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Death Studies
ISSN: 0748-1187 (Print) 1091-7683 (Online) Journal homepage: http://www.tandfonline.com/loi/udst20
Gratitude, psychological well-being, and
perceptions of posttraumatic growth in adults who
lost a parent in childhood
Nathan Greene & Katie McGovern
To cite this article: Nathan Greene & Katie McGovern (2017): Gratitude, psychological well-being,
and perceptions of posttraumatic growth in adults who lost a parent in childhood, Death Studies,
DOI: 10.1080/07481187.2017.1296505
To link to this article: http://dx.doi.org/10.1080/07481187.2017.1296505
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Published online: 17 Feb 2017.
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DEATH STUDIES
http://dx.doi.org/10.1080/07481187.2017.1296505
Gratitude, psychological well-being, and perceptions of posttraumatic
growth in adults who lost a parent in childhood
Nathan Greene and Katie McGovern
Clinical Psychology Program, The Wright Institute, Berkeley, California, USA
ABSTRACT
Findings from an online survey of 350 adults who experienced early parental death showed that
current dispositional gratitude was positively correlated with psychological well-being and
posttraumatic growth and negatively correlated with depression. Further, 281 participants
produced textual responses indicating they could remember the time following their parent’s
death. Increases in gratitude attributable to the experience of losing a parent were reported by
79% of these participants. They associated their increased gratitude with a newfound belief that life
is precious and with greater appreciation for loved ones. Direction of change in gratitude was
associated with psychological well-being, posttraumatic growth, and depression.
Introduction
In the United States, at any given time, 3.5% of
individuals, or roughly 2.2 million people, have experi-
enced the death of one or both of their parents prior to
reaching the age of 18 (Social Security Administration,
2000). Childhood bereavement, otherwise known as
early parental death (EPD), has been identified as one
of the most significant, stressful events that a child
can experience (Melhem, Walker, Mortz, & Brent,
2008). Such a profound psychological event can threa-
ten the emotional and social development of a child
and can have enduring consequences (Osterweis,
Solomon, & Green, 1984).
Numerous studies have documented negative
outcomes in individuals who have experienced early
parental death. For example, parentally bereaved chil-
dren are more likely to suffer from lower self-esteem,
diminished academic success, and lower self-efficacy
when compared to similarly aged peers (Dowdney,
2000). Further, a child who has lost a parent or sibling
is also at risk for anxiety, anger, guilt, peer-isolation,
loneliness, and posttraumatic stress symptoms (Christ,
2010; Haine, Ayers, Sandler, & Wolchick, 2008; Koehler,
2010). The impact of such a profound loss is not
restricted to childhood. A number of studies have sug-
gested a link between EPD and long-term negative
psychological outcomes into adulthood, including self-
reports of depression, anxiety, posttraumatic stress
symptoms, suicidal ideation, and functional impair-
ments (Agid et al., 1999; Barnes & Prosen, 1985;
Harrison & Harrington, 2001; Kendler, Gardner, &
Prescott, 2002; Melhem, Walker, Moritz, & Brent,
2008; Tyrka, Wier, Price, Ross, & Carpenter, 2008).
Although many studies have documented the
negative outcomes associated with EPD, others have
produced contrary evidence questioning a direct link
between early parental bereavement and depression
(Hurd, 1999, 2004; Kendler, Neale, Kessler, Heath, &
Eaves, 1992) or the development of psychiatric illness
in adulthood (Tennant, Smith, Bebbington, & Hurry,
1981). Evidence thus suggests that some individuals
can adapt healthfully in the wake of parental loss. As
a result, research has been moving toward identifying
factors that mitigate negative outcomes and promote
positive health outcomes in individuals who
experienced EPD.
Factors that promote positive health outcomes in
individuals following the loss of a parent include both
external factors, such as a strong bond with the surviv-
ing caregiver, family economic stability, and positive
engagement in mourning behaviors, as well as internal
factors, such as the possession of a strong self-concept
and the capacity to think about one’s experience in a
positive manner (Hong & Scott, 2013; Hurd, 2004;
Perry, 2006; Worden, 1996).
One internal adaptive factor that has not hitherto
been studied in individuals who lost a parent in child-
hood is dispositional gratitude. Dispositional gratitude
is conceptualized in the present study as “part of a wider
life orientation towards noticing and appreciating the
CONTACT Nathan Greene ngreene@wi.edu Clinical Psychology Program, The Wright Institute, 2728 Durant Avenue, Berkeley, CA 94704.
© 2017 Taylor & Francis
positive in the world” (Wood, Froh, & Geraghty, 2010,
p. 980). In this view, dispositional gratitude is distinct
from the feeling of appreciation in the response to the
action of another (McCullough, Kilpatrick, Emmons,
& Larson, 2001) and from positive emotions such as
hope, optimism, and trust.
