Version June 2024
| CGI severity | CGI improvements |
| 1. | |
| Normal – Feelings of grief are sometimes present but not intrusive. There is evidence of restoration of the capacity for joy and satisfaction in life, a sense of purpose in life, and a feeling that happiness is possible. | Very much improved – Distress and impairment from prolonged grief disorder are markedly improved compared to baseline. Patients feel very differently about the role grief plays in their lives compared to baseline. Prolonged grief disorder CGI severity is usually no more than mild (3); however, patients can (rarely) be very much improved and grief symptoms may still be moderate (4) if baseline severity was very high (7). |
| 2. | |
| Borderline ill – Grief symptoms are present but rarely intrusive or distressing; there is little or no interference in activities and relationships, and evidence of some capacity for pleasure and satisfaction. | Much improved – Distress and impairment from prolonged grief disorder are definitely improved compared to baseline, and this improvement is clinically significant. Patients notice some difference in the role that grief plays in their lives. Prolonged grief disorder CGI severity is usually no more than moderate (4). However, a patient can be much improved and grief symptoms may still be marked (5) if baseline severity was very high (7). |
| 3. | |
| Mildly ill – Prolonged grief disorder symptoms are present and sometimes intrusive and/or distressing but manageable and there is minimal or no functional impairment. There is engagement in activities and relationships with the potential for satisfaction and pleasure. Clinical significance is borderline or subthreshold. | Minimally improved – There is some improvement in distress and/or impairment from prolonged grief disorder compared to baseline, but the clinical significance of the change is questionable or minimal. |
| 4. | |
| Moderately ill – Prolonged grief disorder symptoms are present and intrusive on most days, at a level that is painful but bearable. There is some interference with activities and relationships, but functioning is not substantially impaired. There may be some avoidance of reminders of the loss. A sense of purpose or meaning is usually present, but there may be confusion about this. Suicidal thoughts may be present but there is usually a desire to live. Distraction is temporarily possible, but symptoms are persistent and clinically significant. | No change – Distress and impairment from prolonged grief disorder have not changed in any meaningful way since the baseline assessment. |
| 5. | |
| Markedly ill – Prolonged grief disorder symptoms are frequent and intrusive, at a level that causes substantial pain and definite interference with functioning. There is usually some avoidance of reminders of the loss, loss of a sense of purpose or meaning in life, and/or a feeling that joy and satisfaction are no longer possible; suicidal thoughts are usually present and may be prominent. There may be a feeling of just waiting to die. There is little relief from prolonged grief disorder symptoms; distraction is difficult and when possible, short-lived. | Minimally worse – Distress or impairment from prolonged grief disorder is somewhat worse since the baseline assessment, but the clinical significance of this change is questionable or minimal. |
| 6. | |
| Severely ill – Prolonged grief disorder symptoms are nearly constant on most days at a level that is severe and impairing; extensive avoidance is often present. There is often a belief that joy and satisfaction are no longer possible; there may be active suicidal ideation or indirect suicidal behavior (eg, cutting). Distraction is rarely possible and only partially effective and there may be periods of inability to function. | Much worse – Distress and impairment from prolonged grief disorder are definitely worse since the baseline assessment, and this change is clinically significant. Increased level of care should be considered. |
| 7. | |
| Among the most extremely ill patients – Prolonged grief disorder symptoms are present continuously or nearly continuously at a very severe level. The person is virtually unable to function in activities or relationships. There may be strongly held self-blaming or accusatory beliefs about the death that border on delusional. There is a conviction that joy and satisfaction are no longer possible. Avoidance is usually present and extensive. Active suicidal thoughts or indirect suicidal behavior are usually present. | Very much worse – Distress and impairment from prolonged grief disorder are markedly worse since the baseline assessment. There may be emergent clinically significant suicidal thinking or behavior, or risk of other serious consequences of worsening grief. Increased level of care is definitely needed. |
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