The rapid integration of artificial intelligence (AI) into grief and bereavement care represents a significant technological shift with therapeutic potential and ethical complexity. This paper establishes evidence-informed assumptions and principles to guide the responsible development and use of AI technologies in grief support, addressing the needs of bereaved individuals, families, communities, professionals, technology developers, and policymakers. We define "Grief AI" as applications spanning five core technological domains: Natural Language Processing for information seeking and therapeutic conversations; Computer Vision for emotion analysis and immersive experiences; Machine Learning for trajectory forecasting and treatment matching; Conversational and Generative AI for grief bots; and Integrated Multimodal AI incorporating advanced autonomous systems. The paper classifies these applications into low-, medium-, and high-risk categories based on factors including depth of user engagement, AI autonomy, potential for psychological harm, level of human supervision, and posthumous consent considerations. The paper acknowledges unresolved tensions regarding the authenticity of AI-generated empathy, cultural evolution versus inappropriate technologization of sacred experiences, implications for healthy grief adaptation, environmental ethics, and professional transformation. These provocations highlight the need for ongoing dialogue as the field evolves. We conclude that AI technologies can complement human-centered grief support through responsible development characterized by interdisciplinary collaboration, transparency, cultural sensitivity, and an unwavering commitment to human dignity and welfare over commercial interests.
Death, bereavement, and grief "etiquette" describes a felt-sense of "right," "wrong," "appropriate," "inappropriate," "should" and "must" in death and bereavement contexts. Etiquette was explored qualitatively through eleven semi-structured interviews with reflexive thematic analysis used to answer the question: Where does etiquette arise in death and bereavement contexts, and what does this "look like"? All but one participant were bereaved individuals recruited via gatekeeper organizations. Etiquette arose in how individuals remembered their loved ones (funerals, talking about the deceased) and in spaces of remembrance (e.g., Facebook, gravesites). Findings offer psychotherapeutic practitioners common points of reference to help resolve conflict between clients with opposing etiquettes as well as specific re-frames to enable wider grief expression and practices. Etiquette is a useful theoretical concept for both professionals and the public, the knowledge of which bolsters wider initiatives to build grief literacy and compassionate communities.
In contexts of prolonged insecurity, existential threat becomes a central organizing principle of collective life. Terror Management Theory (TMT) has focused on intrapsychic responses to mortality salience. However, researchers have paid less attention to how public discourse constructs mortality-related threats. This study examines how political communication articulates and manages existential threat over time. Using a qualitative thematic analysis of speeches by Israel's Prime Minister Benjamin Netanyahu and a hybrid inductive-deductive approach informed by TMT, the findings show that political discourse progressively constructs threat as a continuous condition, expanding across social boundaries and reshaping collective belonging. Discourse mobilizes cultural worldviews, identity, and self-esteem as anxiety buffers and positions leadership as an additional symbolic resource. These findings extend TMT by demonstrating that political discourse socially produces and discursively maintains mortality salience.
Patients in a permanent vegetative state present unique emotional, ethical and relational challenges for those who care for them, whose physical presence yet psychological absence may expose staff to ambiguous loss, vicarious grief and disenfranchized grief. This qualitative study used reflexive thematic analysis to explore the lived experiences of 13 healthcare assistants working in a vegetative-state unit in north-east Italy, drawing on semi-structured interviews about caregiving, emotional burden, grief and anticipatory treatment declarations. Five themes were developed, describing care as emotionally complex and requiring continuous negotiation between attachment and protective detachment, alongside ethical distress over prolonged treatment and profound shifts in views on life and death. Caring for these patients involves complex, often unrecognized grief; psychological support, reflective spaces, death education and training on ambiguous loss may help staff process emotional burden and sustain humanized care.
Bereavement is increasingly recognized as a public health concern, yet support systems in many welfare states continue to allocate support according to the circumstances of death rather than the functional needs of bereaved families. Existing bereavement frameworks have substantially advanced understanding of social recognition and public legitimacy but provide more limited guidance for understanding how institutional responsibility for bereaved families is organized. using Israel as a bereavement-saturated case, this study introduces the concept of orphaned bereavement to describe bereavement in which no institution holds clearly defined and continuing responsibility for identifying needs, coordinating support, and ensuring continuity of care. Drawing on 25 semi-structured interviews with five bereaved family members and 20 professionals, analyzed using reflexive thematic analysis, the analysis generated three interrelated themes: institutionalized invisibility and unequal recognition; reorganizing life in the absence of institutional support; and pathways toward a needs-based model of bereavement support. The findings extend existing theories of disenfranchized grief and grievability by introducing institutional responsibility as a complementary lens for understanding bereavement inequality and support a needs-based public health approach in which support is organized according to families' evolving functional needs rather than the circumstances of death.
