelly, University of Zurich, Zürich, Switzerland


Join the network!

Would you like to hear more about a project or explore collaboration opportunities? Please contact the contact persons for each project (see below) or Geert Smid.


Traumatic Grief Inventory-Self Report Plus (TGI-SR+)


Project leader Lonneke Lenferink, Twente University, the Netherlands

Collaborate: Further translations and validation studies are welcome. If interested contact Lonneke Lenferink.

The TGI-SR+ is a 22-item measure to assess prolonged grief disorder as defined in ICD-11 and DSM-5-TR and persistent complex bereavement disorder as defined in DSM-5 (Lenferink et al., 2022), an extended version of the 18-item TGI-SR (Boelen et al., 2019; Boelen & Smid, 2017).


This measure is available in 11 languages:

All can also be downloaded for free via

A version that is suitable for multiple loss facilitates the use in humanitarian crisis situations, following mass trauma, and in refugee populations is available in English and Dutch.

  • Boelen, P. A., Djelantik, A. A. A. M., de Keijser, J., Lenferink, L. I. M., & Smid, G. E. (2019). Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder. Death Studies, 43(6), 351–364.

  • Boelen, P. A., & Smid, G. E. (2017). The Traumatic Grief Inventory Self Report version (TGI-SR): Introduction and preliminary psychometric evaluation. Journal of Loss and Trauma, 22(3), 196–212.

  • Lenferink, L. I. M., Eisma, M. C., Smid, G. E., de Keijser, J., & Boelen, P. A. (2022). Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+). Comprehensive Psychiatry, 112, 152281.

The Bereavement and Grief Cultural Formulation Interview (BG-CFI)


Project leader: Geert Smid, University of Humanistic Studies, Utrecht, and ARQ National Psychotrauma Centre, Diemen, the Netherlands

Collaborate: Feasibility, acceptability, and clinical utility of the BG-CFI need further investigation. If interested contact Geert Smid

The Bereavement and Grief Cultural Formulation Interview (BG-CFI) consists of 10 brief, person-centered, and open-ended questions to assess (1) cultural traditions associated with death, bereavement, and mourning, (2) cultural meaning of encounters with the deceased, and (3) help-seeking and coping. It was designed as a supplementary module to the DSM-5 Cultural Formulation Interview (CFI). The BG-CFI aims to validate diagnosis of grief disorders, support treatment negotiation, increase rapport between patient and clinician, facilitate sharing of emotionally sensitive information, enhance the patient’s ability to find meaningful ways of dealing with the loss, and help patient and therapist to integrate meaningful rituals in grief treatment.

  • Smid, G. E., Groen, S., de la Rie, S. M., Kooper, S., & Boelen, P. A. (2018). Toward cultural assessment of grief and grief-related psychopathology. Psychiatric Services, 69(10), 1050–1052.

  • Smid, G. E., Groen, S., de la Rie, S. M., Kooper, S., & Boelen, P. A. (2019). Culturele evaluatie van verlies en rouw. Tijdschrift voor Psychiatrie, 61(12), 879–883.

  • Lewis-Fernández, R., Aggarwal, N. K., & Kirmayer, L. J. (2020). The Cultural Formulation Interview: Progress to date and future directions. Transcultural Psychiatry, 57(4), 487–496.


Let’s talk about grief

Recognizing traumatic grief among patients with common mental disorders and developing culturally sensitive psycho-education about grief

Project leader: Simon Groen

Collaborate:  culturally sensitive psychoeducational material about traumatic grief is needed worldwide. If interested contact Simon Groen.

The recognition that the loss of a loved one may result in traumatic grief (prolonged grief disorder with (symptoms of) PTSD and depression) has gained broad attention recently. Traumatic grief may impact the identity of the bereaved person and disturb daily functioning to such a degree that mental health treatment focused on traumatic grief is required. Because traumatic grief symptoms may resemble anxiety, depressive, and trauma- or stressor-related disorder symptoms, clinicians may overlook that the symptoms related to grief. Moreover, the divergent expression of traumatic grief in culturally diverse patients may further complicate recognition, although this has not been investigated. This study focuses on the prevalence of traumatic grief across outpatient clinics visited by both Dutch and immigrant patients diagnosed with anxiety, depressive, and trauma- and stressor-related disorders. Further, clinicians’ recognition of traumatic grief symptoms will be investigated, and a culturally sensitive psycho-education module will be developed on traumatic grief support through client expert collaboration. Symptoms of traumatic grief are investigated using the TGI-SR+, the BG-CFI, and debriefing instruments to be assessed among patients, interviews and debriefing instruments among clinicians and focus groups with client experts to adjust psycho-education to the patients’ needs. Hypotheses are that traumatic grief is more prevalent among patients who are referred because of PTSD, anxiety and depression symptoms, that clinicians do not recognize that symptoms may be a result of traumatic grief, and that client expert informed psycho-education will more adequately meet the patient’s needs.

  • Groen, S. P. N., Menninga, M. C., Cath, D. C., & Smid, G. E. (2022). Let’s talk about grief: Protocol of a study on the recognition and psychoeducation of prolonged grief disorder in outpatients with common mental disorders. Frontiers in Psychiatry, 13,944233.


