Review Article | Open Access DOI: 10.23937/2643-4059/1710024

The Association between Gratitude and Depression: A Meta-Analysis

Jo A Iodice, John M Malouff* and Nicola S Schutte

University of New England, Australia


Many studies have explored the association between gratitude and depression, but no meta-analysis has been reported. The purpose of this meta-analysis was to fill that gap. The meta-analysis synthesized the association in 70 reported effect sizes from 62 published and unpublished articles, involving a total of 26,427 child, adolescent, and adult participants. The studies were completed by different research teams, using different samples, different measures, and various correlational research designs. The results showed a significant association between gratitude and depression, r = -0.39 (95% confidence intervals -0.44, -0.34), indicating that individuals who experience more gratitude have lower levels of depression. The results did not vary significantly with the measure of gratitude or depression used, whether the study was longitudinal or cross-sectional, the age of participants or the percentage of female participants, suggesting a robust connection between higher levels of gratitude and lower levels of depression. The findings show a substantial association between gratitude and depression. The association provides a reason to explore further the effects of gratitude-focused interventions as a method to alleviate depression and to prevent the development of depression.


Depression, Gratitude, Meta-analysis, Prevention, Treatment


Depression is a mood disorder that often includes sadness or irritability, along with lack of interest in daily activities, together with appetite change, sleep disturbance and feelings of worthlessness and guilt [1]. Functional consequences of depression can be physical, social, and occupational, including impaired ability to concentrate and make decisions; in severe cases, individuals cannot take care of their basic needs and may be mute or catatonic [1]. Individuals experiencing depression show higher rates of unemployment, relationship breakdown, education dropout [2], and suicide [3].

Depression is a common health problem. Over 264 million people suffer from depression worldwide, and it is one of the leading causes of disability and a major contributor to the global burden of disease [4].

Gratitude and depression

McCullough, et al. described gratitude as a tendency to think of or respond with appreciation for the kindness of others and the positive experiences and outcomes obtained from them [5]. A review by Wood et al. presented a new model of gratitude which incorporates the gratitude that comes from appreciating the kindness of others together with the gratitude that comes from habitual focus on the positive aspects of life [6]. This definition has become known as the life orientation approach and is a commonly used definition in current gratitude research [6].

Although gratitude is usually conceptualized as a trait, it can be cultivated and practiced. For example, Emmons and McCullough conducted longitudinal research on the association between gratitude and mental health [7]. Participants were assigned to one of three groups. The first group wrote about things they are grateful for, the second group wrote about daily hassles, and the third group wrote about a neutral topic. The findings suggested that participants who practiced gratitude by writing about things they are grateful for showed better mood, coping, and physical health than the other participants.

Studies have found that people with higher levels of gratitude report more optimism, positive affect, and satisfaction with life [5,8]. People high in gratitude also have higher self-esteem and evaluate themselves more positively [9].

Gratitude is a key construct in the positive psychology movement [10], which has gained momentum over the past two decades, with its focus on positive thoughts and behaviors. Positive psychology focuses on virtues and strengths to treat and protect against pathology [10]. These virtues include positive constructs such as optimism, hope, and gratitude.

Many studies have investigated the association between gratitude and depression. These studies are relevant to the existence of a causal connection between gratitude and depression in that an association is a foundation for a causal association. Hence, the results of association studies may provide useful information about the potential for gratitude increases, however produced, to either prevent the development of depression or to help alleviate existing depression.

The majority of the research on the association between gratitude and depression has used samples of undergraduate students. In recent years, evidence for a connection between gratitude and depression has also come from studies using a variety of sample groups. These sample groups include young people [11-13], adults and older people [2] and people who have experienced trauma, including patients with chronic illness [14,15].

Measures of gratitude

There are currently two main measures of gratitude used in research. The most commonly used is the Gratitude Questionnaire-6 (GQ-6; [5]). The GQ-6 is a six-item self-report measure with two reverse-scored items. Participants are asked to rate their answers on a scale from one to seven (1 = "strongly disagree", 7 = "strongly agree"). Examples of the items include "I have so much in life to be thankful for" and "I am grateful to a wide variety of people". Although the GQ-6 is a unifactorial measure, the items capture both gratitude towards the good deeds of others and a habitual focus on the positive aspects of life [6]. Scores on the GQ-6 correlate substantially with measures of related constructs such as hope, optimism and life satisfaction [5], thus providing evidence of validity. Also, the GQ-6 has good internal reliability with Cronbach's alpha between 0.82 and 0.87 [5].

