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Gruppi RL, Yaccarini C, Hoffmann AF, Futterman A, Simkin H. Adaptation and Validation of the Texas Revised Inventory of Grief—Present Scale. Health Psychology Research. 2022;10(4). doi:10.52965/001c.39652

Abstract

This study aims to evaluate the psychometric properties and internal consistency of the Spanish version of the Texas Revised Inventory of Grief- Present [TRIG-Present] in Buenos Aires, Argentina, which assesses a series of thoughts, emotions and behaviors in losses related to the present. A total of 285 adults participated in the study with ages between 18 and 80 years (M = 55.09, SD = 15.27) and both sexes (Men = 42.8%, Women = 57.2%). The three-factor model resulted in acceptable fit indices (TLI = .970; CFI = .976; SRMR = .064). The results indicated an acceptable internal consistency for Emotional Response (ω = .850), Not Acceptance (ω = .816) and Thought (ω = .837). The spanish adaptation of the TRIG-Present presents 13 items proposed by the original authors.

Grief is the result of various anticipated losses or losses, especially the death of a close relative.1

The Texas Grief Inventory, evaluated a series of losses related to past and present losses to thoughts, emotions, and behaviors. This scale was expanded on the Texas Revised Grief Inventory [TRIG], which includes 13 items that measure pain present [TRIGPresent], and eight items that evaluate the past interruption due to loss [TRIG - Past].1

Few researchers rigorously examined the reliability and validity of the TRIG- Past, and TRIG- Present scores. Given that most researchers and health professionals are mostly interested in evaluating the current grief to improve emotional well-being,2 we decided to devote ourselves only to the TRIG-Present.

The TRIG-Present contains elements that research a variety of manifestations related to grief. Futterman et al. (2010)2 carried out an exploratory factorial analysis and divided the items into three dimensions: Non-Acceptance, which are the elements that denote difficulty in accepting the loss (3 items), Emotional Response, which evaluates the emotional response to the loss (5 items) and Thoughts, is the combination of the cognitive and emotional components of grief (5 items).

TRIG was initially considered a measure of unresolved grief,3 although it has later been conceptualized as a measure of normal grief.4 Normal grief is the process that a person who suffers a loss goes through, it is the set of physical, emotional, and social reactions to the death of a close person, the duration is variable, but it is considered a normal process between one and two years.5

Different authors state that the symptoms of normal grief are very similar to those of complicated grief during the first six months, but that after this period most people can accept the reality of the loss, in contrast to those who continue to express a chronic pain whose symptoms are observed up to two years after death.6,7

In a research, have compared the TRIG-Present with the Complicated Grief Inventory [ICG], which is a more recent measure that attempts to measure pathological or prolonged grief disorder and assesses symptoms such as severe separation anxiety and functional deficits as a result of the loss. She concludes that the symptoms TRIG evaluates are a reflection of short-lived grief reactions that eventually resolve over time.8

Some authors relate pain to spirituality, in this sense, they explain that those who lose a loved one request to cling to spirituality as a protective resource.9–12 When having an important loss, people try to reconstruct the meaning and sense of spirituality through the search for answers and explanations to what happens after the painful experience; therefore, the belief that the loved one is in a peaceful place creates a feeling of tranquility. Those who go through a grieving process are capable of taking the resources that their practices or beliefs provide to re-signify the loss; these tools have an important relationship with resilience since through this people can give their lives meaning again and find comfort.13,14

Actually, in the Argentine context, there isn´t a psychometric instrument to evaluate non-pathological grief. Therefore, this study aims to test the evidence of validity the TRIG-Present.

Some of the countries in which the TRIG-Present scale was validated are China,15 Germany,16 Spain,17,18 Sweden,19 Turkey20 and United States2,21,22 (Table 1).

