Parental grief: a qualitative analysis of gratitude

ABSTRACT

Background: Gratitude in the context of parental grief is a relatively underexplored area that warrants attention due to its potential impact on the grieving process and personal growth following a traumatic loss.

Objective: This qualitative study aims to explore the role of gratitude within the traumatic context of parental bereavement, examining the types and processes of gratitude experienced by bereaved parents.

Method: The research employed thematic analysis based on a conceptual model of gratitude to investigate the experiences of grieving parents. It identified various manifestations of gratitude, both explicit and implicit, throughout the grieving process.

Results: Findings reveal that gratitude plays a complex role in the experience of parental bereavement. Participants reported experiencing interpersonal, transcendental, and adversity-related gratitude. Key processes identified include recognition of gifts, attribution to agents, and valuing experiences. Factors that facilitate or hinder gratitude were also explored.

Conclusions: This study contributes to the limited literature on gratitude in parental bereavement and provides valuable insights for developing supportive interventions. It highlights the potential of gratitude as a coping mechanism and a pathway for personal growth in the face of profound traumatic loss, offering a nuanced understanding of its role in the grieving process.

HIGHLIGHTS

• Exploration of Gratitude: The study investigates how different types of gratitude manifest in bereaved parents during their grieving process.

• Complex Role in Grief: Findings reveal that gratitude can be both a source of comfort and a complex emotional experience for parents coping with loss.

• Implications for Support: Insights from this research can inform the development of interventions aimed at helping bereaved parents harness gratitude as a coping strategy for personal growth.

1. Introduction

1.1. Parental grief

Gratitude and parental grief sound somewhat contradictory as they evoke representation of different affective valence. However, we intended to delve deeper into the relationship between these contradictory concepts to better understand the complexities of grief after losing a child, aligning ourselves with the perspective that grief can be a catalyst for growth within the context of second wave positive psychology (Daly et al., 2019; Lomas & Ivtzan, 2016).

According to the 2022 annual report by the United Nations International Children's Emergency Fund (UNICEF), a staggering five million children die before reaching their fifth birthday. Additionally, over two million children and young people aged five to twenty four lost their lives in 2021, with the UN estimating that fifty nine million more could die by 2030. These figures underscore the significant number of parents who are and will be confronted with parental grief, along with the psychological challenges it entails (Foraster Garriga, 2023).

In a culture where death is a strong taboo, the loss of a child is particularly traumatic, leaving parents feeling misunderstood, isolated, and inexperienced in managing their grief (Porta et al., 2013; Reis et al., 2021). While parental grief is acknowledged as an extremely challenging psychological experience, it remains under-researched compared to general grief, with relatively few empirical studies focusing specifically on this profound form of loss (Hazzard et al., 1992).

1.2. Theoretical framework of parental grief

Parental grief has often been described as an unending process, wherein parents find themselves in a profoundly altered reality (Denhup, 2017). This form of grief has been noted for its heightened severity, duration, and complexity compared to other types of grief (Hazzard et al., 1992). It also has the potential to evolve into complicated grief (American Psychiatric Association, 2013), exacerbating adverse symptoms that can lead to maladaptive behaviours, thereby hindering the healing process (Neimeyer & Ramírez, 2002). Research conducted by Burke et al. (2014) indicated that parental grief significantly increases the risk of insomnia, substance abuse, cardiovascular diseases, and suicide attempts, underscoring the profound psychological and physical impact of such loss. However, this perspective may offer only a partial view of the grieving process. In contrast, the Dual Process Model of coping with bereavement proposed by Stroebe and Schut (1999) emphasizes that grief is not a linear trajectory and highlights the importance of acknowledging potential positive outcomes, such as personal growth and identity reconfiguration. This model encourages a more nuanced understanding of bereavement, moving beyond a focus solely on pathology.

As previously noted, the existing literature on parental grief is already limited, as evidenced by three systematic reviews (Ainscough et al., 2019; Kochen et al., 2020; Pelacho-Rios & Bernabe-Valero, 2023). Within this already scarce body of work, research that specifically addresses our focus – the role of gratitude in parental grief – is even more limited, making it an underexplored and highly relevant area of study.

Regarding gratitude and grief, Greene and McGovern (2017) showed that dispositional gratitude correlates with psychological well-being and post-traumatic growth in adults who lost their parent in childhood. Beckley's (2022) research indicated that gratitude can mediate prolonged grief, while Popovich (2014) found that spiritual traditions fostering gratitude help manage perceptions of loss. Lastly, Upenieks and Ford-Robertson (2022) showed that gratitude towards God can mitigate negative health effects associated with loss, suggesting that gratitude predicts better health outcomes. In summary, it is highlighted that gratitude not only has positive effects on psychological well-being since certain findings suggest that practicing gratitude influences attitude, meaning and positive emotion, and can generate resilience and personal growth throughout the process of grief (Elfers et al., 2024).

However, only two studies have explored the relationship between gratitude and parental grief. The first, by Meert et al. (2005), examined the spiritual needs of parents grieving a child's death in a pediatric intensive care unit, finding that gratitude for their child's life and care provided comfort and meaning. The second study, by Cuervo-Suarez et al. (2024), involved a workshop where bereaved families created thank you cards, reflecting themes like communication, hope, and acceptance, demonstrating how gratitude can aid emotional management in grief.

In conclusion, despite extensive literature on grieving, the specific impact of gratitude on parental grief remains highly underexplored. Additional research is needed to understand how gratitude influences grieving parents and how it can be integrated into psychological interventions and emotional support for affected families.

1.3. Gratitude

Our aim was to explore the processes of gratitude within parental grief, drawing on a conceptualization and theoretical framework from the Psychology of Gratitude that was both comprehensive and specifically suited to this context. For this purpose, we were guided by Bernabe-Valero's (2012) model of Gratitude, which allowed us to differentiate between different types of gratitude and processes that can happen for gratitude to occur. This model forms the theoretical basis of the G-20 Gratitude Questionnaire (Bernabe-Valero et al., 2020) in Spanish and (Bernabe-Valero et al., 2020) in English.