The other popular measure of gratitude is the Gratitude Resentment and Appreciation Test (GRAT; [16]). This measure is based on a multifactor model. The GRAT is a 44 item self-report measure with five reverse-scored items. Participants are asked to rate their answers on a scale from one to nine (1 = "I strongly disagree"; 9 = "I strongly agree"). There are three subscales: Appreciation for life's simple pleasures, sense of abundance, and social appreciation. An example item is "Life has been good to me".

The GRAT and the GRAT short form, with 16 items, have both been shown to have good validity and reliability [16]. A meta-analysis of the reliabilities of gratitude measures showed GRAT has good internal reliability with Cronbach's alpha 0.92 [17].

Measures of depression

There are many measures of depression. A commonly used measure for depression is the Center for Epidemiologic Studies Depression Scale (CES-D; [18]). The CES-D is a 20-item self-report measure used to assess the frequency of depressive symptoms in the past week. Participants rate themselves on a scale ranging from zero (rarely or none of the time) to three (most or all of the time). Example items include "I felt sad" and "My sleep was restless" [18]. Reliability, validity and factor structure are shown to be similar across different populations and different types of depressive symptoms [18]. Cronbach's alpha has been reported as 0.90 [19].

Three other measures of depression have been commonly used in studies of the relationship between gratitude and depression. The Depression Anxiety Stress Scale (DASS) is a 42-item self-report measure of depression, anxiety and stress developed by Lovibond and Lovibond [20]. Participants are asked to rate how much a statement applies to them over the past week on a scale ranging from zero (never) to three (almost always). An example item is "I felt that life was meaningless". Evidence shows the DASS to be a valid and reliable measure of depression in clinical and non-clinical samples [21]. Cronbach's alpha of the depression subscale of DASS has been reported as 0.96 in clinical samples [22] and 0.95 in non-clinical samples [21].

The Beck Depression Inventory, 2nd edition (BDI-II; [23]) is a 21-item self-report scale that measures the severity of depressive symptoms over the past two weeks. Each item is rated on a four-point Likert scale, ranging from zero to three. The BDI-II shows good validity and reliability; Cronbach's alpha is reported to be 0.92 in psychiatric outpatient samples and 0.93 in non-clinical samples [23].

The final measure common to the relevant studies is the Hospital Anxiety and Depression Scale (HADS; [24]). It is a 14-item measure of anxiety and depressive symptoms. An example item is "I feel as if I am slowed down". Participants rate themselves in the past week on each item using a scale that goes from zero (not at all) to three (nearly all the time) Reliability and validity of the depression scale has been demonstrated in numerous studies with medical patients; Cronbach's alpha for the depression subscale is reported as 0.82 [24].

Although many studies have examined the relationship between gratitude and depression, no meta-analysis has been reported on the association between these two variables. The aim of this study was to use meta-analysis to combine results from studies on the association between gratitude and depression and find an overall weighted effect size. The main research hypothesis was that a higher level of gratitude would be associated with fewer symptoms of depression. We had no specific hypotheses regarding moderators of the size of the association, so we conducted exploratory moderator analyses, using meta-regression or subgroup analyses, to test as moderators: a) Mean sample age; b) Percentage of female participants; c) The gratitude measure used; d) The depression measure used, and e) Whether the study was cross-sectional or longitudinal.


Protocol and registration

This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; [25]). We developed a protocol for this meta-analysis and registered it at Prospero [26]. A record of the registered protocol for this meta-analysis can be found at

Literature search

We conducted a systematic literature search to locate reports of relevant studies, including published and unpublished studies. Online databases searched included PsychINFO, PubMed, Google Scholar, and Web of Science. Search terms included gratitude, depress*, associat*, correlat*, and predict*. Boolean operators AND and OR were used to refine the search. We screened the results from these searches by title and abstract initially and then focused on relevant full articles.