Table 1.Validation articles of TRIG- Present
Authors Year Country Sample N Cronbach's Alpha CFI RMSEA
Holm et al. 2018 Sweden Family caregivers 129 0.95 0.97 0.086
Li et al. 2018 Spain General population 466 0.95 0.92 0.098
Diaz et al. 2016 Spain Unemployed 217 0.90 - -
Ilsung y Shaun 2012 United States Senior caregivers 200 0.74 a 0.89 0.95 0.06
Yildiz y Cimete 2011 Turkey Parents of children who died 154 0.84 0.86 0.089
Futtermanet al. 2010 United States Older adults 212 0.86 0.92 0.057
Hansjong-Tnoj 2008 Germany Parents of children who died 400 0.87 - -
Wilson 2007 United States Latino Seniors 134 0.95 0.74 0.18
Garcia- Garcia 2005 Spain Widowers in health centers 118 0.86 - -

Note: N= Sample

Method

Participants

Sample was composed of 285 Argentinian adults with ages between 18 and 80 years (M= 55.09, SD= 15.27) and both sexes (Men =42.8 %, Women= 57.2 %). Those participants who were under psychiatric treatment were excluded. Participation was anonymous and voluntary, data were collected through an online form complying with the codes of ethical conduct established by the National Scientific and Technical Research Council (CONICET) (Res. D No. 2857/06).

Measures

Texas Revised Inventory of Grief- Present [TRIG-Present].1 It is a 13 items self-administered questionnaire that evaluates three dimensions: (1) Emotional Response (items 1, 2, 5, 7, 13) (e.g. “I even cry when I think of the person who died” / “Todavía lloro cuando pienso en la persona que murió”). (2) Non-Acceptance (items 3, 10, 12) (e.g. “I feel it is unfair that this person have died” / “Siento que es injusto que esta persona haya muerto”). (3) Thoughts (items 4, 6, 8, 9, 11) (e.g. “I can’t avoid thinking of the person who died” / “No puedo evitar pensar en la persona que murió”).

Sociodemographic data questionnaire: An ad hoc questionnaire was developed that asked participants to record their age, gender and months of the death.

Assessment of Spirituality and Religious Sentiments Scale [ASPIRES].23,24 It is a 35 items self-administered that evaluates two dimensions: (1) Religious feelings [Religious Participation (α > 0.84) and Religious Crisis (α > 0.68)] and (2) Spiritual Transcendence [Realization in Prayer (α > 0.91), Universality (α > 0.76) and Connectivity (α > 0.57)]. Items 1, 2, 3, 4, 8, 9,10, 12, 14, 15, 16, 19 and 20 are scored in reverse. The scale presents a likert-type format of five to seven response anchors depending on the degree of agreement with the participants. The scale showed adequate psychometric properties.

Procedure

For the adaptation and validation of TRIG- Present a backtranslation of the original technique was made, trying to maintain the psychological sense of each term. The questionnaire was carried out online through Facebook advertising between November 6 th 2020 and April 8th 2021 aimed at the general adult population of Buenos Aires, Argentina. Participation was anonymous, voluntary and no compensation or incentive was offered.25

Ethical aspects

The research project in which the study is framed was submitted for evaluation by an ethics committee. Participation was voluntary, specifying that completing the form would be equivalent to signing an informed consent, complying with the codes of ethics established by the National Council for Scientific and Technical Research (CONICET) (Res. D No. 2857/06). Finally, it was indicated that the results were used exclusively for scientific-academic purposes in accordance with National Law 25,326 on the Protection of Personal Data.

Data analysis

First, a confirmatory factor analysis was performed to verify if the structure of the model is replicated in the sample collected in the present study. Vea used the DWLS estimation method and polychoric correlation matrices given the ordinal character of the items.26 The fit of the model was interpreted using the Tucker-Lewis index (TLI), Comparative fit index (CFI) and Standardized Root Mean Square Residual (SRMR). TLI and CFI values above .90 and SRMR values below .08 are considered indicators of good fit.27 The internal consistency of the dimensions was also analyzed using the omega coefficient where the appropriate values are located above .70.28,29

Secondly, a cross-validation was carried out to corroborate whether a three-factor model presented adequate fit and similar performance when the sample was divided according to gender. To evaluate the fit of the model in the cross-validation study, the following fit indices were analyzed: TLI, CFI, and SRMR.