Although dispositional gratitude may be conceptua-
lized as a trait, it is understood to be a mutable trait,
one shaped by our experience and not a fixed individual
characteristic. This understanding is promoted by Froh
and Bono (2014) who viewed gratitude as a personality
trait and a life orientation that can be learned, practiced,
and cultivated. Empirical support for this view of
gratitude comes from self-reported increases in grati-
tude and subjective well-being following interventions
such as maintaining a gratitude journal or counting
one’s blessings in randomized control studies (e.g.,
Emmons & McCullough, 2003; Froh, Sefick, &
Emmons, 2008).
There are many psychological health benefits to
fostering gratitude. The burgeoning field of gratitude
research has provided strong evidence that gratitude is
a causal predictor of subjective well-being and psycho-
logical well-being in the general population (Emmons
& McCullough, 2004; Wood et al., 2009). Further, grati-
tude has been shown to buffer the effects of external
stressors on overall health (Krause, 2006) and protect
against the impacts of stress and depression over time
(Wood, Maltby, Gillett, Linley, & Joseph, 2008a).
Gratitude also plays an important role in helping indivi-
duals form and maintain relationships (McCullough
et al., 2001). In short, grateful people tend to be happier
(Watkins, 2004).
For those who have endured traumatic experiences,
dispositional gratitude can protect against negative
psychological outcomes. A study with female breast
cancer patients, for instance, found that gratitude
correlated strongly with reported posttraumatic growth,
positive emotions, and lower levels of distress (Ruini &
Vescovelli, 2012). Vernon, Dillon, and Steiner (2009)
similarly found positive relationships between gratitude
and posttraumatic growth in women with trauma
histories, including transportation accidents, sexual
assault, and other events identified on the Clinician-
Administered PTSD Scale (Blake et al., 1990).
Particularly relevant to the present study are findings
from a study of college-aged adults with chronically ill
parents indicating that dispositional gratitude moder-
ated the relationship between parental health status
and the students’ depression and anxiety (Stoeckel,
Weissbrod, & Ahrens, 2014). Froh and Bono (2014)
suggested that gratitude promotes healthy adjustment
following a trying experience through two primary
mechanisms: by the garnering of social support and
by making meaning from the experience. Similarly, it
has also been suggested that benefit-finding plays an
important role in recovery from a potentially traumatic
experience (Davis, Nolen-Hoeksema, & Larson, 1998;
Wood et al., 2010), a process that is likely more
accessible in individuals with a grateful disposition.
Although it has been documented that gratitude is
correlated with aspects of healthy adjustment following
distinct traumas, it has also been suggested that
experiencing a trauma may actually encourage gratitude
formation, despite the host of negative emotions
commonly associated with traumatic experience. For
instance, Peterson, Park, Pole, D’Andrea, and Seligman
(2008) demonstrated that when individuals experience
traumatic events, such as a life-threatening illness or
accident, the character strength gratitude as measured
by the Values in Action Inventory of Strengths
(Peterson, Park, & Seligman, 2005) could increase.
Similarly, Fredrickson, Tugade, Waugh, and Larkin
(2003) studied the psychological impact of the
September 11th terrorist attacks and found that
gratitude was one of the three most reported positive
emotions from traumatized persons. Peterson and
Seligman (2003) found that adults who experienced
the attacks demonstrated increases in self-reported
gratitude when compared with self-reports prior to
the attack. One potential mechanism that could account
for this unexpected finding is the concept that facing
mortality increases one’s orientation toward gratitude.
This was supported in a study by Frias, Watkins,
Webber, and Froh (2011), who showed that when
individuals were encouraged to imagine their own death
in a realistic fashion, they were likely to report higher
levels of gratitude. Frias and colleagues’ findings seem
to provide empirical support for Bonanno’s (2009)
theory that loss forces individuals to face the bigger
existential questions such as the meaning of life and find
greater value in life, which in turn could encourage one
to have a more grateful disposition.
Given the documented benefits of having a grateful
disposition for general health and well-being and the
existing literature demonstrating gratitude’s relation to
healthy adjustment following traumas, the present
researchers were curious about gratitude’s relationship
to healthy adult functioning in individuals who lost a
parent in childhood. We hypothesized that positive
relationships would be found between reports of dispo-
sitional gratitude and reports of current psychological
well-being and perceived posttraumatic growth related
to the death of the parent. Furthermore, we predicted
that dispositional gratitude would be negatively corre-
lated with reports of depression.