To reduce the risk of the file drawer problem, we sent emails to corresponding authors of all included articles to request any unpublished or in press research relevant to the relationship between gratitude and depression. Also, we reviewed the reference list of each included article to identify any other studies of interest.

Eligibility criteria

In order to be included in this meta-analysis, the report or data set had to provide the association between gratitude and depression. Studies using either cross-sectional design or longitudinal design were eligible for inclusion the titles and abstracts of identified articles were reviewed, and irrelevant articles were excluded. The full texts of remaining articles were reviewed to determine if they met the eligibility criteria. Figure 1 shows the PRISMA study flow diagram.

Figure 1: PRISMA flow diagram showing identification, screening, eligibility and inclusion of articles. View Figure 1

Collecting and managing data

The data recorded for each study included effect size or data necessary to calculate effect size, along with moderator information. Potential moderators were percentage of female participants, mean participant age, gratitude measure used, and depression measure used. Gratitude measures used were coded as GQ, GRAT or other. Depression measures used were coded as CESD, BDI, DASS-Depression, or other.

When there were multiple measures of gratitude reported in one study, to avoid biasing the results by reporting too many effect sizes from one sample, we used an average effect size. Each study was coded as either cross-sectional or longitudinal. For studies that were longitudinal the number of weeks between measuring gratitude and measuring depression was recorded. The effect size reported for longitudinal studies was chosen as the relationship between baseline gratitude and the longest follow-up of depression.

In some studies, there were missing data for moderator analysis. Corresponding authors were contacted in an attempt to gain access to the missing data. Where mean age was not provided for the study, the median was used as a substitute. Where other data were missing, the study was excluded from the related moderator analysis.

One of us entered data, another one then checked the entries, the third one of us independently checked data from 20% of articles. Using the standard of a disagreement of less than 5% is an agreement, we found an inter-rater agreement of 94%. Follow-up discussion led to all authors agreeing on the final data set.

Data analysis

We used r for the effect size and meta-analysis software Comprehensive Meta-Analysis by Borenstein, et al. [27]. To generalize beyond the data set, we used the random effects model, as suggested by Borenstein, et al. [28]. Under the random effects model, it is assumed that the true effect size varies from study to study. Random effects models produce larger confidence intervals compared to fixed effects models and lead to more conservative conclusions [29].

We used meta-regression to conduct exploratory analysis of continuous-data moderators. We used the Q statistic to test significance in moderator analyses. Publication bias was evaluated using observation of a funnel plot and the Duval and Tweedie [30] trim and fill procedure.


This meta-analysis synthesized 70 effect sizes from 62 published and unpublished studies, with a total of 26,427 participants. Table 1 shows the key characteristics of studies included in the meta-analysis. Figure 2 shows a forest plot of correlation coefficients and confidence intervals for studies included in the meta-analysis. A fixed effects analysis of homogeneity indicated that variance between studies was significant Q (69) = 2227.81, p < 0.001 and I2 was 96.9. These results suggest the presence of heterogeneity, so we used the random-effects model for the meta-analysis. The overall weighted correlation coefficient was significant, r = -0.39, 95% confidence interval (-0.44, -0.34), p < 0.001. The data file for the meta-analysis is available at The Association between Gratitude and Depression [34].

Figure 2: Forest plot and effect size for each study. View Figure 2

Table 1: Key characteristics of the studies included in this meta-analysis. View Table 1

The classic fail-safe N test indicated that 3571 correlation coefficients averaging null results would need to be added to the meta-analysis to reduce the current overall correlation coefficient to a non-significant level. The funnel plot, presented in Figure 3, shows that the distribution of correlational coefficients is not symmetrical, indicating some publication bias may be present. The Duval and Tweedie trim and fill analysis suggested that 13 studies be removed from the funnel plot, leaving an adjusted effect size of r = -0.36, 95% CIs (-0.40, -0.32), down slightly from the unadjusted r of -0.39.

