Validation of the Ukrainian Prolonged Grief Assessment for Children (PGA‑C) in a Wartime Context

Imagine your mind as a vast, bustling city. Usually, when a loved one leaves, the city goes through a temporary construction zone. There's traffic, some buildings are closed, and the mood is gloomy, but eventually, the roads clear, the signs are updated, and life finds a new rhythm. This is normal grief. But sometimes, the construction never stops. The cranes stay up, the roads remain blocked, and the city gets stuck in a permanent state of "under repair." In the world of psychology, this stuck state is called Prolonged Grief Disorder. It's like a heavy fog that doesn't lift, making it hard for a person to feel joy, focus on school, or connect with friends.

Now, imagine trying to measure how thick that fog is. You need a special tool, a "fog meter," to tell the difference between a little bit of mist and a blinding storm. For a long time, scientists had great fog meters for adults, but they didn't have a good one for kids, especially kids living in places where the war itself is like a constant, loud thunderstorm. If you're a kid in a war zone, losing someone is terrifying enough, but if the whole world feels unsafe, it's even harder to know if your sadness is just part of the chaos or if it's something deeper that needs help. This is where the story of this paper begins: trying to build and test a new "fog meter" specifically for Ukrainian children living through the war.

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The Mission: Building a New Compass for a Stuck Heart

The researchers, led by Oleksandr Avramchuk and a team from the Ukrainian Catholic University, set out to test a new tool called the PGA-C (Prolonged Grief Assessment for Children). Think of this tool as a detailed map designed to help adults understand exactly where a child's heart is stuck. The map has 17 questions, asking about things like "Do you miss them so much it hurts?" or "Do you avoid places that remind you of them?"

To test if this map works, the team gathered 129 bereaved children and teenagers (ages 8 to 18) from Ukraine. These weren't just any kids; they were young people who had lost a parent or loved one while living through the ongoing war. Some lost their fathers in combat, others lost mothers to shelling, and a few lost both parents. The researchers asked these brave kids to fill out the PGA-C map, along with a few other maps that check for anxiety, sadness, and how well they are doing in life (like their quality of life).

The Results: A Map That Holds Up in the Storm

When the team looked at the data, the PGA-C turned out to be a very sturdy tool. Here is what they found, translated into plain language:

1. The Tool is Reliable (It doesn't wobble)
Imagine you weigh yourself on a scale. If you step on it, take a step off, and step back on a week later, and the number is exactly the same, you know the scale is trustworthy. The researchers did something similar with the kids. They asked the same group of 111 children to fill out the map again 4 to 5 weeks later. The results were almost identical. The tool showed a score of 0.88 for this "test-retest" reliability (a high score on a scale where 1.0 is perfect). This means the PGA-C isn't just a fluke; it consistently measures the same thing over time, even while the war continues.

2. The Questions Stick Together (The "Internal Consistency")
The researchers checked if all 17 questions were working together like a well-orchestrated choir. They found an internal consistency score of 0.92, which is excellent. It means that when a child says "I feel stuck," they are likely to say "I feel sad" and "I can't focus" too. The questions all point in the same direction.

3. The Map Points to the Right Places (Validity)
A good map should show you where you are relative to other landmarks. The researchers checked if the PGA-C map lined up with other known maps:

• The Sadness/Anxiety Map: Kids who scored high on the PGA-C (meaning they had stuck grief) also scored high on tests for depression and anxiety. This makes sense; if you are stuck in grief, you are likely feeling sad and worried.
• The "Life Quality" Map: This was the most important test. The researchers found a strong negative link between the PGA-C and how well the kids were living their lives. The more stuck grief a child had, the lower their quality of life. The correlation was -0.622. This is a strong signal that the PGA-C is actually measuring something that hurts a child's daily life, not just a fleeting mood.
• The "Not-Just-PTSD" Test: The team wanted to make sure the PGA-C wasn't just measuring Post-Traumatic Stress Disorder (PTSD), which is common in war zones. They found that while PTSD and grief are related, the PGA-C was a better predictor of how a child's life quality was suffering than the PTSD test was. In other words, the PGA-C is catching a specific type of pain that the other tests might miss.

The Shape of the Map: Two Roads, One Journey

When the researchers tried to see if the 17 questions could be grouped into smaller categories (like sorting a toolbox into "screws" and "hammers"), they found two main groups:

1. Detachment/Avoidance: This is the part where kids try to push away the pain, avoid thinking about the person who died, or feel emotionally numb.
2. Yearning/Disbelief: This is the part where kids miss the person terribly, can't believe they are gone, and feel a deep ache.

The data suggested these two groups exist, but when the researchers tried to force the data into a perfect mathematical shape (a "Confirmatory Factor Analysis"), the fit wasn't perfect. It was a bit like trying to fit a square peg into a round hole; the shape was close, but not quite right. However, because the whole tool worked so well together, the researchers decided it's still safe to use the total score (the sum of all questions) to get a clear picture of a child's grief.

What the Map Does NOT Show

The researchers also looked to see if the map worked differently for boys versus girls, or for kids who lost a father versus a mother. They found no significant differences. Whether the child was 8 or 18, a boy or a girl, or if the loss happened recently or a while ago, the map showed the same patterns. This suggests that in the context of a war zone, the sheer weight of the loss and the ongoing danger might overshadow other factors like age or gender. The grief is just as heavy for everyone.

The Bottom Line

This paper suggests that the Ukrainian version of the PGA-C is a reliable and valid tool for understanding prolonged grief in children living through war. It is like a sturdy, well-calibrated compass that works even in a storm. It can help doctors and psychologists identify which children are stuck in that "construction zone" of grief and need extra help to clear the roads.

While the mathematical shape of the two groups (Avoidance and Yearning) needs a little more tweaking to be perfect, the tool as a whole is ready to be used. It proves that even in the chaos of war, we can measure the invisible weight of a child's heart, and that is the first step toward helping them find their way back to a life where the fog can finally lift.