2 N. GREENE AND K. MCGOVERN
We also wanted to know how the loss experience
itself may have shaped individual orientations toward
gratitude. The ideal study design to approach this ques-
tion would involve a longitudinal study measuring levels
of dispositional gratitude in each individual prior to and
following the loss. Given the logistical issues of such a
study, we instead focused on individuals’ retrospective
accounts of how their sense of gratitude was influenced
by the loss of the parent with a question that asked if
they believe they experienced an increase, decrease, or
no change in their sense of gratitude following loss of
their parent. To further investigate how individuals
understood this change or lack thereof, we asked a
simple open-ended question asking that they explain
their previous response. The aim of the qualitative ques-
tion was to help us gain more context for how some
individuals were able to access gratitude following the
loss while others found benefit-finding and gratitude
formation more difficult.
Methods
Participants and procedure
A sample of 350 adults was recruited primarily via social
media sites including online bereavement organizations
such as Motherless Daughters, Parentless Parents, the
Loss of a Mother or Father Facebook Group, and others.
Inclusion criteria were loss of one or both parents prior
to age 18 and current age of at least 18 years; there were
no additional exclusion criteria. Participants composed
a primarily white female sample, varying widely in
age, education, social class identification, and religious
affiliation.
Participants represented 21 different countries with
the large majority of participants (n ¼297, 83.9%)
residing in the United States. The study was conducted
online via SurveyMonkey.
Measures
Gratitude Questionnaire-6
The Gratitude Questionnaire-6 (GQ-6; McCullough,
Emmons, & Tsang, 2002) is composed of six items rated
on a 7-point Likert scale ranging from 1 (strongly
disagree) to (strongly agree) and measures one’s prone-
ness to experience gratitude in daily life. The GQ-6
assesses gratitude as a single factor on the basis of the
frequency and intensity of grateful affect (Wood et al.,
2010). Items include statements such as “I have so much
in my life to be thankful for” and “I am grateful to a
wide variety of people.” The GQ-6 is the most widely
used measure of gratitude and has been used with a
number of distinct populations including adults, adoles-
cents, cancer patients, and United States veterans
(Wood, Maltby, Stewart, & Joseph, 2008b; Stoeckel,
Weissbrod, & Ahrens, 2014; Ruini & Vescovelli, 2012;
Kashdan, Uswatte, & Julian, 2006). The GQ-6 has
demonstrated excellent psychometric properties and
been shown to be associated with life satisfaction,
vitality, optimism, and pro-social traits— all constructs
relevant to gratitude (McCullough et al., 2002). The
Cronbach’s alpha estimates for the six item totals have
ranged from .76 to .84 (McCullough et al. 2002), reflect-
ing good internal consistency.
Posttraumatic Growth Inventory-Short Form
The Posttraumatic Growth Inventory-Short Form
(PTGI-SF; Cann et al., 2010) is an adapted version of
the Posttraumatic Growth Inventory (PTGI; Tedeschi
& Calhoun, 1996), which retrospectively assesses the
extent to which individuals are successful in
reconstructing or strengthening their perceptions of
themselves, others, and the meaning of events following
a significant traumatic event. The PTGI-SF has 10 items
rated on a 6-point Likert scale ranging from 0 (“I did
not experience this change as a result of my crisis”) to
5 (“I experienced this change to a very great degree as
a result of my crisis”). Five domains of posttraumatic
growth are assessed, which include Relating to Others
(greater intimacy and compassion for others), New
Possibilities (developing new roles and meeting new
people), Personal Strength (feeling personally stronger),
Spiritual Change (feeling more connected spiritually),
and a deeper Appreciation of Life (Tedeschi & Calhoun,
2004). Three studies tested the psychometric properties
of the original PTGI and found that the PTGI has good
internal consistency (α ¼.90) and acceptable test-retest
reliability (r ¼.71; Tedeschi & Calhoun, 1996). The
psychometric properties of the PTGI-SF were assessed
with a sample of 186 adults and it was shown to have
good internal consistency (α ¼.89) (Cann et al., 2010).
Confirmatory factor analysis demonstrated that the
PTGI-SF has a five-factor structure that is equivalent
to that of the PTGI.
Flourishing Scale
The Flourishing Scale (FS; Diener et al., 2009), formerly
known as The Psychological Well-Being Scale, is a shor-
tened measure of psychological well-being that is based
upon theories of universal psychological needs from Ryff
(1989) and Ryan and Deci (2000). The FS features eight
Likert scale items that assess several domains of social
and psychological functioning, including the maintenance
of positive social relationships, engagement in personally
DEATH STUDIES 3
rewarding activities, possession of a sense of purpose, and
feelings of competence (Diener et al., 2009). The FS has
been shown to have strong psychometric properties and
is related to various measures of well-being. Diener et al.
(2009) found that the measure has good internal consist-
ency, with a Cronbach’s alpha of 0.86, and adequate tem-
poral stability at 0.71. The FS also showed strong
convergent validity with Ryff’s (1989) and Ryan and
Deci’s (2000) long-form measures of psychological well-
being at .78 and .73, respectively.