Figure 3: Funnel plot of standard error by Fisher's Z. View Figure 3

We used meta-regression to examine whether sample mean age or percentage of female participants in samples had a moderating effect on the relationship between gratitude and depression. Mean age did not have a significant moderating effect, r = 0.001 (-0.001, 0.002), p = 0.31, with study means ranging from 10-years-old to 74. Percentage of female participants did not have a significant moderating effect, r = 0.000 (-0.002, 0.002) p = 0.48. Type of gratitude measure, depression measure and whether the study was longitudinal or cross-sectional did not explain a significant proportion of between-study heterogeneity. Table 2 shows the results of these subgroup analyses.

Table 2: Moderator results. View Table 2


A meta-analysis of 70 effect sizes based on the responses of 26,427 participants found that higher gratitude was significantly associated with lower depression. The weighted average association between gratitude and depression was r = -0.39. An adjustment suggested by the Duval and Tweedie assessment for publication bias caused by Small N studies reduced the meta-analytic r slightly to -0.36. The results, which indicate a medium negative relationship between the two variables according to guidelines from Cohen [35], support the hypothesis that higher levels of gratitude would be associated with lower levels of depression.

As the Q statistic test and I squared percentage showed significant heterogeneity in effect sizes, we examined several possible moderators in the meta-analysis. There was no evidence that the degree of association varies with sample mean age or the percentage of female participants. Subgroup analysis provided no evidence to show that the specific measures used for gratitude and depression had a moderating effect on the association between the two variables. There was a marginally significant trend in the direction of cross-sectional studies showing a higher effect size than longitudinal studies. All moderator subcategories showed a significant negative association between gratitude and depression.

The current findings are consistent with the positive psychology model [10]. Individual studies have shown that positive-psychology constructs such as optimism and hope have shown similar correlations with depression [36,37].

The results from this meta-analysis are consistent with research focusing on gratitude interventions as a treatment for depression. A number of studies have examined the effects of gratitude interventions on depression; reviews and meta-analyses have found that the effects were significant but small, especially when the comparison group received an active placebo [6,38,39]. Hence, some or all of the intervention effects may be due to placebo or nonspecific aspects of the interventions, and the connection between higher gratitude and lower depression may be due to various factors. It may be that gratitude reduces depression [9], as suggested by the results of some intervention studies (e.g., Cregg & Cheavans [38]), or depression may reduce gratitude. It is also possible that a third variable, such as specific genes [40], could lead to both high gratitude and low depression. Finally, there might be reciprocal and continuous relationships between gratitude and depression such that increases in the experience of gratitude lead to alleviation of symptoms of depression, and alleviation of depression in turn allows individuals to more fully experience and be grateful for positive elements of life.

A strength of the present meta-analysis is that it quantified the extent of the association between gratitude and depression across many studies, with a large total number of participants and diverse samples and research groups. While an asymmetrical distribution of correlation coefficients in the funnel plot displayed in Figure 3 suggests the possibility of publication bias, the Duval and Tweedie trim and fill analysis suggests that an adjustment for publication bias would only have a minor impact on the overall effect size.

Another strength of the meta-analysis is that most included studies used psychometrically sound measures of gratitude and depression. The reliability and validity of the measures helps ensure that the meta-analytic results are meaningful. A final strength of the meta-analysis was that the large number of included studies provided reasonable power to search for moderators that might be associated with the effect size.

One of the limitations of this meta-analysis is that all included studies used measures of self-report for both variables. The exclusive use of self-report measures creates the possibility of inflated correlations due to same-method and same-source response bias [41].

Future research could examine whether gratitude interventions help prevent the development of depression. Also, future research could use longitudinal analyses to test for reciprocal relationships between gratitude and depression.

High heterogeneity of effect sizes in the present meta-analysis suggests that there might be moderators of effect size. However, none of the moderators examined in this meta-analysis showed significant evidence of an effect. One interesting potential moderator would be whether individuals feel grateful (the cognitive and emotional elements of gratitude) or express gratitude to others (the behavioral aspect). Any differences in association with depression might provide valuable clues about how best to structure gratitude interventions.

In conclusion, the significant association between gratitude and depression found in the present meta-analysis, together with previous research focusing on the effect gratitude interventions have on lessening depression, suggests that more research is appropriate to determine the causal relationship between gratitude and depression.

Authors Declaration

The authors have no conflicts of interest and have no financial disclosures to make related to this work.


