Anticipatory Grief Scale
Also known as: AGS, Theut Anticipatory Grief Scale
The Anticipatory Grief Scale (AGS) is a measure developed by Theut, Jordan, and colleagues in 1990 to assess grief responses in individuals facing impending loss—such as family members caring for a terminally ill loved one or anticipating a predicted death. The AGS captures the emotional burden, depression, existential concern, and functional disruption that often precede and accompany the final illness period, distinct from post-death grief.
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When to use it
The AGS is indicated for: assessment of emotional burden in family members of terminally ill or seriously ill individuals to identify those needing support; research examining relationships between anticipatory grief and post-death outcomes (e.g., complicated grief, depression, caregiver health); outcome measurement in hospice and palliative care interventions targeting family emotional support; identification of high-risk individuals (high anticipatory grief, depression, burden) warranting intensified support; and longitudinal research tracking grief trajectories from anticipatory period through bereavement.
Strengths & limitations
- Addresses under-recognized period of grief; acknowledges that grief begins before death and that pre-death emotional burden warrants assessment and support.
- Practical application in healthcare settings: identifies family members at risk for poor post-death outcomes or depression during caregiving; guides supportive interventions.
- Captures unique dimensions of anticipatory grief (role change, existential concern, preparation) distinct from post-death grief, enabling more nuanced understanding.
- Well-validated in diverse populations (spouses of dying partners, adult children of dying parents, parents of dying children); consistently predicts post-death depression and complicated grief.
- Brief and easy to administer in medical and hospice settings where time and respondent burden are limited.
- Anticipatory grief is not uniformly negative; some research suggests that gradual adaptation before death, saying goodbye, and completing unfinished business can facilitate better post-death adjustment. The AGS measures grief burden but not adaptive processes.
- Substantial variability in AGS scores based on illness stage and trajectory; individuals in early illness may score lower than those in active dying phase. Serial assessment across illness period is valuable but increases administrative burden.
- Limited assessment of individual and contextual factors predicting anticipatory grief intensity; same loss context produces wide variation in anticipatory grief across individuals.
- Relationship to post-death grief is complex: high anticipatory grief may predict greater post-death complications (loss of caregiver role, depression), but gradual adaptation may reduce post-death distress. Prognostic utility is modest.
- Cultural variation in anticipatory grief expression not explicitly addressed; cultures vary in whether pre-death grief is openly expressed or privately experienced.
Frequently asked
Is anticipatory grief the same as grief after death?
No. Anticipatory grief occurs before death and involves grief about the impending loss, anxiety about the dying process, and role/identity changes coming. Post-death grief occurs after death and involves responding to the actual loss, accepting the reality, and reconstructing identity. Both are forms of grief but differ in context, focus, and available coping (you can still interact with the dying person; not with the deceased). Some aspects of anticipatory grief (saying goodbye, completing unfinished business) can facilitate post-death adaptation.
If I score high on the AGS, does that mean I'm not coping well?
High AGS scores indicate significant emotional burden from anticipatory grief—sadness, anxiety, depression about impending loss. This is often a normal response to terminal illness, not necessarily a sign of poor coping. However, if high scores are accompanied by depression (hopelessness, anhedonia), social withdrawal, or neglect of self-care, professional support is warranted. Differentiate anticipatory grief (normal) from depression (potentially requiring intervention).
Can anticipatory grief prevent complicated grief after the death?
Partially. Research shows anticipatory grief can facilitate pre-death adaptation, saying goodbye, and meaning-making, which may reduce post-death distress. However, high anticipatory grief (particularly accompanied by caregiver role burden and isolation) can also predict post-death complications, particularly loss of caregiver identity and depression. Moderate anticipatory grief with good support tends to predict the best post-death outcomes.
Should I take medication if my AGS score is high?
Medication is rarely necessary for anticipatory grief alone. First-line support includes counselling, validation, family support, meaning-making activities (legacy projects, memory work), and potentially hospice/palliative care support. Medication is indicated if depression symptoms (hopelessness, anhedonia, suicidality) emerge, which warrant psychiatric assessment. Discuss with your healthcare provider.
When should the AGS be administered during an illness?
The AGS is most meaningfully administered when the dying trajectory is clear—typically when death is expected within weeks to months, prognosis is communicated, or active dying phase is approaching. Administering at diagnosis of a serious but potentially treatable illness may be premature; anticipatory grief intensity increases as death becomes more imminent. Serial assessment across the illness period tracks grief changes over time.
Sources
- Theut, S. K., Jordan, P., Ross, L. A., & Mutlak, S. (1990). Grief, depressive symptoms, and physical health in elderly adults. Journal of the American Geriatrics Society, 38(10), 1041–1048. link ↗
How to cite this page
ScholarGate. (2026, June 3). Anticipatory Grief Scale. ScholarGate. https://scholargate.app/en/bereavement-psychology/anticipatory-grief-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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