Adaptación al español y validación de la Escala de Continuidad de Vínculos (ECV) con el ser querido fallecido

  1. Alfonso Miguel García Hernández 1
  2. Pedro Ruymán Brito Brito 1
  3. Martín Rodríguez Álvaro 1
  4. Domingo Ángel Gutiérrez Fernández 1
  5. Cristo Manuel Marrero González 1
  6. Carlos Enrique Martínez Alberto 1
  7. Daniel Martínez Esquivel 1
  1. 1 Universidad de La Laguna

    Universidad de La Laguna

    San Cristobal de La Laguna, España


Cultura de los cuidados: Revista de Enfermería y Humanidades

ISSN: 1699-6003

Year of publication: 2021

Issue: 60

Pages: 266-290

Type: Article

More publications in: Cultura de los cuidados: Revista de Enfermería y Humanidades


This study presents the Spanish validation of the Continuituing Bonds Scale (CBS) composed of two dimensions: Internalised (10 items) and externalised (6 items). First, translation-retro translation was carried out. A total of 255 mourners from the Canary Islands (Spain) participated in the test and responded through a survey (FebruaryMarch 2021). Profile: women, middle-aged, higher education, active at work, time since loss 2-5 years and most common relationship, parents. Internal consistency yielded a Cronbach's α=0.914 and good item-total score correlations, ranging 0.478-0.720. In testretest reliability, agreement scores were excellent (ICC=0.889; 0.795-0.940). In convergent validation, a correlation with the Inclusion of the Other in the Self (IOS) scale of rs=-0.402 (p<0.001) was adequate. For concurrent construct validity total scores correlated with summative variables of Prigerson prolonged grief and NANDA-I nursing diagnoses: rs=0.568, rs=0.391, rs=0.408, and rs=0.446 (p<0.001). Factor analysis confirmed two dimensions, and the total variance explained was 57.153%. Finally, known-group validity showed differences according to sex, kinship and cause of death. The CBS adapted and validated to the Spanish context, ECoVin, is a valid, reliable and easy-to-use instrument to assess the continuity of bonds with deceased loved ones.