  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. (5th edn), Arlington.
  2. Disabato DJ, Kashdan TB, Short JL, Jarden A (2017) What predicts positive life events that influence the course of depression? A longitudinal examination of gratitude and meaning in life. CTR 41: 444-458.
  3. Lambert NM, Fincham FD, Stillman TF (2012) Gratitude and depressive symptoms: The role of positive reframing and positive emotion. Cogn Emot 26: 615-633.
  4. GBD 2017 Disease and Injury prevention incidence and prevalence collaborators (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet 392: 1789-1858.
  5. McCullough ME, Emmons RA, Tsang JA (2002) The grateful disposition: A conceptual and empirical topography. JPSP 82: 112-127.
  6. Wood AM, Froh JJ, Geraghty AWA (2010) Gratitude and well-being: A review and theoretical integration. Clin Psychol Rev 30: 890-905.
  7. Emmons R, McCullough M (2003) Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol 84: 377-389.
  8. Dickens LR (2017) Using gratitude to promote positive change: A series of meta-analyses investigating the effectiveness of gratitude interventions. BASP 39: 193-208.
  9. Lin CC (2015) Gratitude and depression in young adults: The mediating role of self-esteem and well-being. Personality and Individual Differences 87: 30-34.
  10. Seligman MEP, Csikszentmihalyi M (2000) Positive psychology: An introduction. Am Psychol 55: 5-14.
  11. Padilla-Walker LM, Millett MA, Memmott-Elison MK (2020) Can helping others strengthen teens? Character strengths as mediators between prosocial behavior and adolescents' internalizing symptoms. J Adolesc 79: 70-80.
  12. Rey L, Quintana-Orts C, Mérida-López S, Extremera N (2019) Being bullied at school: Gratitude as potential protective factor for suicide risk in adolescents. Front Psychol 10: 1-10.
  13. Tam HL, Yuk-Ching Kwok Lai S, Hay-Ming Lo H, Yiu-Tsang Low A, Wai-Keung Yeung J, et al. (2017) The moderating effects of positive psychological strengths on the relationship between parental anxiety and child depression: The significance of father's role in Hong Kong. CYSR 73: 283-290.
  14. Ruini C, Vescovelli F (2013) The role of gratitude in breast cancer: It's relationships with post-traumatic growth, psychological well-being and distress. JHS 14: 263-274.
  15. Sirois FM, Wood AM (2017) Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health Psychol 36: 122-132.
  16. Watkins PC, Woodward K, Stone T, Kolts RL (2003) Gratitude and happiness: Development of a measure of gratitude and relationships with subjective well-being. SBP 31: 431-452.
  17. Card NA (2018) Meta-analyses of the reliabilities of four measures of gratitude. JPP 14: 576-586.
  18. Radloff LS (1977) The CES-D scale: A self-report depression scale for research in the general population. APM 1: 385-401.
  19. Cosco TD, Prina M, Stubbs B, Wu YT (2017) Reliability and validity of the center for epidemiologic studies depression scale in a population-based cohort of middle-aged U.S. adults. J Nurs Meas 25: 476-485.
  20. Lovibond SH, Lovibond PF (1995) Manual for the depression anxiety stress scales. Psychology Foundation of Australia.
  21. Crawford JR, Henry JD (2003) The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. Br J Clin Psychol 42: 111-131.
  22. Brown TA, Chorpita BF, Korotitsch W, Barlow DH (1997) Psychometric properties of the depression anxiety stress scales (DASS) in clinical samples. Behav Res Ther 35: 79-89.
  23. Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio, 78: 490-498.
  24. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: An updated literature review. J Psychosom Res 52: 69-77.
  25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ.
  26. Booth A, Clarke M, Dooley G, Ghersi D, Moher D, et al. (2012) The nuts and bolts of PROSPERO: An international prospective register of systematic reviews. Syst Rev 1: 2.
  27. Borenstein M, Hedges L, Higgins J, Rothstein H (2013) Comprehensive meta-analysis version 3.0. Biostat, Englewood, NJ.