Ambiguous Loss Inventory Plus (ALI+)


Project leader: Hannah Comtesse

Project group: Hannah Comtesse, Geert Smid, Paul Boelen, Sophie Hengst, Simone de la Rie, Clare Killikelly, Lonneke Lenferink.

Collaborate: the ALI needs translation and validation in many languages. If interested contact Hannah Comtesse.

Ambiguous loss is a person's profound sense of loss and sadness that may occur due to the disappearance of a significant person but is not associated with the death of a loved one. People may go missing in the context of natural disasters, displacement, armed conflicts, or forced disappearance. Several studies indicate elevated levels of psychological distress in relatives of disappeared persons. Still, ambiguous loss due to disappearance seems to be a specific type of loss as it is accompanied by persistent uncertainty about the fate of the disappeared person, which hampers closure.


Relatives of missing persons may have various Mental Health and Psychosocial Support (MHPSS) needs. Up to now, no questionnaire exists that specifically captures the psychological consequences of ambiguous loss after the disappearance of a significant other. To close this gap, we have started a collaboration to develop, evaluate and translate the Ambiguous Loss Inventory Plus (ALI+).

Clare Killikelly and colleagues translated the Ambiguous Loss Inventory Plus (ALI+) in Arabic, both Classical Arabic and Modern Arabic. More translations will follow.

Ambiguous Loss Inventory Plus:

All available translations are also freely available through Open Science Forum:


  • Comtesse, H., Killikelly, C., Hengst, S.M.C., Lenferink, L.I.M., de la Rie, S.M., Boelen, P.A., & Smid, G. E. (2023). The Ambiguous Loss Inventory Plus (ALI+): Introduction of a Measure of Psychological Reactions to the Disappearance of a Loved Person. International Journal of Environmental Research and Public Health, 20(6), 5117.

The Grief Assessment toolbox for refugees: development and implementation in Syrian refugees

Project leader: Clare Killikelly

Project group: Clare Killikelly, Eva Heim, Alexandra Reymond, Olivia Gabban, Rahel Bachem, Andreas Maercker.

Collaborate:  We seek further collaborations to translate and validate the toolkit in other refugee populations. If interested contact Clare Killikelly.

Background and aims

Prolonged grief disorder (PGD) is a new and significant addition to the ICD-11 WHO disease classification system. As a new disorder, it stands to improve diagnostic precision, improve communication among health professionals and patients, improve access to care and lead to effective treatments and intervention. However, it remains to be determined if the ICD-11 criteria for disordered grief are applicable to different cultural groups. We used a multi-step questionnaire development process with two main phases 1) the content development of the Grief Assessment toolbox and 2) the validation of a PGD questionnaire in 121 migrants. The development of the Grief assessment toolbox involved two focus groups with clinicians and health care workers and six cognitive interviews with bereaved Syrian refugees. The resulting PGD grief measure (IPGDS migrant supplement) was then validated in 121 migrants. Psychometric analysis confirmed good criterion validity, excellent convergent validity with another measure assessing disturbed grief, and excellent reliability for both scales. The results indicate that the IPGDS migrant supplement is a reliable and valid measure of core grief symptoms as well as items adapted specifically for migrants.

Digital early detection of psychological disorder after the loss of a loved one: DeathGRIP (Grief Response in Post Pandemic society)


Project leader: Clare Killikelly, Division of Clinical Intervention and Global Mental Health, University of Zurich

Project group: vacancy for PhD student and Postdoc researcher. If interested contact Clare Killikelly.

Background and aims

The mental health field is at a tipping point. As the world adjusts to the impact of COVID-19

to physical health, there is an urgent need to prepare for a ‘shadow’ pandemic of mental health disorders such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). Simultaneously, the recent introduction of a new mental health disorder, prolonged grief disorder (PGD), in the eleventh edition of the International Classification of Disorders (ICD-11) and Diagnostic Statistical Manual 5th edition (DSM 5-TR) is both an opportunity and a serious challenge. The inclusion legitimizes a long-known mental health challenge and thus creates an opportunity to provide those suffering from prolonged grief with the right care at the right time. At the same time, researchers and clinicians are faced with the challenge of filling substantial research and clinical knowledge gaps. Currently, this lack of knowledge about the illness course of PGD, symptom structure, and predictors of illness severity, is contributing to a crisis of missed diagnosis, long-term chronic care needs and increased burden on care systems.



This project will use experience sampling methodology to give longitudinal, fine-grained data on the sequelae of psychological disorder after bereavement as the first investigation to do so. Three studies are proposed:

(1) Longitudinal digital experience sampling methodology (ESM) on the psychological

impact of bereavement in Switzerland;

(2) Mapping of digital markers of PGD in Iran, Kenya, and China (cross-cultural cohort

comparison study); and

(3) Digital First Response for humanitarian migrants: early detection and alerting of

psychological disorder using personalized ESM.


The global recognition of PGD is an opportunity to unite clinicians and researchers with a systematic, evidence-based, and multi-levelled response. The main aim of this proposal is to provide a digital early detection system for PGD and its psychological sequelae so that chronic and debilitating outcomes may be prevented for individuals and health care systems.

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