Bibliographic References

  • Albuquerque, S., Pereira, M., & Narciso, I. (2019). Portuguese Version of the Continuing Bonds Scale-16 in a Sample of Bereaved Parents. Journal of Loss andTrauma, 25(3), 245-263. doi:
  • Anastasi, A. 1976. Psychological testing (4th ed.). New York: MacMillan.
  • Aron, A., Aron, E.N., & Smollan, D. (1992). Inclusion of the other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology,63, 596-612. doi:
  • Badía, X., & Alonso, J. (2007). La medida de la salud. Guías de escalas de medición en español. 4ª ed. Barcelona: Editec.
  • Bruner, J. (1986). Actual minds, possible worlds. Jerusalem: Harvard University Press.
  • Carretero-Dios, H., & Pérez, C. (2005). Normas para el desarrollo y revisión de estudios instrumentales. International Journal of Clinical and Health Psychology, 5(3), 521-551.
  • Chan, Y.H. (2003). Biostatistics 104: correlational analysis. Singapore medical journal,44(12), 614–619.
  • Clark, L.A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309-319. doi:
  • De Luca, M.L., Grossi, G., Zacarello, G., Greco, R., Tineri, M., Slavic, E., …Palummieri, A. (2016). Adaptation and validation of the “Continuing Bond Scale” in anItalian context. An instrument for studying the persistence of the bond with the deceased in normal and abnormal grief. International Journal of Psychoanalysis and Education,8(2), 37-52.
  • Djelantik, A.A.A.M., Smid, G.E., Mroz, A., Kleber, R.J., & Boelen, P.A. (2020). The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. Journal of Affective Disorders,15(265), 146-156. doi:
  • Field, N.P., Nichols, C., Holen, A., & Horowitz, M.J. (1999). The relation of continuing attachment to adjustment in conjugal bereavement. Journal of Consulting and Clinical Psychology, 67, 212-218. doi:
  • Field, N.P., Gal-Oz, E., & Bonanno, G.A. (2003). Continuing bonds and adjustment at 5 years after the death of a spouse. Journal of Consulting and Clinical Psychology, 71(1), 110-117. doi:
  • Field, N.P., & Filanosky, C. (2010). Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement. Death Studies, 34, 1-29.
  • Freud, S. ([1917] 1957). Mourning and melancholia. En: J. Strachey (Ed., trans.), Standard edition of the complete psychological works of Sigmund Freud (pp. 251-268). London: Hogarth.
  • García Hernández A.M., (2010). Vivir el duelo. La experiencia de perder un hijo. Tenerife, España: Ediciones Idea.
  • García Hernández, A.M., Rodríguez Álvaro, M., Brito Brito, P.R., Fernández Gutiérrez, D.A., Martínez Alberto, C.E., & Marrero González, C.M. (2021). Duelo adaptativo, no adaptativo y continuidad de vínculos. Revista ENE de Enfermería, 15(1). Recuperado de
  • García García, J., Landa, V., Prigerson, H., Echeverría, M., Grandes, G., Mauriz, A., & Andollo, I. (2002). Adaptación al español del Inventario de Duelo Complicado (IDC). Medicina Paliativa, 9(2), 10-11.
  • George, D., & Mallery, P. (2003). SPSS for Windows step by step: A simple guide and reference. 11.0 update (4th ed). Boston: Allyn & Bacon.
  • Herdman, T.H., & Kamitsuru, S. (2015). Diagnósticos enfermeros. Definiciones y clasificación 2015-2017. (10ª ed.). Barcelona: Elsevier.
  • Herdman, T.H., & Kamitsuru, S. (2019). Diagnósticos enfermeros. Definiciones y clasificación 2018-2020. (11ª ed.). Barcelona: Elsevier.
  • Herdman, T.H., Kamitsuru, S., & Takáo Lopes, C. (2021). Nursing diagnoses. Definitions and classification 2021-2023. (12ª ed.). New York: Thieme.
  • Holmes, T.H., & Rahe, R.H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11(2), 213-218. doi:
  • Klass, D., Silverman, P.R., & Nickman, S.L. (Eds.) (1996). Continuing bonds: New understandings of grief. New York: Routledge.
  • Kline, P. (1994). An easy guide to factor analysis. New York: Routledge.
  • MacCallum, R.C., Widaman, K.F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84-99. doi:
  • Maneesriwongul, W., & Dixon, J.K. (2004). Instrument translation process: A method review. Journal of Advanced Nursing, 48(2), 175-186. doi:
  • Mei, L., Jie, L.I., & Kan, S. (2015). Chinese version of continuing bonds scale: Validation and preliminary application. Chinese Journal of Clinical Psychology, 23(2), 251-255. doi:
  • Nunnally, J.C., & Bernstein, I.H. (1994). Psychometric Theory (3th ed.). New York: McGraw-Hill.
  • Prigerson, H.G., Shear, M.K., Jacobs, S.C., Reynolds, C.F., Maciejewski, P.K., Davidson, J., ... Zisook, S. (1999). Consensus criteria for traumatic grief. A preliminary empirical test. The British Journal of Psychiatry, 174, 67-73. doi:
  • Prigerson, H.G., & Jacobs, S.C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria and a preliminary empirical test. En: Stroebe, M.S., Hansson, R.O., Stroebe, W., & Schut, H. (eds.). Handbook of bereavement research: Consequences, coping, and care (pp.613-645). Washington DC: American Psychological Association.
  • Rodríguez Álvaro, M., García Hernández, A.M., & Toledo Rosell, C. (2008). Duelo y duelo complicado en las consultas de Enfermería de Atención Primaria. Revista ENE de Enfermería, 3, 20-33.
  • Rodríguez Álvaro, M., García Hernández, A.M., & Brito Brito, P.R. (2020). Grieving is not a nursing diagnosis. International Journal of Nursing Knowledge, 31(4), 260-261. doi:
  • Stroebe, M., Schut, H., & Boerner, K. (2010). Continuing bonds in adaptation to bereavement: Toward theoretical integration. Clinical Psychology Review, 30(2010), 259-268.