Thus, based on Bernabe-Valero's model (2012), it is proposed that there four fundamental types of gratitude exist; two depending on the agent; (1) interpersonal gratitude (the gratitude towards other people who have benefited us) and (2) transcendental gratitude (gratitude towards transcendental forces, according to the existential reference of each person; commonly God, Divine Fortune, Life … etc.). On the other hand, two other types of gratitude depending on the object exist; (3) gratitude in the face of suffering that arises as a response to adversity and (4) gratitude for the recognition of positive gifts, experienced when the most prototypically positive aspects are valued (qualities, pleasant experiences, help, … etc.). In addition, the following processes are involved in gratitude: detection/recognition of gifts; appraisal of the object of gratitude (positive object or resignification of adversity); emergence of the emotion of gratitude and expression of gratitude (Bernabe-Valero, 2012). For a representation of the model, see Figure 1. The proposed model helps to understand the role that gratitude plays in parental bereavement.

Figure 1.

Conceptual scheme of the Bernabé-Valero (2012) Gratitude model.

These conceptualizations align with the findings of Hlava and Elfers (2014), who explored the lived experience of gratitude and identified similar elements. Notably, they described trascendental experiences of gratitude as especially intense and emotionally rich. These experiences – often evoked by encounters with nature, the sacred, or overwhelming emotional states – were described by participants as moments of reverence, awe, or the sublime. In some cases, participants reported being moved to silence, highlighting the difficulty of cognitively processing such powerful emotional experiences in the moment. Including these dimensions deepens the understanding of how gratitude can be felt and expressed in contexts of profound existential significance, such as the loss of a child.

To enrich the theoretical framework, we expanded the literature review to include gratitude as an emotional experience, emphasizing its phenomenological and cognitive aspects. Gratitude is an emotional experience involving a range of subjective feelings, such as joy, love, awe, and relief, often accompanied by a sense of being blessed. These emotions can be intense, especially when evoked by experiences of reverence or emotional awakening. Gratitude fosters a sense of connection and reciprocity between the self and others (Hlava & Elfers, 2014).

On the other hand, cognitive appraisal theories suggest that gratitude results from specific evaluations of the emotional experience, with key factors such as the responsibility attributed to the benefactor, perceived responsiveness, and the unexpected nature of the benefit (Kuranaga & Higuchi, 2011; Ruyi et al., 2014). In some contexts, gratitude may coexist with mixed emotions such as guilt, disappointment, or anger, especially when there is conflicting evaluation (e.g. receiving unwanted help) (Oh & Tong, 2023).

Therefore, previous literature suggested that gratitude was a multidimensional construct that combined both affective and cognitive components, which predicted subjective well-being. While affective gratitude typically correlated with positive well-being, cognitive gratitude, particularly when linked to obligation, had less favourable outcomes in certain contexts. This understanding helped frame the role of gratitude in parental bereavement (Li et al., 2024; Zhang et al., 2022).

1.4. Investigation objectives

We intended to analyse the gratitude processes among parents who have experienced parental grief. The principal research question that guided our analysis was: What role does gratitude play in the experience of parental bereavement and how is gratitude experienced after the loss of a child?

The specific objectives were:

1. To analyse the different phases of the gratitude process experienced by parents who have gone through parental bereavement.

2. To explore the diverse forms of gratitude that have emerged throughout the grieving process.

3. To explore variables that may facilitate or hinder the process of gratitude in parental bereavement.

2. Materials and methods

Considering the novelty of the topic, this study was conducted using qualitative methodology involving interviews with parents about their grief. This approach is effective in providing the researcher with substantial information on topics that have scarce antecedents. In the field of psychology, qualitative methodology allows us to explore and understand the complexity of human behaviour and subjective psychological processes and the contexts in which they take place (O'Brien et al., 2014). We therefore considered qualitative methodology to be suitable and that interviews were the best tool to study particularly sensitive topics on a personal level, such as the loss of a child (Tong et al., 2007). Additionally to this, any interaction about a loss has the potential to provide new awareness, integration and feelings of healing, making interviews even more appropiate (Rosenblatt, 1995).

In this study, we positioned ourselves within a pragmatist epistemology in which three processes interrelate (Morgan, 2007). The first process combines diverse approaches for generating and testing theories; the experience the research group had as researchers and in parental bereavement therapists provided insight that gratitude could play an important role in parental bereavement (top-down approach) combined with knowledge about the psychology of gratitude (bottom-up approach). In the second process, from an intersubjective approach, moving between two perspectives, in our study the experience of parental bereavement can be viewed objectively and experienced subjectively, and recognizing both allows us to comprehend its complexities. In the third process, we focus on the transferability of knowledge that our study will have for its application to parents experiencing parental bereavement (Morgan, 2007).

To ensure maximum transparency in this study, the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used (Tong et al., 2007).

2.1. Participants

The study purposive sample includes 12 parents affiliated with the Renacer group (Renacer Barcelona, n.d.), a mutual aid group whose main objective is to accompany fathers and mothers after the death of their children. All parents had experienced parental bereavement, thus possessing high ‘informative power’, which may be considered as more important than the size of the sample (Malterud et al., 2016). Our 12 participants make up an adequate sample that has provided high-quality data, thus able to obtain valid conclusions.

The characteristics of the participants are shown in Table 1. Of the 12 participants, 9 of them were women and 3 were men. The average age of the participants was 60.7 years (ranging from 45 to 76). The ages of the children at death had an average of 17.17 years (ranging from 8 to 31 years old), being 7 of them female and 4 of them males. The time since death ranged from 1 year to 13 years. Average time elapsed since death was approximately 4 years and 2 months. The types of death were varied, including natural and external causes of death.