End-of-life decisions, including euthanasia and physician-assisted suicide (PAS), remain highly debated, particularly in countries like France, where legislative changes are under discussion. This study replicates Guedj et al. to assess changes in acceptability judgments over two decades using Anderson's (1981) information integration theory. Participants from the general public (N = 263: 115 in 2005, 148 in 2024) and healthcare professions (N = 126: 72 in 2005, 54 in 2024) evaluated life-ending decisions across scenarios. The study analyzed four factors: patient desire to die, suffering type (physical, psychiatric, or total dependence), actor (patient/physician), and procedure (active/passive). Results show stable overall acceptability, but PAS gained acceptance, while involuntary euthanasia became less tolerated. Physicians rated these decisions as less acceptable than the public, with nurses and nursing assistants positioned intermediately. Findings underscore increasing patient autonomy, informing France's end-of-life policy debates.
Bereaved individuals encounter the deceased through social media profiles, message histories, and algorithmic reminders, yet no validated instrument measures prolonged grief expressed through digital interactions. We developed and validated a multidimensional measure of digital-environment prolonged grief severity (DPGSS). Turkish bereaved adults (n = 577) bereaved at least 12 months earlier completed the DPGSS alongside grief, distress, and other less relevant measures, and 125 completed it again about three weeks later. Factor analyses supported a four-factor structure-digital separation distress and preoccupation, digital emotional responses, digital avoidance, and digital functional impairment-in 15 items. The correlated four-factor model fit the data well, outperforming a one-factor alternative. The DPGSS demonstrated strong internal consistency, test-retest reliability, and measurement invariance across nine demographic variables. Convergent associations with grief and distress, and negligible associations with rigidity and AI acceptance, supported its construct specificity. The DPGSS-15 is a reasonable tool for assessing digital prolonged grief.
The hypothesis based on terror management theory and fear of death was that higher state ageism is associated with lower state suicide rates among the 48 contiguous U.S. states. Ageism scores were based on responses of 331,056 adults to an implicit association test between 2002 and 2020. Age-adjusted suicide rates for 2018-2022 pertained to four different age categories: 20 years and over, 20-39 years, 40-64 years, and 65 years and older. Statistical controls were socioeconomic status, income inequality, urbanization, Black population percent, religiosity, political conservatism, distress, and depression. Pearson correlations between ageism and the four age-based suicide rates ranged from -.55 to -.62. Multiple regressions with the eight controls and ageism as predictors produced βs for ageism ranging from -.52 to -.59. Multicollinearity and spatial autocorrelation were not problematic. Explanatory speculation focuses on higher fear of death, which is integrally associated with higher ageism, serving as a deterrent to suicide.
Suicide-related stigma may hinder help-seeking and timely mental health support among emerging adults aged 18-29 years. Although empathy may be protective, evidence on its association with suicide-related attitudes remains limited. This cross-sectional study examined associations between empathy and the three subscales of the Stigma of Suicide Scale-Short Form among 1,003 Peruvian university students (Mage = 20.47, SD = 1.97; 51.4% men). Participants completed the Cognitive and Affective Empathy Test and the Stigma of Suicide Scale-Short Form. Structural equation modeling with WLSMV showed that higher empathy was associated with lower stigma (β = -.367), isolation/depression beliefs (β = -.297), and glorification/normalization beliefs (β = -.195; all p < .001). Associations remained significant after adjustment for age, sex, and religious practice, and structural invariance was supported across sex. Findings suggest that empathy may be a relevant correlate of less stigmatizing and stereotyped suicide-related attitudes among Peruvian emerging adults.
Through a constructivist qualitative design and semi-structured, in-depth interviews with 11 adults, this study examines how Arab-Muslims retrospectively make sense of childhood maternal loss and how it continues to shape them in adulthood. Analysis identified two interrelated themes: participants experienced sudden maternal death as a biographical rupture dividing life into a "before" and "after," and they sustained ongoing bonds with their deceased mothers, neither fully absent nor present, through everyday relational practices. These themes suggest that participants move from rupture toward relational continuity, reconstructing access to maternal presence over time. Highlighting the evolving meanings of childhood maternal loss, the study challenges detachment-oriented and stage-based grief models; contributes to qualitative social work scholarship, showing how sudden loss, cultural context, and relational continuity intersect in shaping identity and belonging; and informs culturally responsive bereavement support.