  28. Borenstein M, Hedges L, Higgins J, Rothstein H (2009) Introduction to meta-analysis. Wiley, Chichester, United Kingdom.
  29. Lipsey MW, Wilson DB (2001) Practical meta-analysis. Sage Publications, Thousand Oaks, USA.
  30. Duval S, Tweedie R (2000) Trim and fill: A simple funnel-plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56: 455-463.
  31. Alkozei A, Smith R, Kotzin MD, Waugaman DL, Killgore WDS (2019) The association between trait gratitude and self-reported sleep quality is mediated by depressive mood state. Behav Sleep Med 17: 41-48.
  32. Allenden N, Boman P, Mergler A, Furlong MJ (2016) Positive psychology constructs as predictors of depression in retirees. Ageing & Society 38: 995-1017.
  33. Begg MSC (2016) How do the five facets of mindfulness and dispositional gratitude relate to depression, anxiety, and stress? University of Newcastle 67: 588-597.
  34. The association between gratitude and depression: A meta-analysis.
  35. Cohen J (1988) Statistical power analysis for the behavioral sciences. (2nd edn), Routledge Academic, NY.
  36. Garner MJ, McGregor BA, Murphy KM, Koenig AL, Dolan ED, et al. (2015) Optimism and depression: A new look at social support as a mediator among women at risk for breast cancer. Psycho-oncology 24: 1708-1713.
  37. Li Z, Wang Y, Mao X, Yin X (2018) Relationship between hope and depression in college students: A cross-lagged regression analysis. Personal Ment Health 12: 170-176.
  38. Cregg DR, Cheavens JS (2020) Gratitude interventions: Effective self-help? A meta-analysis of the impact on symptoms of depression and anxiety. JHS 22: 413-445.
  39. Davis DE, Choe E, Meyers J, Wade N, Varjas K, et al. (2016) Thankful for the little things: A meta-analysis of gratitude interventions. J Couns Psychol 63: 20-31.
  40. Liu J, Gong P, Gao X, Zhou X (2017) The association between well-being and the gene: Dispositional gratitude and forgiveness as mediators. J Affect Disord 214: 115-121.
  41. Podsakoff PM, MacKenzie SB, Podsakoff NP (2012) Sources of method bias in social science research and recommendations on how to control it. Annu Rev Psychol 63: 539-569.
  42. Bryan JL, Young CM, Lucas S, Quist MC (2018) Should I say thank you? Gratitude encourages cognitive reappraisal and buffers the negative impact of ambivalence over emotional expression on depression. PID 120: 253-258.
  43. Celano CM, Beale EE, Beach SR, Belcher AM, Suarez L, et al. (2017) Associations between psychological constructs and cardiac biomarkers after acute coronary syndrome. Psychosom Med 79: 318-326.
  44. Chamizo-Nieto MT, Rey L, Sanchez-Alvarez N (2020) Validation of the Spanish version of the cognitive emotion regulation questionnaire in adolescents. Psicothema 32: 153-159.
  45. Corona K, Senft N, Campos B, Chen C, Shiota M, et al. (2020) Ethnic variation in gratitude and well-being. Emotion 20: 518-524.
  46. Crouch TA, Verdi EK, Erickson TM (2020) Gratitude is positively associated with quality of life in multiple sclerosis. Rehabil Psychol 65: 231-238.
  47. Deichert NT, Chicken MP, Hodgman L (2019) Appreciation of others buffers the associations of stressful life events with depressive and physical symptoms. JHS 20: 1071-1088.
  48. Enko J, Behnke M, Dziekan M, Kosakowski M, Kaczmarek LD (2020) Gratitude texting touches the heart: Challenge/threat cardiovascular responses to gratitude expression predict self-initiation of gratitude interventions in daily life. JHS 22: 49-69.
  49. Fenollar Bataller J (2011) Reflecting on gratitude: Promoting healthy lifestyles in adults.
  50. Froh JJ, Emmons RA, Card NA, Bono G, Wilson JA (2011) Gratitude and the reduced costs of materialism in adolescents. JHS 12: 289-302.
  51. Gavian ME (2011) The effects of relaxation and gratitude interventions on stress outcomes.
  52. Greene N, McGovern K (2017) Gratitude, psychological well-being, and perceptions of posttraumatic growth in adults who lost a parent in childhood. Death Stud 41: 436-446.
