Toward a preventive approach to prolonged grief disorder in palliative care: Insecure attachment moderates the impact of perceived support on the severity of symptoms

Objective This study aimed to investigate the relationships between perceived support at the time of assistance, insecure attachment (i.e., avoidance and anxious attachment), and prolonged grief symptoms in family caregivers of palliative care patients deceased for at least one year. We also investigated the moderating role of insecure attachment in the relationship between perceived support and the intensity of prolonged grief symptoms. Method An exploratory cross-sectional design was used. A sample of 157 participants completed the Prolonged Grief Scale (PG-13) and the Attachment Style Questionnaire (ASQ). Results Correlational analyses indicated that prolonged grief symptoms were positively correlated with Avoidance attachment but not with Anxious attachment. Perceived support was nega- tively correlated with both the Avoidance and Anxious attachment factors. Lastly, the two insecure attachment dimensions were moderately and positively correlated with each other. Results of moderation analysis showed that high Avoidance attachment moderated the effect of perceived family and social support on the intensity of prolonged grief symptoms among family caregivers of palliative home-care-assisted patients. Results also showed that the Anxious attachment factor had a significant effect on prolonged grief symptoms, even though the interaction with perceived support was not significant. Conclusions Overall, these results underline that a high level of avoidance attachment may moderate the relationship between perceived support and the intensity of grief symptoms, thereby increasing the risk of developing a mental disorder. Interventions to prevent prolonged grief disorder among family caregivers should take these findings into account.