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Appendix 1: Questionnaire

Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

4. Did you have bad dreams of □ □ □ □ □

your baby's death?

5. Did you have upsetting □ □ □ □ □

memories of your baby's death?

6. Did you have any sudden □ □ □ □ □

feelings as though your baby's


death was happening again?

7. Did you try to avoid thinking □ □ □ □ □

about your baby's death?

8. Did you avoid doing things that □ □ □ □ □

might bring up feelings you had


about your child's death (e.g. Not
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

watching a TV show about


SIDS)?

9. Were you unable to remember □ □ □ □ □


aspects of your baby's death?

10. Did you lose interest in doing □ □ □ □ □

things you usually do (e.g. Did

you lose interest in your work or


family)?

11. Did you feel alone and □ □ □ □ □

removed from other people (e.g.

Did you feel like no one


understood you)?

12. Did it become more difficult □ □ □ □ □

for you to feel tenderness or love


with others?
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

13. Did you have unusual □ □ □ □ □

difficulty falling asleep or staying


asleep?

14. Were you more irritable or □ □ □ □ □

angry with others than usual?

15. Did you have greater □ □ □ □ □

difficulties concentrating than


before your baby died?

16. Did you feel more jumpy (e.g. □ □ □ □ □

Did you feel more sensitive to


noise, or more easily startled)?
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

17. Did you feel more guilty about □ □ □ □ □

the death than you felt you should


have?

How do you feel now

Less Once a Once a week, Once a Many times


than month, but but less than day during the
once a less than once a day day
month once a week

17. I feel myself longing for my □ □ □ □ □

baby

18. I feel that I have trouble □ □ □ □ □


accepting the death of my baby
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

19. I think about my baby so □ □ □ □ □

much that it's hard for me to do


the things I normally do

20. Memories of my baby upset □ □ □ □ □

me

21. I feel drawn to places and □ □ □ □ □


things associated with my baby

22. I can't help feeling angry □ □ □ □ □

about my baby's death

23. I have happy memories about □ □ □ □ □


my baby
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

24. I go out of my way to avoid □ □ □ □ □


reminders of my baby

25. I feel envious of others who □ □ □ □ □

have not lost someone close

26. I feel disbelief over what □ □ □ □ □


happened

27. I have episodes of feeling □ □ □ □ □

happy or content overall

Do not Mostly disagree Neither agree nor Mostly agree Completely


agree at all disagree agree

28. I have come to accept the □ □ □ □ □


death of my baby
Your feelings

Please tick the box for the answer that best reflects your grief in the first 6 months following the
death of your baby using the following responses:

Not at all Once or Sometimes Often but Often, for


twice less than more than
one one month
month

29. I have felt on edge, jumpy or □ □ □ □ □

easily startled since the death of


my baby

30. I feel that life is empty since □ □ □ □ □

the death of my baby

31. I draw strength from the □ □ □ □ □


memory of my baby