  53. Harbaugh CN (2014) Gratitude and well-being: Replication and extension of the benefits of a gratitude exercise and investigation of potential moderators and mediators.
  54. Hoffman DL (2015) The effects of a practice of gratitude on quality of life and depression in head and neck cancer survivors.
  55. Kaniuka AR, Kelliher Rabon J, Brooks BD, Sirois F, Kleiman E, et al. (2020) Gratitude and suicide risk among college students: Substantiating the protective benefits of being thankful. J Am Coll Health 16: 1-8.
  56. Kashdan TB, Breen WE (2007) Materialism and diminished well-being: Experiential avoidance as a mediating mechanism. JSCP 26: 521-539.
  57. Kleiman EM, Adams LM, Kashdan TB, Riskind JH (2013) Grateful individuals are not suicidal: Buffering risks associated with hopelessness and depressive symptoms. Personality and Individual Differences 55: 595-599.
  58. Koenig HG, Berk LS, Daher NS, Pearce MJ, Bellinger DL, et al. (2014) Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness. JPR 77: 135-143.
  59. Langer AI, Ulloa VG, Aguilar-Parra JM, Araya-Veliz C, Brito G (2016) Validation of a Spanish translation of the gratitude questionnaire (GQ-6) with a Chilean sample of adults and high schoolers. Health Qual Life Outcomes 14: 53.
  60. Lau BHP, Cheng C (2017) Gratitude and coping among familial caregivers of persons with dementia. Aging Ment Health 21: 445-453.
  61. Lee JY, Kim SY, Bae KY, Kim JM, Shin IS, et al. (2018) The association of gratitude with perceived stress and burnout among male firefighters in Korea. PID 123: 205-208.
  62. Jinghua Li, Phoenix KHM, Christopher WK, Joseph TFL, Mengran D, et al. (2016) Prevalence and associated factors of depressive and anxiety symptoms among HIV-infected men who have sex with men in China. AIDS Care 28: 465-470.
  63. Liang H, Chen C, Li F, Wu S, Wang L, et al. (2018) Mediating effects of peace of mind and rumination on the relationship between gratitude and depression among chinese university students. Current Psychology 39: 1430-1437.
  64. Lin CC (2015) The relationships among gratitude, self-esteem, depression, and suicidal ideation among undergraduate students. Scand J Psychol 56: 700-707.
  65. Lin CC (2019) The effects of gratitude on suicidal ideation among late adolescence: A mediational chain: Research and reviews. Current Psychology 40: 2242-2250.
  66. Mann DJ (2011) The relationship between well-being and the pressure to date and marry among modern orthodox jews. Hofstra University.
  67. Martin F, Clyne W, Pearce G, Turner A (2019) Self-management support intervention for parents of children with developmental disorders: The role of gratitude and hope. Journal of Child and Family Studies 28: 980-992.
  68. Mills PJ, Redwine L, Wilson K, Pung MA, Chinh K, et al. (2015) The role of gratitude in spiritual well-being in asymptomatic heart failure patients. Spirituality in Clinical Practice 2: 5-17.
  69. Olawa BD, Idemudia ES (2019) Satisfaction with adult children's achievements is associated with depression and loneliness in later-life: The mediating roles of children's support and gratitude. Educational Gerontology 45: 269-282.
  70. Petrocchi N, Couyoumdjian A (2016) The impact of gratitude on depression and anxiety: The mediating role of criticizing, attacking, and reassuring the self. APS 15: 191-205.
  71. Renshaw TL, Rock DK (2018) Effects of a brief grateful thinking intervention on college students' mental health. Mental Health and Prevention 9: 19-24.
  72. Rey L, Sánchez-Álvarez N, Extremera N (2018) Spanish gratitude questionnaire: Psychometric properties in adolescents and relationships with negative and positive psychological outcomes. Personality and Individual Differences 135: 173-175.
  73. Sánchez-Álvarez N, Quintana-Orts Cirenia (2019) Effect of gratitude on depression and suicidal behavior in adolescents: How can being grateful save your life?" IV Spanish National Congress of Psychology in Alava.
  74. Sánchez-Álvarez N, Extremera N, Rey L (2021) Can being grateful save your life? Journal of Positive Psychology.