Third, the factorial invariance of the model according to gender was analyzed. Three nested models were tested -configural, metric, structural- imposing different levels of restriction progressively. The metric equivalence of the model was interpreted from the CFI and RMSEA indices, where values less than .01 and .015, respectively, are indicators of invariance.30

Fourth, the internal consistency of the instrument’s dimensions was compared between men and women. For this purpose, the omega coefficient was calculated.29 Then, the indices were compared by the Alpha Test software.31,31 Besides, the effect size was calculated with Cohen’s q index,32,33 where values are interpreted as null ( < .10), small (between .10 to .30), medium (between .31 to 50) and large (> .51).

Fifth, item equivalence was examined by differential item function analysis (DIF). The Mantel-Haenszel (MH) statistic suggested for the analysis of ordinal items was applied.34 To interpret this analysis, a conservative criterion (M-X2 > 6.63) was adopted to determine the presence of significant differences (p < .01) between the focus group and the reference group.35 The jMetrik 4.1 software was used.

Sixth, an external validation was carried out, analyzing the correlation between the constructs of grief and spirituality.

Seventh, an analysis of mean differences for each of the scales according to gender was carried out to decide whether it would be appropriate to design unified or independent statistical norms for men and women.

Results

Confirmatory factor analysis

Confirmatory factor analysis indicated a good fit to the data of the three factor correlated model proposed by the authors.27,36 All parameters were statistical signification (p < .05). Besides, internal consistency analyses report optimal indices in all dimensions (Table 2).

Table 2.Confirmatory factor analysis of TRIG-Present.
  Emotional Response Non-Acceptance Thoughts
TRIG1 .796
TRIG2 .628
TRIG5 .869
TRIG7 .481
TRIG13 .834
TRIG3 .747
TRIG10 .645
TRIG12 .912
TRIG4 .808
TRIG6 .838
TRIG8 .553
TRIG9 .763
TRIG11 .568
Emotional Response 1
Non-Acceptance .845 1
Thoughts .901 .855 1
Omega .850 .816 .837
Fit índices
TLI .970
CFI .976
SRMR .064

In the cross-validation using gender as a segmentation variable, both samples of women and men demonstrated a good model fit, with an TLI and CFI above .90 and a SRMR below .080 for both subsamples (Table 3).

Table 3.Cross-validation of TRIG-Present by gender.
TLI CFI SRMR
Female .969 .976 .076
Male .971 .977 .075

Factorial invariance of the model was tested by gender. Three models with different restriction levels -configural, metric, structural- were analyzed. Its procedure verified the metric equivalence of the internal structure instrument in both genders (Table 4).

Table 4.Factorial invariance of TRIG-Present by gender.
CFI Δ CFI RMSEA [CI95%] Δ RMSEA
Configural .982 - .073 [.057-.089] -
Metric .981 .001 .072 [.056-.087] .001
Structural .980 .002 .074 [.058-.088] -.001

Therefore, the internal consistency of the dimensions in each subsample -male and female- was estimated to be compare later. Omega indices did not register statistical significative differences. Besides, the effect size for each comparison was small or null (table 5).

Table 5.TRIG-Present. Internal consistency comparing by gender.
Male (n = 122) Female (n = 163) X2 gl p q
Emotional Response .877 .839 1.640 1 .200 .145
Non-Acceptance .808 .824 .130 1 .717 .048
Thoughts .859 .818 1.476 1 .224 .139

Then, a differential item functioning test was applied to verify the items metric equivalence among gender (Table 6). Results did not verify statistical differences (p > .01 and M-X2 > 6.63).

