The Construct Validity and Reliability of the Persian Version of the Depressive and Anxious Avoidance in Prolonged Grief Questionnaire in Suicide-Loss Survivors

Abstract

Background: Suicide loss survivors (SLSs) commonly experience negative grief responses, including symptoms of prolonged grief disorder (PGD). Cognitive-behavioral models propose that both anxious and depressive avoidance (DA) are critical factors in the onset and maintenance of prolonged grief. Objectives: This study aimed to evaluate the construct validity and reliability of the Persian version of the Depressive and Anxious Avoidance in Prolonged Grief Questionnaire (DAAPGQ) among Iranian SLSs. Methods: A cross-sectional study was conducted between 2023 and 2024. A total of 170 suicide survivors were selected through convenience and snowball sampling. Participants completed the DAAPGQ, the Prolonged Grief Disorder Scale-13-Revised (PG-13-R), the Hospital Anxiety and Depression Scale (HADS), and the Utrecht Grief Rumination Scale (UGRS). Construct validity was investigated using confirmatory factor analysis (CFA), assessing both a correlated two-factor model and a higher-order factor model. Convergent and discriminant validity were examined via average variance extracted (AVE), average shared variance (ASV), and maximum shared variance (MSV). Concurrent validity was assessed through correlations with relevant psychological constructs. Internal consistency was estimated using Cronbach’s alpha and McDonald’s omega coefficients. Results: The CFA results showed that both the correlated two-factor model and the higher-order factor model provided satisfactory model fit, with the higher-order factor solution demonstrating slightly superior indices. Internal consistency for the total scale was excellent (Cronbach’s α = 0.91; McDonald’s ω = 0.91), and subscales for DA (α = 0.91, ω = 0.91) and anxious avoidance (AA, α = 0.82, ω = 0.84) were also robust. Both subscales had AVE values above 0.50 and exceeded ASV and MSV, supporting construct validity. The DAAPGQ scores were positively associated with PGD, depression, anxiety, and rumination, and negatively with time since loss. Hierarchical regression showed DA (β = 0.553, P < 0.001) and AA (β = 0.242, P < 0.001) significantly predicted PGD symptoms, with the final model explaining 66.4% of the variance. Conclusions: The Persian DAAPGQ is a psychometrically sound measure for the assessment of depressive and AA in SLSs with symptoms of prolonged grief.