Table 1.

Demographic information of participants.

ID number	Sex	Age	Age of child at death	Years since death	Sex of child	Cause of death
1	Woman	60	20	6 years and 1 month	Female	Allergy
2	Woman	50	15	2 years and 4 months	Male	Cerebral haemorrhage
3	Woman	54	19	5 years	Female	Car accident
4	Woman	57	19	3 years and 8 months	Female	Suicide
5	Woman	56	18	2 ½ years	Male	Accident
6	Woman	45	8	1 year	Female	Accident
7	Woman	63	17	13 years	Female	Cancer
8	Woman	51	20	1 year and 3 months	Female	Car accident
9	Woman	76	31	6 years	Male	Asfixia
10	Man	51	19	5 years	Female	Car accident
11	Man	63	30	4 years and 9 months	Male	Tetraplegia
12	Man	52	20	1 year and 2 months	Female	Car accident

One aspect that may influence the experience of grief is religious belief, particularly beliefs regarding life after death. In this regard, it is worth noting that all participants who spoke about their religious beliefs identified as Catholic – a religion rooted in the belief in eternal life, whereby the soul continues to exist after death. Among these participants, the degree of religious involvement varied, ranging from individuals with strong religious convictions to those with low levels of religiosity. It should be noted, however, that this observation only applies to participants who explicitly mentioned their religious beliefs; for those who did not address this topic, no assumptions can be made.

2.2. Research team

The research team comprised two clinical psychologists and researchers specializing in existentialist and positive psychology, being one of them doctoral-level experts in gratitude, grief, and life meaning and the other, a doctoral student, experienced in grief counselling, who assisted in conducting interviews and transcriptions and also led the data analysis. Additionally, an expert in sociology with expertise in qualitative data also guided the data analysis process. Postgraduate students with training in psychological intervention and grief studies also conducted interviews under supervision of the research team. Interviewers were prepared to support participants, providing introductions and debriefings to address concerns sensitively. This diverse team ensured a comprehensive approach to the study of parental grief.

2.3. Methods of data collection

An interview guide was designed to address various topics of interest. In the frames of the current paper we are focusing on gratitude. The inquiries during the interview addressed the experience of parental grief, as well as the factors that contributed to their recovery. The interviewers made sure to establish rapport with the participants before starting to inquire about bereavement, in order to favour verbal and emotional expression of this sensitive topic.

The interview collected sociodemographic information and various aspects of the bereavement experience, including the inquiry about the factors that have helped and hindered the bereavement process. Specifically, to investigate gratitude, the main objective of this article, the following questions were asked:

What role has gratitude played in this entire grieving process? Gratitude towards others, towards God or life? Has your way of experiencing gratitude changed?

These specific questions on gratitude were designed to elicit more explicit manifestations of this process. However, throughout the interview, inquiries about the experiences during the bereavement continued to be made, allowing for less explicit elements of gratitude to emerge. Thus, elements of gratitude emerged throughout the interview and were incorporated into the thematic analysis.

2.4. Procedure

Firstly, contact was established with the head of the Renacer association, with the aim of proposing the research and coordinating a pilot test for the designed interview. This step was essential to ensure the viability and relevance of the study, by allowing the perspective of the participants themselves to be incorporated into the design of the data collection instruments.

Once confirmation was obtained from the person in charge, an appointment was scheduled with two mothers who were part of the association to carry out the pilot test of the interview. This exercise allowed us to evaluate the clarity and understanding of the questions, as well as adjust the language and duration of the interview according to the needs and characteristics of the target population. This pilot test was carried out in the training context in which the interviewers could be trained and resolve doubts about the interviews.

After implementing the modifications suggested during the pilot test, the rest of the interviews were carried out, interviewing a total of 12 participants from December 2022 to March 2023. Before proceeding with the interviews, participants were provided with a detailed explanation of the procedure and objectives. Their informed consent was obtained, and they were informed that they could revoke their participation in the study at any time. The study had the ethical approval of the Catholic University of Valencia (code UCV/2022-2023/024).

Psychologists specialized in bereavement conducted the designed interview, offering support to process what was discussed and providing additional emotional assistance to the participants if necessary.

All participants were offered three options for an interview: interview through a virtual platform (TEAMS), in-person interview in the Gesell room of the Faculty of Psychology of the Catholic University of Valencia or at the participant's own residence. Subsequently, after choosing the mode of the interview (in-person or online), a date was coordinated for its execution. A total of ten interviews were done in-person and 2 two were done online. All interviews were recorded and later transcribed. The transcriptions were carried out manually by our research team to prevent potential errors or loss of nuance and to ensure maximum data security throughout the process. Once transcribed, the interviews were anonymized and uploaded to a password-protected folder with restricted access.

2.5. Analysis

Thematic analysis was chosen to identify and describe patterns in qualitative data, specifically examining parents’ discourses primarily through a deductive approach (Braun & Clarke, 2021). The interviews were analysed through the lens of the conceptual model of gratitude (Bernabe-Valero, 2012) exemplified in Figure 1. Thus, the analysis followed the themes of gratitude processes (recognition of gifts, attribution to an agent, valuation of the gift, and emergence of gratitude), which in turn lead to different types of gratitude: interpersonal, transcendental, and in the face of suffering. After this analysis, variables that could favour or hinder the gratitude process emerged from an inductive perspective and were integrated into our analysis.

Prior to analysing the interviews, the research team convened several meetings to align on themes, codes, and resolve uncertainties, following Boyatzis’ (1998) recommendations: (1) establishing themes through reading and theory, (2) checking the compatibility of themes with the data, and (3) determining coder reliability. This collaborative approach aimed to minimize subjectivity and enhance objectivity in the analysis process, as recommended by Franklin and Ballan (2001).