Table 6.Differential item functioning of TRIG-Present by gender.
Items M-χ2 p
Emotional Response
TRIG1 .49 .48
TRIG2 1.22 .27
     TRIG5
     TRIG7
     TRIG13
Non-Acceptance
     TRIG3
     TRIG6
     TRIG8
Thoughts
     TRIG4
     TRIG5
     TRIG9
     TRIG10
     TRIG11
.37
4.62
.13
 
.02
.72
2.68
 
3.71
.55
1.86
.24
2.67
.54
.03
.72
 
.90
.40
.10
 
.05
.46
.17
.62
.10

Regarding external validation, a correlational analysis was carried out between TRIG-Present and ASPIRES, taking into account the theoretical relevance of the relationship of the constructs evaluated by these scales.37–39 The trifactorial model of grief was correlated with the dimensions of Spirituality (Universality, Connectivity and Fulfillment in Prayer), obtaining a positive correlation between Universality with Emotional Response and Non-acceptance, while the relationship was inverse between Thought and connectivity (Table 7). No significant results were found with the Realization dimension in the sentence.

Table 7.Correlations between the Texas Revised Inventory of Grief-Present (TRIG-Present) and the Scale of Spirituality and Religious Feelings (ASPIRES)
1 2 3 4 5 6 7 8
ER -
NA 0,657** -
T 0,674** 0,656** -
R 0,112 0,038 0,111 -
RC 0,076 0,082 -0,010 -0,031 -
RP -0,021 0,052 -0,005 -0,588** 0,097 -
U 0,155** 0,175** 0,086 -0,230** 0,172** 0,447** -
C -0,072 -0,025 -0,119** -0,096 0,173** 0,247** 0,193** -

Notes: ER= Emotional Response = 1. NA= Non-Acceptance = 2. T= Thoughts =3. R= Religious Participation =4. RC= Religious Crisis =5. RP= Realization in Prayer =6. U= Universality =7. C= Connectivity =8.
*p. < 0.05; **p.<0.01

Finally, dimension differences between gender were examined to evaluate the necessity to take some care when in the score’s interpretation. Non-statistical differences were verified.

Table 8.Dimension differences between gender.
Gender Emotional Response Non-Acceptance Thoughts
Male M 15.07 8.36 18.50
SD 5.43 3.54 4.81
Female M 15.76 8.44 19.35
SD 5.61 3.82 4.66
Levene F .032 1.001 .756
p .858 .318 .385
t 1.050 .178 1.498
p .295 .859 .135
d .125 .022 .180

Discussion

This article set out to explore evidence of the validity of the Argentinian version of the TRIG- Present inventory. The results suggest that concerning factor structure and internal consistency, the TRIG- Present inventory has acceptable psychometric properties in the Argentinean context.

The results of the CFA present an adequate fit of the model for the one estimation method used, Diagonally Weighted Least Squares [DWLS], which verifies the robustness of the internal structure of the instrument. According to the CFA, this study presents acceptable Fit Index (CFI > .90; TLI >.90; SRMR < .08), showing a CFI of .976; TLI .970 and SRMR .064.

Regarding the CFI obtained higher values than the validations carried out in other countries, that oscillated between .86 and .97.2,15,19–21

Regarding internal consistency, the Emotional Response dimension had the highest values with an Omega of .850, then in the Thought dimension an Omega of .837 was obtained and the lowest value was that of the Non-Acceptance dimension with a value of .816.

One of the most appropriate procedures to examine whether the fit of a model is maintained in different samples is cross-validation. In this study, the fit indices obtained in the two sub-samples based on gender were adequate and provide further support to the trifactorial structure of the TRIG- Present scale. Obtaining fit indices for female of TLI .969; CFI .976 and SRMR .076. Regarding male of a TLI .971; CFI .977 and SRMR .075.

Within cross-validation, the analysis of factorial invariance is important, which showed that the structure of the instrument does not vary in samples with different characteristics. It allowed to verify the metric equivalence of the model. Finally, within the cross-validation, no statistically significant differences were obtained, although there is evidence of a tendency for female to have higher scores than male.

