Table 2.

Overview of the methodology.

Type of data	Research question(s)	Sample	Data collection	Analysis	Results
QUAN	Do parents bereaved by DRDs report PTG post loss, and if so, which factors can explain high levels of PTG?	n = 89 73 mothers 16 fathers	Background variables and five instruments: The Post-traumatic Growth Inventory (PTGI-SF; Cann et al., 2010) is an 8-item questionnaire, based on a 6-point scale, ranging from “not at all” (1) to “extremely” (6), with higher scores indicating high levels of post-traumatic growth (PTG). We assessed four subscales of the PTG: “Relating to Others,” “New Possibilities,” “Personal Strength” and “Appreciation of Life.” Internal consistency with eight items was good, and Cronbach’s alpha (α) = 0.865. The General Self-Efficacy Scale-SF (GSE-SF; Schwarzer and Jerusalem, 1995) measures self-efficacy. A 5-item short version was used in this study (Tambs and Røysamb, 2014), based on a 4-point scale, ranging from “not at all true” to “exactly true,” with higher scores indicating high levels of self-efficacy; this was applied to investigate whether high levels of self-efficacy are associated with high levels of PTG. Internal consistency was good: α = 0.861. The Crisis Support Scale (CSS; Elklit et al., 2001) measures social support following a crisis. The first five items measure positive support, scored on a 7-point rating scale, ranging from “never” to “always”; a higher total score indicates more support received (Christiansen et al., 2013). The CSS was applied to investigate whether high levels of support are associated with high levels of PTG. Internal consistency was acceptable: α = 0.777. The Work and Social Adjustment Scale (WSAS; Marks, 1986; Mundt et al., 2002) measures self-experience of whether the event affects the ability to perform daily activities (e.g., work, housework, leisure activities, and maintaining social relationships). This is a 5-item questionnaire, scored on a 9-point scale, ranging from “no impairment” (0) to “very severe impairment” (8). This was used to investigate whether high scores on the WSAS are associated with low levels of PTG. Internal consistency was good: α = 0.886. The Prolonged Grief Disorder-13 (PG-13; Prigerson and Maciejewski, n.d.) measures symptoms of prolonged grief (PG). A 13-item questionnaire is scored by summing the 11 symptom items (cognitive, behavioral, and emotional), rated on a 5-point Likert scale. Total scores range from 11 to 55, with higher scores indicating more severe grief symptoms. This was applied to investigate whether high levels of PG symptoms constitute a predictor of low levels of PTG. Internal consistency for the 11 items was good: α = 0.892.	Descriptive, correlation and regression analyses were performed using SPSS 26. Continuous variables were described by means (M), standard deviations (SD), medians (Md) and range, whereas frequencies and percentages described categorical variables. The PTGI-SF sum score was chosen as the dependent variable since positive changes and predictors for high levels of change constitute the primary outcome of our analyses. Missing scores were imputed using the individuals’ mean for all items completed (for the PTGI-SF, n = 1 (one missing); for the PG-13, n = 1 (one missing), and n = 1 (two missing)). No replacement was provided for background variables. Hierarchical multiple regression analysis was used to examine the influence of the WSAS, GSE-SF, CSS, and PG-13 on the PTGI-SF outcome variable. The PTGI-SF was regressed on the WSAS, GSE-SF, and CSS in the first step, and the PG-13 was included in the second step. A possible curvilinear effect of prolonged grief was also examined by including a polynomial PG-13 term (PG-132) in the third and final step. The PG-13 was centered around its mean prior to computing the polynomial term.	Presentation of PTGI-SF descriptive analyses, correlations and a hierarchical multiple regression analysis
QUAL	What positive changes do parents bereaved by DRD describe?	n = 14 seven mothers and seven fathers	In-depth interviews: A semi-structured interview guide, based on questions in the survey, was developed for the interviews. The guide consisted of five topics: (1) the time before the death; (2) the loss; (3) stigma from the environment and self-stigma; (4) help, support, and coping; and (5) post-traumatic growth (PTG). Data from the fifth PTG topic were included in this study. The following topics were explored: • What is the most important thing you have been able to do to live on after the death? • What has promoted or inhibited adjustment to life? • Have you experienced that you have changed as a person after the death – and if so, can you describe how? The interviews were carried out between August 27 and December 4, 2018. To synchronize the interview method and pilot-test the interview guide, the third author conducted a trial interview with a bereaved parent, with the first author present. The interview was discussed with the bereaved individual and the research interviewers. The interview guide was adjusted according to discussions after the trial interview and before other in-depth interviews.	Reflexive thematic analysis, as described by Braun and Clarke (2022), is a 6-phase process: (1) familiarization with the data; (2) coding; (3) generating initial themes; (4) reviewing themes; (5) defining and naming themes; and (6) writing up. Each phase builds on the previous one, and the analysis moves back and forth between the phases. After reading and rereading all the interviews to become immersed and familiar with their content, the entire dataset was coded in Nvivo. We collated data to identify broad patterns of meaning illustrated by themes.	Presentation of codes and themes
MIXED	Can integrating quantitative and qualitative data provide a deeper understanding of PTG experienced by bereaved parents following a DRD?	QUAN: n = 89 QUAL: n = 14	Data from the survey and the in-depth interviews were collected in parallel.	Quantitative and qualitative data were independently analyzed. The mixed-method analysis was completed at the results stage. We used data from the qualitative interviews to elaborate on the quantitative findings.	Presentation of results from the survey and interviews in a joint display

Overall purpose: To explore positive changes among bereaved parents following a DRD and factors that can explain positive changes.