A table was designed based on the themes of the Conceptual model of gratitude and was presented on an excel sheet (Figure 1 Supplementary material). Each researcher read the entire transcript of the interview and identified the themes in the table and added literal quotations. While the interview covered multiple aspects, this analysis focused specifically on the role of gratitude throughout the entire interview, not just when explicitly asked about this topic. By examining the interview in its entirety, it was possible to identify how gratitude was intertwined with other experiences and perspectives of the participants during their grieving process.

Weekly meetings were held to discuss the findings and reach consensus on the interpretation of the results. In this way, with the involvement of multiple coders, as suggested by Tong et al. (2007), contributed to a more comprehensive understanding of the phenomenon under study, enriching the overall analysis.

3. Results

The themes followed to structure the thematic analysis were based on Figure 1. It should be noted that in Tables 1 and 2 of the Supplementary material, explicit and implicit manifestations of gratitude were differentiated. We understand by explicit manifestations when the interviewees verbalized the word ‘thank you’, ‘gratitude’ or any of its variants following its etymological root (Table 1). The implicit manifestations that we have reflected in Table 2 take into consideration a broader model of gratitude, identifying those psychological processes congruent with the model, even when the interviewees did not explicitly express gratitude verbally or behaviourally.

3.1. First process: recognition of the gifts

In relation to the first process identified, the recognition of gifts, significant variability was observed among participants. A subgroup of interviewees had previously developed the ability to identify benefits or positive aspects derived from the experience of child loss. These participants spontaneously demonstrated this ability by mentioning specific situations during the interview, even before they were asked the explicit question about the role of gratitude in parental grief:

I was thankful for the family I had, starting with my husband and ending with my children … so I gave thanks for each one of them. (Participant 1)

On the other hand, a second subgroup of participants was identified who had not previously developed this awareness. For these participants, the interview itself functioned as an activator for awareness, allowing them to recognize for the first time that certain situations or experiences arising from the loss could be the object of gratitude. This finding suggests that the research process can have a transformative effect, facilitating reflection and the discovery of positive aspects in experiences previously perceived as exclusively negative. For example, there was one participant who commented:

Well, I think it is very important to be grateful from the first moment of the loss … I have a loss because I have had a gift before. (Participant 3)

Thus, we can say that those who had already become aware of the positive aspects obtained during the mourning process, would have been able to obtain the benefits of gratitude, since this first step of ‘Recognition of the gifts’ works as a funnel, and without it, the activation of the whole process is not possible. For the second subgroup, the explicit question functioned as an activator of the gratitude process, which allowed us to further deepen the entire process.

3.2. Second process: attribution of an agent

Regarding the process of Attribution of an Agent, it was possible to obtain elements of both the attribution of a personal agent and agents of transcendental forces, giving rise to two categories: Interpersonal gratitude and transcendental gratitude. The specific responses about the different agents are reflected in Table 1 (explicit expressions of gratitude), and Table 2 (implicit elements of gratitude) of the Supplementary material.

As presented in Tables 1 and 2 of the Supplementary material, the analysis of the interviews revealed that the participants in this study express gratitude in complex and multifaceted ways, encompassing both interpersonal and transcendental gratitude.

3.2.1. Interpersonal gratitude

Interpersonal gratitude (both explicit and non-explicit) is usually directed towards a wide range of individuals and groups, including family, friends, support professionals such as doctors and teachers, as well as institutions, associations and schools. It can be observed that in the non-explicit elements of gratitude, numerous parents specifically mentioned psychologists and Renacer as agents they value positively:

Renacer, it did us a lot of good at the beginning, it was very good for us because of not feeling that … alone, you know? (Participant 6)

Going to a psychologist helps. (Participant 11)

We also saw that this type of interpersonal gratitude extends to the deceased child, which blurs the line between interpersonal and transcendental gratitude, referring to a personal agent that is itself transcendental. The importance of religious beliefs, and specifically, the belief in ‘life after death or eternal life’ for the elicitation of this process is evident, as this suggests an ongoing and complex connection with the deceased child that transcends conventional categories, something that appears frequently in the participants’ narratives.

3.2.2. Transcendental gratitude

Transcendental gratitude, on the other hand, manifests itself in appreciation for Life, the present, a connection to something greater than themselves, and a thankfulness to a transcendental agent. Transcendental gratitude, though present, appeared in a more limited and abstract way than interpersonal gratitude This type of gratitude is directed toward abstract entities and concepts such as God or the Lord, nature, the gift of life, and the memory of deceased children.

However, within the aforementioned agents, we observed that participants manifest their gratitude in two main ways: some directed it specifically to God, reflecting the importance of religious beliefs in their grieving process, while others mentioned feeling grateful to life in general.

In the first place, gratitude towards ‘God’ or ‘the Lord’ was well reflected in the case of a woman. For her, faith and religious beliefs were fundamental in her grieving process. Through these beliefs, her gratitude intensified since the tragedy:

So, this circumstance, my daughter, through the Lord, has saved me, has saved me from a new life, a new life with meaning. (Participant 6)

My religious beliefs have helped me a great deal. (Participant 1)

In addition, as mentioned, we found interesting examples of transcendental gratitude without a traditional religious basis. A non-believer participant showed great spirituality and deep gratitude towards Life:

There is such a brutal change in me that I can only thank Life for what it has given me, now I relate to X (my deceased son) in a much more beautiful and healthy way. (Participant 1)

Continuing with the other most manifested agent in transcendental gratitude, being the gratitude towards life, we found another participant who, initially, found it difficult but who, with time, has come to be grateful for life in its totality:

At almost 13 years [of X … 's death] is when I give thanks to Life. I used to give gratitude for sectors, I gave gratitude for this, I gave gratitude for that … Now I am grateful for the whole of life. (Participant 7)

A particularly revealing theme in the context of transcendental gratitude manifested in a non-explicit way, has been the emergence of nature as a new and significant agent, indicating that, some bereaved parents have found solace, peace, or a deeper connection to the natural world.