Regarding external validity, ASPIRES was used to analyze the external validity of TRIG-Present. The TRIG-Present correlates directly and significantly with the two dimensions of the spirituality scale (universality and Connectivity). This result makes sense if one takes into account that people in critical situations, such as the loss of a loved one, tend to cling to spirituality as a protective resource, that is, they manage to accept the loss more as a result of an emotional bond that transcends the thought.12

Concerning the limitations of this study, it should be noted that the population that arrived for the study is only limited to the inhabitants of the Province and the Autonomous City of Buenos Aires. Analyzes were based on an urban convenience sample, excluding participants in psychiatric treatment, limiting generalizability. Future studies should replicate the findings with more representative and clinical samples. The external validation was performed only with one of the variables to which grief is related, in future studies they could use variables such as Burnout syndrome.40

However, the present study presents initial evidence that the scale provides a valid and reliable method to evaluate the TRIG-Present in the Argentinean context.


Conflicts of Interest

The authors declare they have no conflict of interest.

It was stated that completing the form would be equivalent to giving informed consent. Participants were also informed that the data derived from this research would be used exclusively for scientific purposes in accordance with National Law 25,326 of Protection of personal data.

Funding

This research was funded by the Universidad Abierta Interamericana

References

1.
Faschingbauer TR, Devaul RA, Zisook S. Texas Revised Inventory of Grief- Present Scale. Am J Psychiatry. 1977;150(June):321-323.
Google Scholar
2.
Futterman A, Holland JM, Brown PJ, Thompson LW, Gallagher-Thompson D. Factorial validity of the Texas Revised Inventory of Grief—Present scale among bereaved older adults. Psychological Assessment. 2010;22(3):675-687. doi:10.1037/a0019914
Google ScholarPubMed CentralPubMed
3.
Faschingbauer TR. Texas Revised Inventory of Grief Manual. (Houston, ed.).; 1981.
Google Scholar
4.
Neimeyer RA, Hogan NS, Laurie A. The measurement of grief: Psychometric considerations in the assessment of reactions to bereavement. In: Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. American Psychological Association; 2008:133-161. doi:10.1037/14498-007
Google Scholar
5.
Martín Rodríguez M. El papel de enfermería en el duelo de familiares de pacientes terminales. Universidad de Valladolid; 2017.
Google Scholar
6.
Zhang B, El-Jawahri A, Prigerson HG. Update on bereavement research: Evidence-based guidelines for the diagnosis and treatment of complicated bereavement. Journal of Palliative Medicine. 2006;9(5):1188-1203. doi:10.1089/jpm.2006.9.1188
Google Scholar
7.
Maercker A, Lalor J. Diagnostic and clinical considerations in prolonged grief disorder. Dialogues in Clinical Neuroscience. 2012;14(2):167-176. doi:10.31887/dcns.2012.14.2/amaercker
Google ScholarPubMed CentralPubMed
8.
Prigerson HG, Maciejewski PK, Reynolds CF III, et al. Inventory of complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research. 1995;59(1-2):65-79. doi:10.1016/0165-1781(95)02757-2
Google Scholar
9.
Hernández Nicolás B. Desarrollo de la dimension espiritual en procesos de duelo. Universidad de Salamanca; 2021.
Google Scholar
10.
Singer J. An Examination of Preparedness for Family Members of Individuals with a Life Limiting Illness: A Possible Protective Factor for Pre-Loss Grief (Issue May). University of Nevada; 2021.
Google Scholar
11.
Parra A, Reyes F. El duelo complicado y su relación con la resiliencia y la esperanza en religiosos practicantes. Psocial. 2020;6(2).
Google Scholar
12.
Piedmont RL. Does spirituality represent the sixth factor of personality? Spiritual transcendence and the Five-Factor Model. Journal of Personality. 1999;67(6):985-1013. doi:10.1111/1467-6494.00080
Google Scholar
13.
Villagómez-Zavala PG, Ornelas-Tavares PE, Franco-Chávez SA, Martínez-Becerra AK, Gutiérrez-Castillo LA. Evaluación de la espiritualidad en pacientes con duelo utilizando la terapia de aceptación y compromiso en la Clínica de Duelo por Suicidio del Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara, México. Rev Sal Bosq. 2020;10(1):22-30. doi:10.18270/rsb.v10i1.2901
Google Scholar
14.
Yoffe L. Religión, espiritualidad y apoyo social en el duelo, desde la visión de la Psicología Social. Published online 2017.
Google Scholar
15.
Li T, Wang SW, Zhou JJ, Ren QZ, Gao YL. Assessment and Predictors of Grief Reactions among Bereaved Chinese Adults. Journal of Palliative Medicine. 2018;21(9):1265-1271. doi:10.1089/jpm.2018.0001
Google Scholar
16.
Znoj H. texas-revised inventory of grief: Validierung der deutschen Version TRIG-D. Psychosomatik Und Konsiliarpsychiatrie. 2008;2(4):236-239. doi:10.1007/s11800-008-0131-3
Google Scholar
17.
