Empirical Validation and Predictive Utility of the Perinatal Grief Scale in Men after Perinatal Loss

Background. The Perinatal Grief Scale (PGS) is a widely used instrument for assessing grief following pregnancy loss, yet no study has validated it specifically in men despite documented use in several studies. This gap is critical given fathers' persistent underrepresentation in perinatal bereavement research and the absence of empirically supported screening thresholds for this population. Methods. This cross-sectional validation study used data from the OPALE project (Observatory on PerinatAL hEalth) conducted by the CiaoLapo Foundation in Italy. Among 276 fathers who experienced stillbirth or miscarriage, we examined criterion validity by testing the association between PGS scores and trauma-related symptomatology assessed via three validated instruments: the Revised Impact of Event Scale (RIES, n=103), National Stressful Events Survey Short Scale (NSESSS, n=95), and SCL-90 (n=173). We systematically tested multiple threshold combinations to identify optimal discriminative performance. Results. The PGS demonstrated excellent criterion validity. The optimal threshold (PGS >=92) showed sensitivity 81.0%, specificity 81.8%, and Youden's J index 0.628. Fathers scoring >=92 had 19.12 times the odds of high trauma symptoms (95% CI: 9.35 to 39.14, p<0.001). ROC analysis yielded AUC=0.829 (95% CI: 0.778 to 0.880). Associations remained robust across all three trauma instruments in stratified analyses and after adjusting for time since loss, father's age, living children, and loss type. Conclusion. This is the first men-specific validation of the PGS, demonstrating strong criterion validity and establishing a clinically meaningful screening threshold (>=92) for identifying fathers at elevated risk following perinatal loss.