In nature, we felt X close, and at first, very close. I mean, it was like being closer to him. It was good for us, the peace, the tranquillity. (Participant 2)

As discussed, an additional finding of considerable interest was the manifestation of transcendental gratitude toward abstract entities or concepts, something observed in a subset of participants, regardless of their religious beliefs. Importantly, this abstract and unspecific form of gratitude emerged as a recurring theme in the narratives of all participants, albeit with variations in expression and emphasis. An example may be that of a mother, who showed gratitude for the type of death her son had:

I also think about it and analyze it later and almost better for him to be happy one weekend and not suffering, compared to those who suffer and spend the last two years having a terrible time. (Participant 5)

Look, I thought that I was even lucky to be the one who found her. (Participant 4)

In summary, these narratives reveal how transcendental gratitude, whether directed towards God, life, or to abstract entities, played a fundamental role in the participants’ grieving process.

3.3. Third process: valuation of the gift

Regarding the process of valuing the gift, it was observed that most of the participants were able to identify positive aspects derived from their experience of loss. The objects of gratitude mentioned in the tables cover a wide range of elements, both at the interpersonal and transcendental levels, with, again, interpersonal gratitude being expressed the most frequently.

3.3.1. Interpersonal gratitude

In the area of interpersonal gratitude, participants experienced gratitude for more concrete objects (explicitly expressed as gratitude or not). Several categories synthesizing these objects of gratitude were identified: (1) appreciation of practical, emotional and psychological support received, particularly from mental health professionals and support groups; (2) recognition of the importance of non-discrimination or rejection by the social environment, suggesting a deep appreciation of social acceptance in times of vulnerability; (3) appreciation of concrete gestures of support, such as meal preparation, reflecting gratitude for practical, everyday care and the affection perceived for it.

3.3.2. Transcendental gratitude

As for transcendental gratitude, the objects of gratitude appeared in more abstract and conceptually broader forms. Participants expressed gratitude for having had the opportunity to parent their deceased child, recognizing the intrinsic value of that experience despite the pain of loss. In addition, they showed gratitude for all that life had given them, including their extended family, the opportunities that have arisen, and the experiences they have had. In addition to this, we found one participant who indicated appreciation for not having fallen into depression:

I feel privileged too. I didn't suffer from depression. (Participant 5)

Some interviewees found comfort in the idea that their deceased child had a happy life. There is also a general appreciation for the opportunities received. In addition, many participants acknowledged the personal growth they experienced through suffering.

Finally, some participants saw the life of their deceased children as a ‘gift from God’. This was the case of one woman, for whom faith and religious beliefs are fundamental in her grieving process. Seeing her daughter's life in this way allowed her to find transcendental meaning in her loss.

In summary, analysis revealed that participants’ personal values played a critical role in their ability to experience and express gratitude in the context of parental grief. These underlying values, such as receiving affection from others, appreciation of social support, and spiritual connection, appeared to facilitate the identification of positive aspects even in extremely painful circumstances:

And we are very grateful, because it takes a lot of courage to stand by a parent who loses a child. (Participant 2)

3.4. Valuation of the gift: resignification

The process of resignification was investigated to understand how some people manage to reject the overall negative connotation of adverse situations, transforming them into more positive conceptions. As shown in the diagram, this process of resignification can lead to the experience of gratitude in the face of suffering. Likewise, Table 3 of the Supplementary material addresses the gratitude that arises in response to suffering, illustrating how resignification contributes to a more adaptive and grateful approach in the face of adversity.

As discussed, the process of resignification is fundamental in facilitating gratitude in the face of suffering, as it allows individuals to transform adverse experiences into opportunities and to discover new meanings and purposes in their lives.

In the analysis of the process of resignification after the loss of a child, several key strategies were identified that allowed parents to find new meanings and purposes in their lives. These strategies, include (1) personal growth, where parents reported an internal strengthening and a change in their life priorities; (2) life purpose, which involved finding new missions, such as helping other parents in similar situations; (3) and spiritual connection, where some parents experienced a strengthening of their faith or a new spiritual connection. In addition, the son's legacy was another significant strategy, with parents finding comfort in keeping their son's memory alive through memorial actions. Appreciation of life and transformation of the loss were also highlighted, with parents who were able to see the loss as an opportunity for growth.

3.5. Appreciation of the gift: gratitude in the face of suffering

Next, we describe gratitude in the face of suffering, which is specifically manifested by the themes related to the death of the child and can emerge thanks to the process of resignification (Table 3 of the Supplementary material).

The qualitative analysis of the participants’ narratives revealed a significant finding: the expression of gratitude in the context of suffering emerges as the least prevalent theme, but for those participants who did experience it, it constituted a great strength. We have seen that the absence of gratitude in the face of suffering was markedly accentuated in circumstances characterized by intense feelings of guilt and in cases of particularly traumatic deaths. Moreover, the study identified an exceptional case that deserves special attention: a participant who demonstrated a total inability to verbalize any form of gratitude in the face of suffering in his traumatic experience.

However, it has been observed that those with a more developed capacity for emotional expression found gratitude in the face of suffering more easily, by processing their emotions effectively and resignifying death, giving it a new meaning that allowed them to integrate the loss in a constructive way:

I have developed an infinite potential, I mean, I had a potential waiting that if it was not for my daughter’s death I would never have developed. (Participant 1)

In the context of parental grief, parents found agents of gratitude in non-specific entities such as life, as well as in support groups such as Renacer and, in some cases, in the spouse. These agents represent to whom or to what the feelings of gratitude are directed despite the suffering.

As for the objects of gratitude in the face of suffering, it can be seen in Table 3 of the Supplementary material that suffering led parents to appreciate more the simple things in life, have greater empathy towards the suffering of others, value life more and experience a spiritual change. They also felt more united as a family and experienced a personal transformation, becoming more generous and grateful. The quotes underscore that, despite the pain, parents experienced a positive change in their outlook on life, leading them to express gratitude for the lessons learned and the resulting personal growth.