Díaz C, Abal YN, Climent JA, Ortega E, López-López MJ, Casado J. Pérdida y Afrontamiento en Desempleados: Adaptación del Inventario Texas Revisado de Duelo a la Situación de Pérdida de Empleo. Revista Iberoamericana de Diagnostico y Evaluacion Psicologica. 2016;2(42):111-124. doi:10.21865/RIDEP42-111
Google Scholar
18.
García García JA, Landa Petralanda V, Trigueros Manzano MC, Gaminde Inda I. Inventario Texas Revisado de Duelo (ITRD): Adaptación al castellano, fiabilidad y validez. Atención Primaria. 2005;35(7):353-358. doi:10.1157/13074293
Google ScholarPubMed CentralPubMed
19.
Holm M, Alvariza A, Fürst C, Öhlen J, Årestedt K. Psychometric evaluation of the Texas revised inventory of grief in a sample of bereaved family caregivers. Res Nurs Health. 2018;41(5):480-488. doi:10.1002/nur.21886
Google Scholar
20.
Yildiz H, Cimete G. Adaptation study of the texas revised inventory of grief. Anatolian Journal of Psychiatry. 2011;12(1):30-36.
Google Scholar
21.
Nam I, Eack SM. Confirmatory factor analysis and cross-cultural examination of the Texas Revised Inventory of Grief (TRIG). Families in Society. 2012;93(1):65-73. doi:10.1606/1044-3894.4177
Google Scholar
22.
Wilson S. Journal of Social Work in End-Of-Life & Palliative Care The Validation of the Texas Revised Inventory of Grief on an Older Latino PEER-REVIEWED ARTICLES The Validation of the Texas Revised Inventory of Grief on an Older Latino Sample. Journal of Social Work in End-of-Life & Palliative Care. 2007;2(4):37-41. doi:10.1300/J457v02n04
Google Scholar
23.
Piedmont RL. Assessment of Spirituality and Religious Sentiments, Technical Manual. 1st ed. Timonium; 2004.
Google Scholar
24.
Simkin H. Adaptación al español de la Escala de Espiritualidad y Sentimientos Religiosos (ASPIRES). Univ Psychol. 2017;16(2). doi:10.11144/javeriana.upsy16-2.aeee
Google Scholar
25.
Iannelli L, Giglietto F, Rossi L, Zurovac E. Facebook Digital Traces for Survey Research: Assessing the Efficiency and Effectiveness of a Facebook Ad–Based Procedure for Recruiting Online Survey Respondents in Niche and Difficult-to-Reach Populations. Social Science Computer Review. 2020;38(4):462-476. doi:10.1177/0894439318816638
Google Scholar
26.
Li CH. The performance of ML, DWLS, and ULS estimation with robust corrections in structural equation models with ordinal variables. Psychological Methods. 2016;21(3):369-387. doi:10.1037/met0000093
Google Scholar
27.
Morata MÁ, Holgado FP, Barbero MI, Mendez G. Análisis factorial confirmatorio. Recomendaciones sobre mínimos cuadrados no ponderados en función del error Tipo I de Ji-Cuadrado y RMSEA. Acción Psicológica. 2015;12(1):79-90. doi:10.5944/ap.12.1.14362
Google Scholar
28.
Hair J, Black W, Babin B, Anderson R. Multivariate Data Analysis. CENGAGE; 2018.
Google Scholar
29.
McDonald RP. Test Theory: A Unified Treatment. Lawrence Erlbaum; 1999.
Google Scholar
30.
Davidov E, Schmidt P, Billiet J, Meuleman B, eds. Cross-Cultural Analysis. Methods and Applications. Routledge; 2018. doi:10.4324/9781315537078
Google Scholar
31.
Merino Soto C, Lautenschlager G. Comparación Estadística de la Confiabilidad Alfa de Cronbach: Aplicaciones en la Medición Educacional y Psicológica. Revista de Psicología. 2003;12(2):127. doi:10.5354/0719-0581.2003.17668
Google Scholar
32.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. Erlbaum; 1988.
Google Scholar
33.
Ventura-León JL, Caycho T. Q de Cohen: Comparación de Correlaciones entre Muestras Independientes en base a Urzúa et al. Revista Médica de Chile. 2017;145(3):411-412. doi:10.4067/s0034-98872017000300020
Google Scholar
34.
Fidalgo A, Quintanilla L, Fernández R, Pons F, Aguerri M. Detección del DIF en ítems politómicos mediante el uso de los métodos Mantel-Haenszel. Revista Electrónica de Metodología Aplicada. 2010;15(1):12-18.
Google Scholar
35.
Sheskin DJ. Handbook of Parametric and Nonparametric Statistical Procedures. CRC Press; 2011.
Google Scholar
36.
Lewis TF. Evidence regarding the internal structure: Confirmatory factor analysis. Measurement and Evaluation in Counseling and Development. 2017;50(4):239-247. doi:10.1080/07481756.2017.1336929
Google Scholar
37.
García Hernández AM. Continuidad de vínculos y espiritualidad en padres que perdieron hijos. 2019;13(3).
Google Scholar
38.
Jueckstock JA. Relational Spirituality and Grief: A Qualitative Analysis of Bereaved Parents. Journal of Psychology and Theology. 2018;46(1):38-51. doi:10.1177/0091647117753902
Google Scholar
39.
Lövgren M, Sveen J, Steineck G, Wallin AE, Eilertsen MEB, Kreicbergs U. Spirituality and religious coping are related to cancer-bereaved siblings’ long-term grief. Pall Supp Care. 2019;17(2):138-142. doi:10.1017/s1478951517001146
Google Scholar
40.
Platania S, Di Nuovo S, Caruso A, Digrandi F, Caponnetto P. Stress among university students: The psychometric properties of the Italian version of the SBI-U 9 scale for Academic Burnout in university students. Health Psych Res. 2020;8(2):9209. doi:10.4081/hpr.2020.9209
Google ScholarPubMed CentralPubMed