  75. Sánchez-Álvarez N, Extremera N, Rey L, Chang EC, Chang OD (2020) Optimism and gratitude on suicide risk in spanish adults: Evidence for doubling up or doubling down? J Clin Psychol 76: 1882-1892.
  76. Sherman AC, Simonton-Atchley S, O'Brien CE, Campbell D, Reddy RM, et al. (2019) Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients. J Behav Med 43: 596-604.
  77. Simon P (2016) An exploratory study about the buffering effect of gratitude on the relationship between neuroticism and anhedonic depression. Psychological Studies 61: 340-347.
  78. Stoeckel M, Weissbrod C, Ahrens A (2015) The adolescent response to parental illness: The influence of dispositional gratitude. JCFS 24: 1501-1509.
  79. Tehranchi A, Neshat Doost HT, Amiri S, Power MJ (2018) The role of character strengths in depression: A structural equation model. Front Psychol 9: 1609.
  80. Tulbure BT (2015) Appreciating the positive protects us from negative emotions: The relationship between gratitude, depression and religiosity. PSBS 187: 475-480.
  81. Van Dusen JP (2014) Relationships amongst gratitude, well-being and depression.
  82. Van Dusen JP (2019) Relationships between gratitude and latent dimensions of depression and generalized anxiety disorder.
  83. Van Dusen JP, Tiamiyu MF, Kashdan TB, Elhai JD (2015) Gratitude, depression and PTSD: Assessment of structural relationships. Psychiatry Res 230: 867-870.
  84. Wood AM, Maltby J, Gillett R, Linley PA, Joseph S (2008) The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. JRP 42: 854-871.
  85. Wood AM, Joseph S, Maltby J (2009) Gratitude predicts psychological well-being above the big five facets. PID 46: 443-447.
  86. Wu Q, Chi P, Lin X, Du H (2018) Child maltreatment and adult depressive symptoms: Roles of self-compassion and gratitude. Child Abuse & Neglect 80: 62-69.
  87. Zhang MX, Mou NL, Tong KK, Wu AMS (2018) Investigation of the effects of purpose in life, grit, gratitude, and school belonging on mental distress among Chinese emerging adults. Int J Environ Res Public Health 15: 1-12.
  88. Zhang H, Wang Y (2019) Bullying victimization and depression among young Chinese adults with physical disability: Roles of gratitude and self-compassion. CYSR 103: 51-56.
  89. Lin CC, Yeh Y (2011) The development of the "Inventory of Undergraduates' Gratitude". Psychological Testing 58: 2-33.
  90. Peterson C, Seligman MEP (2004) Character strengths and virtues: A handbook and classification. American Psychological Association, Oxford University Press, Washington.
  91. Weissman MM, Orvaschel H, Padian N (1980) Children's symptom and social functioning self-report scales: Comparison of mothers' and children's reports. J Nerv Ment Dis 168: 736-740.
  92. Derogatis LR, Spencer PM (1982) The brief symptom inventory: Administration, scoring, and procedures manual. Baltimore: Clinical psychometric research.
  93. Reynolds WM, Kobak KA (1998) Reynolds depression screening inventory: Professional manual. Psychological Assessment Resource. Odessa, Florida.
  94. Casillas A, Clark LA (2000) The mini mood and anxiety symptom questionnaire (Mini-MASQ). In paper presented at the 72nd annual meeting of the midwestern psychological association, Chicago, IL.
  95. Zung WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12: 63-70.
  96. Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, et al. (2003) Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc 51: 694-698.
  97. Kovacs M (1992) Children's depression inventory. NY: Multi-health system, North Tonawanda.
  98. Kellner R (1987) A symptom questionnaire. J Clin Psychiatry 48: 269-274.
  99. Spielberger CD, Carretero-Dios H, De los Santos-Roig M, Buela-Casal G (2002) Spanish experimental version of the statetrait depression questionnaire (STDEP): Trait sub-scale (T-DEP). IJCHP 2: 51-69.


Iodice JA, Malouff JM, Schutte NS (2021) The Association between Gratitude and Depression: A Meta-Analysis. Int J Depress Anxiety 4:024.