3.6. Fourth process: emergence of gratitude

Finally, we observed how gratitude can emerge from three possible processes: cognitive, emotional and behavioural. Cognitively, participants expressed gratitude through reflections on the meaning and value of Life, highlighting a change in their perception that lead them to appreciate simple things more and to value Life in a deeper way.

There are many things that at the beginning I didn't enjoy, I didn't care about, and now there are things that I am beginning to appreciate. (Participant 5)

Emotionally, gratitude manifests itself in a renewed sense of empathy and connection, allowing individuals to better understand the suffering of others and feel more connected to their loved ones, as seen in their narratives of bonding and mutual support.

You have more empathy for the suffering of others because you understand them better … . I put myself much more in other people's shoes. (Participant 5)

Behavioural gratitude is evidenced by concrete actions that reflect gratitude. This may include performing thanksgiving rituals or changes in daily behaviour, such as being more generous and grateful. Some participants mentioned that they have experienced such a significant personal change that they felt compelled to express their gratitude through actions that benefit others and themselves, showing a behavioural transformation toward a more grateful life.

Life has made me a different person and I like the person I am now. I am more generous; I am more grateful. (Participant 7)

3.7. Factors that may facilitate or hinder gratitude in parental bereavement

In order to have a better understanding of the role of gratitude in parental grief, several steps were taken. Analyses were conducted following the outline of the gratitude process. Additionally, it seemed important to explore the factors that may influence the emergence of gratitude in parental grief. This exploration was done from an ideographic approach.

The qualitative analysis of the participants’ narratives revealed significant patterns in the interaction between guilt, resignification, gratitude in the face of suffering, and religious beliefs in the context of child bereavement. The results suggest a complex relationship between these factors, which deserves detailed consideration.

3.7.1. Guilt

First, the prominent presence of guilt in the participants’ narrative was associated with a reduced capacity for resignification and, consequently, with a reduced expression of gratitude in the face of suffering.

In extreme cases, gratitude in the face of suffering may be completely absent. This phenomenon is clearly illustrated in the case of a 50-year-old participant who lost her son to a stroke. Her narrative was characterized by intense emotional expression, including explicit anger toward her social environment and life in general, accompanied by a strong sense of guilt that was present in multiple aspects of her life. Notably, her bereavement experience was also associated with a distancing in her relationship with her partner, generating a family environment marked by irritability and sadness. This case highlights the complexity of the grieving process and the intricate interplay between guilt, anger, absence of gratitude in the context of a traumatic loss.

On the other hand, a contrasting trend was identified in participants who explicitly denied experiencing feelings of guilt. In these cases, a higher frequency of resignification processes and expressions of gratitude in the face of suffering were observed. However, it is important to note that the presence of guilt did not necessarily exclude the capacity for resignification or the experience of gratitude.

3.7.2. Religious beliefs

The analysis revealed that religious beliefs appear to play a facilitating role in the experience of resignification and gratitude in the face of suffering. The majority of participants who reported strong religious beliefs showed a greater capacity for these processes. An illustrative example is the case of a 54-year-old participant whose religious beliefs were central to her grieving process and expression of gratitude. Her narrative reflects an active faith, with explicit gratitude to God and a spiritual perspective that conceives of life as a gift, even in adverse circumstances. This participant demonstrated a remarkable ability to re-signify her experience, influenced by a religious vision that seeks meaning in suffering. In addition, she recognized a strengthening in her marital relationship as a result of the loss, suggesting a belief in the transformative potential that adversity can possess.

It is important to note that although religious beliefs appear to facilitate resignification and gratitude in the face of suffering, they are not a prerequisite. A considerable number of participants without strong religious beliefs also showed capacity for these processes, indicating the existence of other factors that may contribute to resilience and posttraumatic growth in the context of bereavement. Examples of these factors are: (1) social and family support, (2) attendance at support groups, (3) offering help to other parents, and (4) actively seeking therapeutic support, among others.

It is also important to differentiate between spirituality and religion. According to Van Niekerk (2018), spirituality refers to a personal, abstract, and subjective experience of connection with the transcendent or the meaning of life, while religion involves organized systems, practices, beliefs, and traditions shared by a community. These distinctions help to better understand how both dimensions can independently or together influence the grieving process and the experience of gratitude.

3.7.3. Factors influencing experience of gratitude.

Social support, especially through mutual support groups such as the Renacer Group, was crucial in helping parents feel less alone and find comfort in shared connection. In addition, those with a strong and supportive family connection were more likely to experience gratitude.

Emotional expression also emerged as a key factor; those who identified and expressed their emotions found more easily a sense of gratitude, whereas parents who had difficulty expressing their emotions and who were burdened with feelings of guilt were the ones who showed the least gratitude. It was observed that those with religious beliefs or developed spirituality showed greater emotional depth and capacity to detect and experience objects of gratitude.

Furthermore, parents who sought therapeutic help experienced greater well-being and, consequently, a greater expression of gratitude. However, it is important to note that the time elapsed since the loss did not seem to have a significant impact on the occurrence of gratitude.

4. Discussion

The present qualitative study aimed to explore the role of gratitude in the parental grief process. We identified different sub-processes and forms of gratitude in our qualitative analysis of the in-depth interviews with bereaved parents across four main themes as proposed by the Gratitude model (Bernabe-Valero, 2012). Themes included (1) recognition of gifts, (2) attribution to an agent, (3) valuing the gift and (4) emergence of gratitude. For each process, the analysis was broken down into the different types of gratitude: interpersonal, transcendental and in the face of suffering, with special emphasis on the process of resignification necessary to be able to experience the latter type of gratitude. In addition, the analysis of the participants’ responses was extended beyond the explicit mentions of ‘gratitude’ or ‘thankfulness’, thus detecting the elements conducive to gratitude, which increased the possibilities of identifying elements of this process, which otherwise would have been underrepresented.

