Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 1991 Development of an inventory to assess grief reactions: the Comprehensive Inventory of Responses to Common Life Events (CIRCLE) Christine Lynne Fretwell Diesch Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Clinical Psychology Commons, Psychiatry and Psychology Commons, and the Quantitative Psychology Commons Recommended Citation Diesch, Christine Lynne Fretwell, "Development of an inventory to assess grief reactions: the Comprehensive Inventory of Responses to Common Life Events (CIRCLE) " (1991). Retrospective Theses and Dissertations. 9638. https://lib.dr.iastate.edu/rtd/9638 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. 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Ann Arbor, Ml 48106-1346 USA 313/761-4700 800/521-0600 Order Number 9212140 Development of an inventory to assess grief reactions: The Comprehensive Inventory of Responses to Common Life Events (CIRCLE) Diesch, Christine Lynne Eretwell, Ph.D. Iowa State University, 1991 Copyright ©1991 by Diesch, Christine Lynne Eretwell. All rights reserved. UMI 300N.ZeebRd. Ann Arbor, MI 48106 I Development of an inventory to assess grief reactions: The Comprehensive Inventory of Responses to Common Life Events (CIRCLE) by Christine Lynne Fretwell Diesch A Dissertation Submitted to the Graduate Faculty in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Department: Psychology Major: Psychology Approved: Signature was redacted for privacy. In Chai Signature was redacted for privacy. Fo^e ^jor Department Signature was redacted for privacy. For the Gradupté'College Iowa State University Ames, Iowa 1991 Copyright © Christine Lynne Fretwell Diesch, 1991. All rights reserved. TABLE OF CONTENTS ABSTRACT ix CHAPTER 1; REVIEW OF THE GRIEF LITERATURE 1 Introduction 1 Prominent Theories of Grief 2 Freud (1917) 2 Lindemann (1944) 3 Marris (1974) 6 Bowlby (1969; 1973; 1980) 8 Parkes (1971; 1987) 11 Kubler-Ross (1969) 13 Worden (1982) 14 A Critical Evaluation of the Grief Literature 17 Conceptual Difficulties in Definitions and Theories of Grief .... 17 Conceptual Difficulties in Defining Atypical Grief 18 Lack of Empirical Evidence in Support of Theories of Grief .... 18 Lack of Supporting Evidence for Interventions 20 Limitations in Subject Populations Chosen for Study 21 Limitations in Topic Areas Chosen for Study 22 Myths of Coping with Loss 24 Recommendations for Future Research 27 CHAPTER 2: A SUMMARY OF CHARACTERISTICS OF GRIEF AND INSTRUMENTS USED TO ASSESS THIS PHENOMENON 30 Introduction 30 Characteristics of the Grief Process 30 Lindemann (1944) 30 iii Marris (1974) 31 Parkes (1985); Parkes & Weiss (1983); Glick, Weiss, & Parkes (1974) 32 Worden (1982) 34 Instruments Commonly Used to Assess Grief 35 Instruments Designed Specifically to Measure Grief 35 Instruments Not Designed Specifically to Measure Grief 41 Usefulness of Instruments Used to Measure Grief Reactions .... 46 CHAPTERS: DEVELOPMENT OF THE COMPREHENSIVE INVENTORY OF RESPONSES TO COMMON LIFE EVENTS (CIRCLE): METHODOLOGY 49 Purpose of the Present Research 49 Construction of the Inventory 49 Demographic Characteristics 50 Life Events Checklist — Preliminary Item Selection 51 Life Events Checklist — Description of the Scale 64 Affect Checklist 69 Behavior Checklists 69 Cognitions Checklist 73 Physical Symptoms Checklist 73 Subjects 78 Materials and Procedures 79 CHAPTER 4; RESULTS 80 Demographic Characteristics of the Sample 80 Life Events Checklist 80 Frequencies of Life Events 80 Calculation of Life Events Scale Scores 85 iv Life Events Scale Scores Statistics and the Relationship between Life Events Frequencies and Age 92 Description of the Factor Analytic Procedure for the Symptom Checklists 92 Appropriateness of Factor Analysis 93 Description of Factor Analytic Procedures Used 96 Factor Analysis of the Symptom Checklists 99 Affect Checklist 99 Behaviors Checklist 100 Interpersonal Behaviors Checklist 102 Cognitions Checklist 104 Physical Symptoms Checklist 107 Calculation of Scale Scores for the Symptom Checklists 109 Reliability and Validity of the Symptom Checklists 115 Reliability 115 Validity 118 Summary of Reliability and Validity Data by Symptom Checklist .... 