Patient Health Questionnaire-9
The Patient Health Questionnaire (PHQ-9; Kroenke,
Spitzer, & Williams, 2001) is a nine-item self-report mea-
sure that assesses the frequency of occurrence in the past 2
weeks of the nine symptoms of major depressive disorder
as identified by the DSM 5. Respondents report the symp-
toms as 0 (occurring not at all), 2 (more than half the days),
and 3 (nearly every day). Finally, respondents rate the
degree of difficulty they experience in doing work, taking
care of things at home, or getting along with people as a
result of the nine symptoms on a 4-point Likert scale ran-
ging from 0 (not applicable) to 4 (extremely difficult).
Internal consistency of the PHQ evidenced Cronbach’s
alphas of 0.89 and 0.86 in a study with 3,000 primary care
patients and 3,000 patients from obstetrics-gynecology
sites, respectively (Kroenke et al., 2001). Adequate con-
struct validity and criterion validity for the PHQ-9 were
also established in the study mentioned above.
Other childhood trauma item
To estimate level of other childhood trauma, parti-
cipants were asked “Prior to your 18th birthday, did
you experience any significant stressful or traumatic
even other than your parent’s death?” Response options
were “yes” or “no.”
Adult trauma item
Level of adult trauma was assessed by a single question:
“As an adult, to what extent have you experienced
highly stressful and traumatic events?” Response
options were “very little,” “somewhat,” “moderate,”
“quite a bit,” and “extreme.”
Perceived change in gratitude items
A fixed-choice item at the end of the survey assessed part-
icipants’ perceptions of how the loss of their parent had
influenced their current sense of gratitude. The question
asked “How do you believe your sense of gratitude has
changed as a result of losing a parent?” Participants
responded to a fixed-choice scale with three response
options, denoting whether their gratitude increased, stayed
the same, or decreased. Participants then responded to an
open-ended question, which asked them to explain their
response to the perceived change in gratitude item.
Results
Data handling
Initially, 464 participants responded to the survey. Of
these, 116 responded to demographics questions but
did not complete all instruments and were removed
from consideration. Of the remaining 350 complete
surveys, a small number had missing individual
responses within a given measure. Mean substitution
of missing single responses was used as the method to
obtain complete data for all participants. SPSS21 was
used for all data analysis. The demographics of the final
350 participants are shown in Table 1.
Measure descriptive statistics and relation to
demographic variables
Descriptive and reliability statistics for the four mea-
surement scales used in the study are shown in Table 2.
Gender was found to be related to PTGI scores, with
women significantly more likely to report post-
traumatic growth than men (M ¼25.85, SD ¼12.83 vs.
M ¼18.49, SD ¼13.99; p <.005). There were differ-
ences among ethnic groups on levels of post-traumatic
growth. White participants and those who did not
identify ethnicity had significantly higher PTGI scores
than both American Indian/Alaska Natives (p <.03)
and Hispanic/Latino participants (p <.03). No other
associations between demographic variables and
measurement scales were found.
To examine whether the GQ-6 and PTGI were mea-
suring the same or different constructs, tests of multicol-
linearity were conducted. A multicollinearity diagnostic
was obtained from a multiple regression analysis where
GQ-6 and PTGI-SF were considered as predictors of
FS. The variance inflation factor (VIF) was 1.087; the rule
of thumb for interpreting the VIF suggests that GQ-6 and
PTGI-SF are not correlated in this context. They appear
to be measuring different constructs.
Relationship of dispositional gratitude to
psychological well-being, posttraumatic growth,
depression, age at time of death, and years since
death
As expected, dispositional gratitude (GQ-6) was
positively correlated with psychological well-being (FS)
as well as posttraumatic growth (PTGI-SF), and nega-
tively correlated with depression (PHQ-9; see Table 3).
4 N. GREENE AND K. MCGOVERN
GQ-6 scores were also weakly associated with time since
death in years.
FS scores were moderately associated with PTGI,
strongly, negatively correlated with PHQ-9, and weakly
correlated with time since death. PTGI scores were
moderately correlated with age at death and negatively
correlated with time since death. PHQ-9 was negatively
correlated with time since death.
Impact of other early trauma and adult trauma
An effort was made to rule out other childhood trauma
and adult trauma as contributors to adult psychological
outcomes.
To estimate level of other childhood trauma, parti-
cipants were asked “Prior to your 18th birthday did
you experience any significant stressful or traumatic
even other than your parent’s death?” Thirty-two per-
cent of the sample reported no other childhood trauma;
68% did report other childhood trauma. Chi-square
analysis showed that presence of childhood trauma
(yes vs. no) was not significantly associated with reports
of change on the change in gratitude item (decrease, no
change, increase). Finally, in independent means t-tests
Table 2. Descriptive and reliability statistics for GQ-6
(Gratitude Questionnaire-6), Flourishing Scale (FS), PTGI (Post-
traumatic Growth Inventory), and PHQ-9 (Patient Health
Questionnaire).