The COVID-19 pandemic substantially disrupted funeral practices across the world, as public health restrictions limited gatherings and altered how funerals and mourning practices could take place. This study serves as a retrospective account of funeral-related discourse on Twitter, now X, during the first year of the pandemic. We conducted a mixed-methods content analysis of a random sample of 900 English-language posts containing the hashtag #funeral, drawn from a larger corpus of COVID-19-related tweets posted between February 2020 and January 2021. The analysis examined public expressions of grief, ritual disruption, adaptation, the role of funeral service professionals and related concerns during a period of widespread crisis. At the interpretive level, four overlapping discourses were identified across the thematic findings: disrupted rituals and mourning at a distance; visibility, unequal recognition and politicized mourning; funeral economies and unequal mourning; and professional care and ritual continuity under restriction. Rather than signaling a complete transformation of mourning, the findings show how established practices were publicly reconfigured through Twitter, altering how funeral-related experiences were made visible, circulated and contested during the pandemic.
This study presents a qualitative analysis of 16 interviews with Israeli siblings who experienced the loss of a sibling followed by the addition of a new child to the family. The study explores how bereaved siblings encounter and make sense of the subsequent child within the family context. Using thematic analysis, four key themes emerged: (a) resentment toward parents' decision to have another child; (b) the absence of an appropriate term to define the subsequent child's role; (c) the development of semi-parental relationships with the subsequent sibling(s); and (d) a "misery scale," reflecting perceptions of legitimate mourners. Participants' encounters with the subsequent child encompassed both relational and sociocultural dimensions. These findings highlight the need for clinicians to recognize the complex positioning of subsequent children and to address issues of boundary-making, legitimacy of grief, and intra-familial hierarchies. Attending to bereaved siblings' experiences may support more inclusive and attuned family interventions.
Nurses are routinely exposed to critically and terminally ill patients, resulting in frequent encounters with death. Despite this, few studies have examined the distribution of death anxiety within the nursing workforce. This study aims to assess and validate levels of death anxiety among Indian nurses. A cross-sectional study was conducted on nurses employed in public and private hospitals, with a final sample size of 1360 participants. Measures included death anxiety, mental health indicators, and socio-demographic characteristics. Latent profile analysis of death anxiety and mental health scores revealed five distinct profiles: subdued mortality preoccupation, death serenity, existential disquiet, high mortality preoccupation, and balanced resilience. These profiles showed that nurses of older age, with greater professional experience, and those employed in private hospitals exhibited lower levels of death anxiety. The findings emphasize the need for institutional policies and training programs to strengthen resilience and promote mental health of nurses.
The recent legalization of assisted dying (AD) in New Zealand has reshaped experiences of dying and grief, yet AD-related grief remains under-theorised. Guided by the questions of whether particular forms of grief are more prominent at different stages of the AD process, and how these manifestations can inform a grief framework tailored to AD, this qualitative study explores and explains how grief theories apply to AD. Using appreciative inquiry, we interviewed 46 individuals eligible or ineligible for AD and family members. Inductive-deductive thematic analysis identified a distinct AD grief trajectory shaped by anticipatory and preparatory processes. Advocacy work and legacy work emerged as central practices supporting readiness, meaning-making, and continuing bonds, while stigma at times complicated coping and social expression of grief. The resulting framework also explains how loss- and restoration-oriented processes unfold within the intentional and socially embedded context of AD, offering guidance for clinicians, researchers, and policymakers.
Serious youth violence is a significant social concern in the United Kingdom. This qualitative study explores the reported recommendations for the offer of care for families and members of the wider social network who have been bereaved by youth-violence-related homicide. This UK-based study used naturalistic, semi-structured interviews with 24 participants, including immediate and extended family and one peer. The study was initiated and co-produced with an expert by experience. Reflexive thematic analysis was used to identify recommendations for an improved support model. Our results coalesced around four main findings: (1) Need for timely support, (2) Importance of responsive, flexibly tailored help, (3) Importance of accessibility, (4) Specific ideas around the format and structure of help. There was an emphasis on support being more joined up, potentially through the establishment of an integrated keyworker role. Participants described the wish for warm, empathic, and culturally sensitive support provided by workers with specialist training.
Guilt is a common emotional response to bereavement and has been associated with prolonged grief symptoms. Experiential avoidance and rumination are associated with the persistence of grief related symptoms, yet their role in explaining how guilt contributes to grief severity remains unclear. This study examined whether experiential avoidance and rumination mediate the association between guilt and prolonged grief symptoms in bereaved adults. A community sample of 690 Portuguese adults who experienced an expected or unexpected loss completed measures of guilt, experiential avoidance, rumination, and grief. Mediation analyses revealed significant indirect effects of experiential avoidance and rumination (injustice, meaning, and relationship) on the association between guilt and prolonged grief symptoms, alongside a significant direct effect of guilt. These findings suggest that guilt may exacerbate grief through avoidance and repetitive negative thinking processes, identifying potential mechanisms that may serve as targets for prevention and intervention efforts.