126 Symptom Checklists (Negative Symptoms) 126 Symptom Checklists (Positive Symptoms) 134 CHAPTERS: DISCUSSION 138 Interpretation of the Results and Limitations of the Research 139 Adequacy of the Sample 139 Life Events Checklist 140 Symptom Checklists 143 Directions for Future Research 146 Implications for Counseling Psychology 149 REFERENCES 151 V ACKNOWLEDGMENTS 164 APPENDIX A: COMPREHENSIVE INVENTORY OF RESPONSES TO COMMON LIFE EVENTS (CIRCLE) 167 APPENDIX B: LIFE EVENTS CHECKLIST PILOT STUDY 187 APPENDIX C: PROGRAM TO CALCULATE BARTLETT'S CHI-SQUARE 200 I vi LIST OF TABLES Table 1. Symptoms of grief: A summary of symptoms described by Lindemann (1944), Marris (1974), Parkes (Parkes, 1985; Parkes & Weiss, 1983; Glick, Weiss, & Parkes, 1974), and Worden (1982). 36 Table 2. Demographic characteristics assessed 50 Table 3. Alphabetical list of life events proposed for the Life Events Checklist of CIRCLE 51 Table 4. Categorical list of life events proposed for the Life Events Checklist of CIRCLE 53 Table 5. Life Events Checklist pilot study: University Counseling Center, Colorado State University 58 Table 6. Paired comparisons t tests between perception of loss and perception of stress for each life event (life events pilot study) . 59 Table 7. Alphabetical list of the final pool of items for the Life Events Checklist of CIRCLE 64 Table 8. Categorical list of the final pool of items for the Life Events Checklist of CIRCLE 70 Table 9. Items proposed for the Affect Checklist 71 Table 10. Items proposed for the Behaviors Checklist 74 Table 11. Items proposed for the Interpersonal Behaviors Checklist .... 75 Table 12. Items proposed for the Cognitions Checklist 76 Table 13. Items proposed for the Physical Symptoms Checklist 77 Table 14. Demographic characteristics of the sample (frequencies and percentages) 81 Table 15. Frequencies of life events 83 vii Table 16. Paired comparisons t test between importance item and perception of loss item (items f test) 87 Table 17. Paired comparisons t test between reactions item x importance item and reactions item X perception of loss item (severity f test) . 90 Table 18. Evaluation of the significance of the data matrix using Bartlett's chi-square test 95 Table 19. Rotated factor loadings for the Affect Checklist 101 Table 20. Variance accounted for by the factors in the Affect Checklist . 102 Table 21. Rotated factor loadings for the Behaviors Checklist 103 Table 22. Variance accounted for by the factors in the Behaviors Checklist . 103 Table 23, Rotated factor loadings for the Interpersonal Behaviors Checklist 105 Table 24. Variance accounted for by the factors in the Interpersonal Behaviors Checklist 105 Table 25, Rotated factor loadings for the Cognitions Checklist 106 Table 26. Variance accounted for by the factors in the Cognitions Checklist 106 Table 27. Rotated factor loadings for the Physical Symptoms Checklist . 108 Table 28. Variance accounted for by the factors in the Physical Symptoms Checklist 108 Table 29. Descriptive statistics for CIRCLE scale scores 110 Table 30. Correlations between CIRCLE scale scores Ill Table 31. Rotated factor loadings for a principal factors analysis of CIRCLE symptom scales 116 Table 32. Variance accounted for by the factors in a principal factors analysis of CIRCLE symptom scales 116 Table 33. Cronbach's coefficient alpha for CIRCLE symptom scales . .117 I viii Table 34, Correlations between Life Events Checklist severity score (LEC-S) and negative