After the analysis of all the processes, the analysis was completed by identifying, from an ideographic perspective, the variables that may have favoured or hindered the process of gratitude. All these results allowed us to affirm that, not only is it possible to experience gratitude in parental grief, but also that gratitude plays an important role in the post-traumatic growth obtained after the loss.

4.1. Gift recognition ability

It is important to point out the existing variability in the ability to recognize gifts in the parents’ narratives. In this study, we identified variables that may have facilitated or impeded this process. On the one hand, we observed that guilt can be an obstacle to initiate the process of gratitude, since it focuses attention on perceived failures, intensifying emotional pain and hindering the course of parental grief (Hazzard et al., 1992), thus rivalling the process of recognizing the positive aspects of the experience.

On the other hand, it has been empirically evidenced that dedicating time to acknowledge positive aspects of existence increases gratitude (e.g. Emmons & McCullough, 2003), something that we were also able to verify thanks to the results of our study and the effects observed in the participants after conducting the interview, as it provided the opportunity for participants to reflect on these positive aspects. Seligman's concept of gratitude can also be observed in the attitudes of certain participants. This perspective involves recognizing and appreciating positive experiences rather than taking them for granted (Seligman, 2011).

4.2. Types of gratitude

Regarding the types of gratitude investigated, interpersonal gratitude constituted a central theme, highlighting the importance of social relationships in the grieving process. Participants expressed deep gratitude towards a wide repertoire of people such as family, friends and professionals who provided support during their loss. This finding was consistent with previous studies for example Kreicbergs et al. (2007) highlighted the importance of social support in the grieving process. Numerous authors have proposed that gratitude plays a very important role in strengthening social bonds (Algoe et al., 2008; Lambert & Fincham, 2011; Lawler, 2001) and reciprocity (McCullough et al., 2008). In fact, our data align with the evolutionary hypothesis of upstream indirect reciprocity (Nowak & Roch, 2007) that has been proposed as an explanatory mechanism for gratitude. This upstream indirect reciprocity implies that a person who has just received help has an (unreasonable) need to help someone else, as recognized by the vast majority of participants in Renacer Group, whose main purpose is to help other parents in the same situation. Our research highlighted the important role played by interpersonal gratitude as a protective factor in the situation of loss.

We observed that transcendental gratitude allowed parents to find comfort in religious, spiritual or philosophical beliefs, something that broaded our understanding of the existential resources that parents can mobilize after the loss of a child, similarly to Braun and Berg (1994) findings. Elfers et al. (2024) also found that transcendental gratitude played a very important role in bereavement strategies. The results of Krause et al. (2012) were also consistent with our findings as the authors pointed out that, for many people, faith in God represented a significant source of social support, as this spiritual aspect not only provided comfort, but also gratitude towards God can act as a coping mechanism, allowing people to find positive aspects even in difficult circumstances. Furthermore, our results coincided with the findings by Upenieks and Ford-Robertson (2022) that gratitude toward God tends to predict better self-rated overall physical health.

If we compare the presence of these two types of gratitude (interpersonal and transcendental gratitude), it seems that it was easier to express interpersonal gratitude. This was possibly because it is more tangible and directly related to specific actions or people. Transcendental gratitude, perceived as more abstract and less tangible, may be more difficult to articulate, especially in professional or research contexts, often relegating its manifestation to more intimate spaces. Even more, it is important to keep in mind that, although the idea of eternal life is deeply embedded in the cultural background of all participants, it is not necessarily a topic that is easily expressed outside the private sphere. In some cases, it was experienced as a taboo, which may have influenced how participants responded to questions related to this theme during the interviews. Our findings aligned again with the research conducted by Krause et al. (2012), which revealed that mere prayer is not sufficient to fully experience this form of gratitude, requiring behavioural expression, often manifested through acts of helpfulness toward others. This complexity in expression and the need for a more practical and tangible manifestation of transcendental gratitude may explain its lower frequency in participants’ narratives, as these characteristics are not easily captured in a traditional research context. This situation was also congruent with what happens in the scientific field; as stated by Van Cappellen et al. (2024), in which they denounced that gratitude for another person's actions has received exponential attention from the scientific community for its many benefits; however, research on gratitude towards God has been silenced despite billions of people believing in a personal, intervening, and benevolent god.

The lesser manifestation of gratitude in the face of suffering would coincide with a broader, less prototypical conception of gratitude that can only be experienced by ‘truly grateful’ people, those who transform suffering into gratitude and altruism. In the words of Shelton (2004) with this attitude towards life, we experience and interpret situations in a way that provokes in us an openness and commitment to the world through actions with a purpose to share and increase the goods we have received (Shelton, 2004, p. 273). This result coincided with the fact that the participants who were able to experience gratitude in the face of suffering were those who were committed in helping other parents go through this process of loss.

In summary, different types of gratitude played an important role in parental grief, coinciding with the studies of Hlava et al. (2014), who found a significant positive correlation between gratitude and resilience in the grieving process; and Krause et al. (2012) suggesting that the effects of stress on health were diminished in people who felt more grateful to God.

4.3. Meaning of life and resignification

Regarding the process of resignification, participants in our study related how the cultivation of gratitude helped them reinterpret their experience of loss and find new purpose in life. This was also observed by Cuervo-Suarez et al. (2024). They showed that the expression of gratitude allowed parents to find comfort. It also helped them find meaning in the painful process of loss. This process appeared to be crucial for long-term adjustment to loss, and our findings suggested that gratitude may be an important catalyst in this process, as those participants who showed lower resignification capacity generally showed less gratitude throughout their interviews. This was consistent with the study by Meert et al. (2005), where, gratitude was found to be an important spiritual resource that helped parents find meaning, comfort, and connection during the painful process of grieving the death of a child.

