Introduction: Perinatal loss is a highly distressing life event that may lead to severe grief reactions. Individual differences in attachment patterns may contribute to variability in perinatal grief severity. In this study, the association between attachment patterns and the severity of perinatal grief was examined, and the roles of psychological and clinical factors were evaluated.
Methods: The sample consisted of 140 women with a lifetime history of perinatal loss. Perinatal grief severity was assessed using the Perinatal Grief Scale (PGS). Attachment-related variables were measured with the Parental Bonding Instrument (PBI) and the Experiences in Close Relationships -Revised Scale (ECR-R). Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). Associations were examined using correlation analyses. Separate analyses of covariance were conducted to evaluate the effects of maternal and paternal bonding categories on perinatal grief severity while controlling for depressive symptoms, anxiety symptoms, perceived social support, and the time elapsed since the most recent perinatal loss. Mediation analyses were conducted using PROCESS.
Results: Perinatal grief severity was positively correlated with depressive and anxiety symptoms. Maternal and paternal bonding categories were not directly associated with grief severity after adjustment. However, depressive symptoms significantly mediated the associations between maternal neglectful parenting and perinatal grief severity, and between paternal affectionless control and perinatal grief severity. No significant mediation effects were observed via anxiety symptoms.
Conclusion: Attachment-related vulnerabilities appear to influence perinatal grief severity primarily through depressive symptoms rather than direct effects, highlighting the importance of assessing and addressing depression following perinatal loss.
Keywords: Attachment, bereavement, perinatal grief, perinatal loss