Measure M SD Min Max Cronbach’s alpha
GQ-6 35.06 5.97 12 42 .829
FS 44.85 8.42 15 56 .912
PHQ-9 5.45 4.55 0 18 .883
PTGI 25.07 13.14 0 50 .901
Table 1. Demographics.
Variable M Minimum Maximum SD Frequency Percent
Current age 40.05 18 78 12.23
Age at death 11.13 0 18 4.77
Years since death 28.94 3 65 13.46
Gender
Female 314 89
Male 34 10
No report 2 1
Ethnicity
African American 5 1.5
American Indian/Alaska Native 4 1.1
Asian/Pacific Islander 10 2.9
White/Caucasian 305 87.1
Hispanic/Latino 17 4.9
No report 9 2.5
SES
Working class 53 15.1
Lower middle 116 33.1
Upper middle 164 46.9
Upper class 16 4.6
No report 1 .3
Education
High school or less 17 4.9
Some college 83 23.7
Bachelor’s degree 126 36.0
Master’s degree 87 24.9
Doctoral degree 21 6.0
Other certification 14 4.0
No report 2 .6
Religion
Agnostic 48 13.7
Buddhist 14 4.0
Christian 165 47.1
Hindu 4 1.1
Jewish 37 10.6
Muslim 3 .9
None of these 79 22.6
Parent who died
Father 93 26.6
Mother 236 67.4
Both 21 6.0
Table 3. Correlations among GQ-6 (Gratitude Questionnaire-6),
Flourishing Scale (FS), PTGI (Posttraumatic Growth Inventory),
and PHQ-9 (Patient Health Questionnaire), age at time of
death, and time since death.
Variable 1 2 3 4-9 5
1. GQ6
2. FS .654**
3. PTGI .325** .366**
4. PHQ-9 .374** .616** .063
5. Age at death .024 .008 .225** .058
6. Time since death .130* .163** .175** .204** .424**
*p <.05. **p <.001.
DEATH STUDIES 5
presence of childhood trauma was not associated with
levels of adult GQ-6, Flourishing, PTGI, or PHQ-9.
Level of adult trauma experienced by the participants
was also assessed by a single question: “As an adult, to
what extent have you experienced highly stressful and
traumatic events?” Frequencies and percentages of
participants reporting each level of adult trauma are
shown in Table 4. Chi-square analysis showed that, as
with childhood trauma, level of adult trauma was not
associated with perceived change in gratitude.
One way analyses of variance (ANOVAs) allowed
groups with different levels of adult trauma to be
compared on the measures of adult psychological out-
comes. Mean GQ-6 scores did not differ between adult
trauma groups; however, group differences were found
for Flourishing, F(4, 341) ¼2.516, p <.05]; PTGI,
F(4, 341) ¼2.530, p <.05; and PHQ-9, F(4, 341) ¼
9.074, p <.0001. Pairwise comparisons showed that on
Flourishing, those who reported very little adult trauma
had significantly higher scores than those who reported
extreme levels of adult trauma (M ¼47.265 vs. 41.394,
p <.05); other group comparisons were not statistically
significant. On PTGI, those who reported very little
adult trauma had significantly lower scores than those
who reported quite a bit of adult trauma (M ¼19.373
vs. 27.029, p <.05); other group comparisons were not
statistically significant. On PHQ-9, there were many
differences among adult trauma groups, with a linear
increase in average PHQ-9 score from those reporting
very little adult trauma to those reporting extreme adult
trauma (see Table 5).
Perceived change in gratitude in the
remembering group
To ensure that participants’ reports of changes in
gratitude could be attributed to parental death, those
participants (n ¼69) who indicated that they could
not remember their feelings at the time of their parents’
death or could not make the judgement about changes
in gratitude were removed from further analyses. This
left a sample of 281 participants, the remembering
group. The remembering group was not statistically
different from the larger sample in terms of age, age
at time of death, or time since death or PHQ-9.
However, it has a higher GQ-6 level (M ¼35.87 vs.
35.06, p <.02), a higher FS level (M ¼45.80 vs. 44.85,
p <.05), and a higher PTGI level (M ¼27.55 vs. 25.07,
p <.001). The correlation matrix examining relation-
ships between GQ-6, FS, PTGI-SF, PHQ-9, age at
death, and time since death showed that the pattern of
significant correlations and the directions of correla-
tions were not different between the overall sample
and the remembering group.
Based on the Likert scale change in gratitude item, a
large majority of the 281 participants (222 people or
79%) reported that they experienced an increase in their
sense of gratitude related to experiencing the loss of their
parent in childhood. In contrast, 36 participants (12.2%)
reported that they experienced no change in gratitude,
and 23 participants (8.2%) reported that they experi-
enced a decrease in gratitude as a result of the loss.