Thus, the present study revealed that the intensity of grief and the complexity inherent to the grieving process can significantly hinder the participants’ ability to re-signify their experience. This phenomenon explained the lower prevalence of gratitude in the face of suffering in the narratives analysed. As already discussed, the presence of guilt may hinder the process of resignification and, consequently, the experience of gratitude in contexts of suffering, something also investigated by Dutta et al. (2019). In contrast, it was identified that the ability to express emotions and reinterpret the experience acted as a facilitator in the discovery of gratitude motives. This ability was conducive to the manifestation of this particular form of gratitude, suggesting the importance of developing strategies that promote emotional expression and cognitive reinterpretation in the therapeutic approach to parental bereavement. These results coincided with a systematic review that showed that the attribution of meaning to the loss constituted a fundamental therapeutic element in the bereavement process (Pelacho-Rios & Bernabe-Valero, 2023).

These findings on gratitude in the face of suffering, specifically the death of a child, connected with the area of posttraumatic growth. Thus, a significant number of participants described, paradoxically, feelings of gratitude for aspects of their bereavement experience, such as personal growth or increased empathy for others. This phenomenon, although counterintuitive, aligned with the literature on posttraumatic growth and suggests that gratitude may be a key mechanism in the transformation of grief into growth (Peterson & Seligman, 2003).

The findings of our study were supported by previous research on posttraumatic growth in the context of grief. Bray (2013) highlighted how, despite the intense pain associated with loss, some people experienced significant personal growth. Bereavement, especially following the loss of a loved one, can act as a catalyst for this growth, leading to increased resilience, a greater appreciation of life, a development in interpersonal relationships and a reassessment of values, goals, and priorities. In the same vein, Büchi et al. (2007), examining the relationship between bereavement and post traumatic growth in parents who lost premature infants, found that loss can trigger not only a painful long-term grieving process, but also individual personal growth.

In summary, this study highlights the fundamental role of gratitude in the parental grief process, evidencing its capacity to facilitate resignification and promote post-traumatic growth. Through the experiences shared by the participants, it has been demonstrated that gratitude not only acts as an emotional resource, but also strengthens social bonds, promotes greater resilience in the face of loss and personal growth produced from the resignification of the parental grief situation. However, factors such as guilt and the complexity of grief may hinder this experience, indicating the need to develop therapeutic strategies that promote emotional expression and cognitive reinterpretation. These findings underscore the importance of considering individual variations in bereavement and the transformative potential of gratitude in this context.

5. Limitations, methodological considerations and future research

This study has several limitations that should be considered when interpreting the results. The sample was drawn from a support group for bereaved parents, which may introduce a positive bias in participants’ responses. Parents attending such groups might possess a more optimistic outlook on grief and gratitude compared to those who do not seek this type of support. Moreover, this study only explored the religious beliefs of participants who explicitly referred to them during the interviews, all of whom identified with Catholicism. Consequently, we were not able to explore the role of religious beliefs across a broader range of religions, which limits the generalizability of findings in relation to diverse religious or spiritual perspectives. Therefore, our convenience sample is unlikely to represent the broader grieving population, as those attending these groups may have specific coping characteristics not reflected in a more diverse sample. Additionally, due to selection bias, study participants may not represent the general population of bereaved parents, as those more inclined towards post-traumatic growth or finding meaning in their loss may have been more likely to participate. However, for the purpose of our study, this incidental sample holds significant informational value, as it has allowed us to better illustrate these resilience processes. As a qualitative study, the findings may be subject to interpretative biases by the researchers, although there was prior training and ongoing supervision to minimize these effects. Furthermore, qualitative interviews often contain rich language and cultural nuances, which can be lost or misinterpreted in translation.

Therefore, it is proposed to researchers to strive to use larger and more diverse samples selected through probabilistic sampling methods to enhance generalizability. Additionally, conducting studies in various cultural and geographical contexts will provide a more comprehensive understanding of the phenomenon. Future research can significantly enhance the robustness and applicability of findings on the relationship between gratitude and parental grief, contributing to a more nuanced and generalizable understanding of this complex topic.

6. Conclusions

This novel study on parental bereavement offers an innovative perspective by exploring the coexistence of gratitude and grief in the mourning process, challenging the traditional view of bereavement as a purely negative experience. The findings demonstrate that, despite profound suffering, parents who have lost a child develop a remarkable capacity to identify positive aspects and benefits amidst their pain.

The qualitative methodology employed has allowed for the capture of the depth and complexity of individual experiences, revealing patterns of meaning-making and personal growth. Evidence shows that many parents manage to reinterpret their experience, finding meaning and valuing family relationships more deeply. Furthermore, each part of the gratitude process has been exemplified, facilitating its understanding in the context of parental bereavement.

The results suggest that gratitude may act as a valuable psychological resource in the adaptation and recovery process. This has significant implications for both the theoretical understanding of parental bereavement and the development of therapeutic interventions. The importance of fostering gratitude practice and supporting the meaning-making process in psychological support is highlighted.

This innovative approach not only broadens our understanding of parental bereavement but also opens new avenues for research and treatment in the field of bereavement psychology. Future studies could further explore the relationship between gratitude, resilience, and the grieving process in different cultural and social contexts.

Funding Statement

This work was supported by Escuela de doctorado. Universidad Católica de Valencia, San Vicente Mártir; Universidad Católica de Valencia San Vicente Màrtir.

7. Data availability statement

The data that support the findings of this study are available on request from the corresponding author, [L.P-R]. The data are not publicly available due to restrictions e.g. their containing information that could compromise the privacy of research participants.

Authors contribution

LP-R: conceptualization, data curation, formal analysis, investigation, methodology; visualization and writing – original draft. GB-V: conceptualization, formal analysis, investigation, methodology; supervision and writing – review & editing; KK supervision, methodology.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2025.2513854.