Apéndix

Items of the Texas Revised Inventory of Grief—Present Scale
Totalmente en desacuerdo En desacuerdo Ni en desacuerdo ni en acuerdo De acuerdo Totalmente de acuerdo
1. Todavía lloro cuando pienso en la persona que murió. 1 2 3 4 5
2. Todavía me enojo cuando pienso en la persona que murió. 1 2 3 4 5
3. No puedo aceptar la muerte esa persona. 1 2 3 4 5
4. A veces extraño mucho a la persona que murió. 1 2 3 4 5
5. Incluso ahora es doloroso recordar las memorias de la persona que murió. 1 2 3 4 5
6. Estoy preocupado con pensamientos (a menudo pienso) sobre la persona que murió. 1 2 3 4 5
7. Oculto mis lágrimas cuando pienso en la persona que murió. 1 2 3 4 5
8. Nadie ocupará el lugar de la persona que murió en mi vida. 1 2 3 4 5
9. No puedo evitar pensar en la persona que murió. 1 2 3 4 5
10. Siento que es injusto que esta persona haya muerto. 1 2 3 4 5
11. Las cosas y las personas que me rodean todavía me recuerdan a la persona que murió. 1 2 3 4 5
12. No puedo aceptar la muerte de la persona que murió. 1 2 3 4 5
13. A veces todavía siento la necesidad de llorar por la persona que murió. 1 2 3 4 5