A multivariate analysis of variance (MANOVA)
investigated differences across levels of change in grati-
tude (increase, no change, and decrease) on all four
study measures (PHQ-9, GQ6, FS, and PTGI). The
overall MANOVA showed significant differences
among individuals grouped by level of change, Pillia’s
trace ¼. 399, F(8., 552) ¼17.19, p <.001. Univariate
ANOVAs revealed differences between change in
gratitude groups on GQ6, F(2, 278) ¼25.395, p <.001;
flourishing, F(2, 278) ¼31.831, p <.001; PHQ9.
F(2, 278) ¼6.825, p <.001; and PTGI, F(2, 278) ¼
53.540, p <.001.
Pairwise comparisons among the gratitude groups on
each study variable showed a significant (p <.001) over-
all pattern of linear change from decrease in gratitude to
no-change to increase in gratitude in the predicted direc-
tion, with the exception that on PHQ-9 the no-change
and increase were not different and on PTGI the decrease
and no-change group were not different. In other words,
when reported change in gratitude increased between
groups, GQ6, FS, and PTGI also increased and PHQ-9
decreased among the remembering group.
Qualitative themes
Coding of textual responses to the open-ended question
asking for explanation of each participant’s perceived
change in gratitude response offers rich descriptions
Table 4. Reported levels of other adult trauma.
Level of reported trauma n %
Extreme 33 9.4
Quite a bit 104 29.7
Moderate 108 30.9
Somewhat 67 19.1
Very little 34 9.7
No response 4 1.1
Table 5. Differences among adult trauma groups on Patient
Health Questionnaire.
Level of adult trauma M SD
Extreme 8.519
a,b,e
5.922
Quite a bit 6.296
c,d
4.561
Moderate 5.378
e
4.207
Somewhat 3.910
b,d
3.423
Very little 3.375
a,c
4.113
a
p <.0001.
b
p <.0001.
c
p <.01.
d
p <.01.
e
p <.004.
6 N. GREENE AND K. MCGOVERN
of participants’ experience of their loss and its impact
(see Table 6).
Texts were obtained from 237 participants (84%) of
the remembering group. The principal investigators
and two additional coders read the responses and
developed thematic codes that capture meanings of
individual texts. Themes extracted from the texts were
sorted according to whether the participants reported
an increase in gratitude, no change, or a decrease in
gratitude attributable to their parent’s death.
Participants who report increases in gratitude due to
their parent’s death offered uniformly positive
explanations for their attribution. The most common
explanation (n ¼49, 27.4%) was the idea that life is pre-
cious and that one should get the most out of it while
they can. The second most frequent theme was gratitude
for family and friends (n ¼36, 20.1%).
Reports of no change in gratitude were accompanied
by both positive and negative themes including stories
of variation in gratitude, other kinds of changes, other
sources of gratitude, and other difficult experiences.
The most common theme was that the participant does
not associate any outcomes with their parent’s death
(n ¼12, 33.3%). The second most common theme was
that other difficult circumstances inhibited gratitude
(n ¼5, 13.9%).
Participants’ reports of decreases in gratitude were
accompanied by themes of pain, conflict, anxiety, and
fragility—92% of the texts contained negative state-
ments. The most common theme was participants’
experience of being afraid and anxious (n ¼4, 82%).
The next most common themes were the participants’
beliefs that they cannot depend on others (n ¼3,
13.6%) and that other difficult circumstances inhibited
gratitude (n ¼3, 13.6%).
Discussion
The present study found that for this mostly White,
female sample of individuals who experienced EPD,
gratitude was positively associated with psychological
well-being and with posttraumatic growth. In other
words, individuals who reported that they were more
grateful also tended to report higher levels of psycho-
logical well-being and posttraumatic growth. As
predicted, gratitude also demonstrated an inverse
relationship with depression. In addition, those indivi-
duals who reported positive changes in gratitude
attributable EPD tended to report higher dispositional
gratitude, psychological well-being, and posttraumatic
growth, and lower depression than those who either
reported no change in gratitude or a decrease in
gratitude following the loss.
The findings are in alignment with previous studies
of the general population suggesting that grateful people
are generally happier and that there are positive
relationships among gratitude, optimism, positive affect,
pride, and hope (Emmons & Shelton, 2002; Gallup,
1999; Watkins, 2004). The present study provides
additional support for Wood et al.’s (2008a) assertion
that gratitude can serve as a protective factor against
stress and depression over time. Given gratitude’s role
in promoting positive feelings and in protecting against
stress and depression, it follows that gratitude would be
associated with adaptive functioning in adults who
experienced EPD, a major finding of the present study.
Among those who remembered the time following
the death of their parent, a large majority (79%)
reported that they believed their sense of gratitude or
appreciation for life increased as a result of losing their
Table 6. Qualitative themes from open ended question about
change in gratitude attributed to parental death (n ¼237
responses across all groups).
Theme n Percentage
Increase in gratitude responses 179 100
Life is precious/Get the most from it 49 27.4
Grateful for family and friends 36 20.1
Things can change in an instant/ No guarantees 23 12.8
Grateful for the relationship with my children/ 18 10.1
Wanting to give them the best
Shift in perspective that helps you not sweat the
small stuff
10 5.6
Grateful for lost parent 8 4.5
Grateful for my health 9 5.0
Focus on God/Higher Power/Spirituality 11 6.1
The loss taught me self-reliance 7 3.9
Grateful for surviving parent 5 2.8
Other: I just do, maturity, grateful for other helpers 3 1.7
No change in gratitude responses 36 100
Don’t associate any outcomes with parent’s death 12 33.3
Other difficult circumstances inhibit gratitude 5 13.9
Grateful for surviving parent 3 8.3
Grateful waxes 3 8.3
Not as grateful as I should be/Stuck on negatives 2 5.6
Poor relationship with surviving caregiver. 2 5.6
Grateful for family and friends 1 2.8
Grateful for lost parent 1 2.8
I can’t say 1 2.8
I confronted death 1 2.8
I felt lost 1 2.8
Life is meaningless 1 2.8
Parental death was a relief 1 2.8
Shift in perspective that helps you not sweat the
small stuff
1 2.8
The loss taught me self-reliance 1 2.8
Decrease in gratitude responses 22 100
I am afraid and anxious 4 18.2
I can’t depend on others 3 13.6
Other difficult circumstances inhibit gratitude 3 13.6
Gratitude waxes and wanes 2 9.0
I became reckless 2 9.0
Life is meaningless 2 9.0
Not as grateful as I should be/Stuck on negatives 2 9.0
Grateful for family and friends 1 4.5
I felt lost 1 4.5
I still feel sad 1 4.5
Resentment toward those who have parents 1 4.5
DEATH STUDIES 7
parent in childhood. This contrasted with the 12.8% of
participants who reported that they had experienced no
resultant change in gratitude and a mere 8.2% who
reported that they believe they are less grateful as a
result of the parental loss. These results lend support
to the counterintuitive idea that a negative experience
such as losing a parent in childhood could lead one to
feel more gratitude or appreciation for life.
The most common explanations provided by
individuals who reported increases in gratitude were
associated with newfound belief that life is precious
and with greater appreciation for loved ones. Both of
these concepts are in agreement with the scarcity
heuristic explanation put forth by King, Hicks, and
Abdelkhalik (2009). The scarcity heuristic suggests that
when individuals are reminded of death in a highly
personal manner, they place a higher value on their
own life. Subjective accounts from individuals who have
faced death and report a newfound appreciation for life
support this theory (Zamora, 2006), as do findings from
study in which individuals who were prompted to
think about their own death in a vivid way via a “death
contemplation exercise” reported higher levels of
gratitude (Frias, Watkins, Webber, & Froh, 2011).
The link between familial loss and gratitude forma-
tion is understudied in the literature. The results of this
study seem to suggest that witnessing first-hand the
death of a parent at a young age could lead one to view
life as a finite commodity, and in turn value one’s own
life more as well as the lives of loved ones. As one
participant reported:
I know and understand very much how short life can be
and how the important people in our lives might only
be here for a short amount of time. I take each day as
an opportunity to do things that are meaningful to
me and try to find ways to connect with the people I
care about.
Although a large majority of participants attributed
an increase in gratitude to the loss, a substantial number
of respondents also reported experiencing either no
change or even a decrease in gratitude. This raises the
important question of why some individuals experience
an increase in their sense of gratitude or appreciation
for life whereas other individuals experience no change
or even a decrease.
The qualitative findings speak to the factors that
inhibited gratitude formation among these participants.
The most common reason given for experiencing no
change or a decrease in gratitude was that the emotional
pain related to the loss inhibited the formation of
gratitude. Many others reported that anxiety, fearful-
ness, difficulty trusting others, resentment, multiple
traumas, and family conflict inhibited gratitude
formation. It seems that for these individuals, the loss
too greatly taxed their personal psychological resources
to allow for benefit-finding.
This study is limited by the nature of the sampling, as
the sample is composed of self-selected volunteers. Self-
selection is apparent in the large number of participants
recruited from the online bereavement organization
Motherless Daughters and the Facebook groups Parent-
less Parents and The Loss of a Mother or Father. The
sample disproportionately represents adults who report
a high degree of adult and childhood traumas and are
actively seeking support through a community of others
who share their experience. Further, generalizability of
the findings is limited due to the lack of heterogeneity
in a sample that was predominantly White, North
American, female, and highly educated.
Given the correlative nature of the design of this
study, questions still remain regarding whether the dis-
positional gratitude experienced by participants as
adults was a personality trait that was present prior to
the loss or whether it was developed through the experi-
ence of the loss. Addressing this question would require
a long-term prospective study to assess gratitude levels
of a large number of children before and after the loss
of a parent and compare these changes in gratitude with
a matched control group and is beyond the scope of this
study.
The retrospective nature of the study design pre-
sented some inherent challenges. Tennen and Affleck
(2009) have raised concerns about assessing posttrau-
matic growth multiple years after a traumatic incident
due to the difficulty that individuals may have in accu-
rately assessing a baseline of functioning prior to the
loss. A number of participants expressed this sentiment
in the open-ended responses, reporting that they were
either too young at the time of loss to remember their
functioning prior or that at the age when they lost a
parent they lacked a clear understanding of gratitude.
We addressed this issue by removing these individuals
from the analysis of perceptions of gratitude. Frazier
et al. (2009) have argued that most individuals have dif-
ficulty assessing their baseline functioning prior to
experiencing a trauma and that PTGI more accurately
measures perceived posttraumatic growth than actual
posttraumatic growth. The researchers decided that
the PTGI-SF was nevertheless an appropriate measure
for this population because the focus of the study is
on both current functioning of adults who lost a parent
in childhood as well as their personal attributions of
posttraumatic growth and changes in gratitude in
relation to the loss.
8 N. GREENE AND K. MCGOVERN
To further investigate the impact of the passage of
time, we analyzed the relationship between age at the
time of death, years since death, and the study variables.
Age at the time of the death was found to have a small
positive association with posttraumatic growth such
that those who were older when they lost a parent
report higher levels of posttraumatic growth as adults.
It is possible that those participants who were adoles-
cents at the time of the loss had more self-reflective
capacities and were thus more able to make meaning
from the loss than those who were younger at the time
of loss. Age at time of death was not associated with
gratitude, flourishing, or depression.
Small positive associations were found between years
since the death with gratitude and flourishing; small
negative associations were noted between time since
death and posttraumatic growth and depression. In
other words, individuals for whom more time had
passed since the death reported higher gratitude and
psychological well-being, less posttraumatic growth,
and less depression. This may suggest that as time
passes following the loss, emotional recovery from the
loss occurs, individuals acquire additional life
experiences, and they incorporate the loss more
comprehensively into their personal narrative.
The impact of additional traumas in childhood and
adulthood on change in gratitude and current function-
ing was also investigated. Reports of childhood traumas
in addition to parental death were not associated with
change in gratitude, current dispositional gratitude,
flourishing, posttraumatic growth or depression.
Although the degree of trauma that participants had
experienced in adulthood was not found to be related
to dispositional gratitude, reported adult trauma was
found to be related to other aspects of current function-
ing. For instance, a linear relationship was evidenced
between degree of adult trauma and current levels of
depression. Although such a clear linear relationship
was not present between adult trauma and other mea-
sures of functioning, those in the upper extremes of
trauma reported lower posttraumatic growth and
flourishing than those who reported the lowest levels
of adult trauma.
It was somewhat surprising that although the
presence of additional traumas in adulthood was related
to current functioning, those experienced in childhood
were not, especially in light of prior studies that suggests
that cumulative childhood traumas negatively impact
adult physical and psychological health outcomes
(Chapman et al., 2004; Felitti et al., 1998). Perhaps for
the participants who experienced additional traumas
in childhood have had adequate time to adapt to effects
of those traumatic events, whereas those who have
experienced the traumas in adulthood are currently still
dealing with their effects. Further investigation is
warranted.
Findings from this study contribute to research
demonstrating that gratitude plays a role in promoting
health and well-being in those who experience psycho-
logical trauma. The demonstrated link between grati-
tude and adaptive functioning in adults who have
experienced EPD provide important clinical implica-
tions. Research supports the concept that gratitude
can be fostered (Froh & Bono, 2014; Froh et al., 2008)
and a number of empirically supported strategies geared
toward fostering gratitude have been created (e.g.,
Emmons, 2013). When working with children and
adults who have lost a parent in childhood, it is
important that clinicians consider using gratitude inter-
ventions to facilitate meaning making, promote social
connectedness, and foster healthy adaptation. With
support, people who lost a parent in childhood may
come to feel as one woman in this study reported,
“Losing my mother reminds me daily how precious
life is and that I shouldn’t take a single second for
granted … From darkness I eventually came into the
light.”
Acknowledgments
This article contains data presented in the corresponding
author’s original doctoral dissertation submitted in June
2015 to the Wright Institute Graduate School of Psychology
entitled “The Role of Gratitude in Psychological Well-Being
and Posttraumatic Growth in Individuals Who Have
Experienced Early Parental Death: A Quantitative Study.”
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DEATH STUDIES 11
