In Study 1 it was found that adults with different attachment styles generate different narratives of their childhood bereavement experience. As was discussed above, this finding was consistent with previous research supporting a link between adult attachment style and the experience of bereavement (Meier, Carr, Currier, & Neimeyer, 2013; Stroebe, 2002). Study 1, however, did not provide explicit links between adult complicated grief, adult attachment style, and childhood experience. Such links were assumed but were not directly assessed, although the above literature suggests that they exist. The aim of Study 2 was to clarify the relationship between quality of parental care and separation anxiety in childhood, adult attachment style, and complicated grief in adulthood. That would suggest a link between insecure attachment in childhood, unresolved loss in childhood, insecure attachment in adulthood, and unresolved loss in adulthood.
Study 2 explored one research question (what are the best predictors of adult complicated grief among indices of parental care) and tested eight research hypotheses:
1. Complicated grief would be positively related to parental protection, separation anxiety, adult attachment avoidance, and adult attachment anxiety.
2. Complicated grief would be negatively related to parent care.
3. Adult attachment style (both anxiety and avoidance) would mediate the link between paternal care (maternal and paternal) received in childhood and complicated grief in adulthood.
4. Adult attachment style (both anxiety and avoidance) would mediate the link between parental overprotection (both maternal and paternal) received in childhood and complicated grief in adulthood.
5. Adult attachment style (both anxiety and avoidance) would mediate the link between separation anxiety experienced in childhood and complicated grief in adulthood.
6. Separation anxiety in childhood would mediate the link between quality of parental care received in childhood and complicated grief in adulthood. 7. Separation anxiety in childhood would mediate the link between parental
overprotection received in childhood and complicated grief in adulthood. 8. Separation anxiety in childhood would mediate the link between the
quality of parental bonding in childhood (care and overprotection) and adult attachment (anxiety and avoidance).
Methodology
Research Design
This was a simple correlational study, involving a sample of adults who experienced loss of a caregiver in childhood or adolescence (up to the age of 16). Caregivers were either parents or relatives who acted as caregivers. Complicated grief in adults was the main dependent variable (DV), parental care and parental overprotection were independent variables (IV), and adult attachment anxiety and avoidance were mediators (M). Separation anxiety was tested both as an independent variable (hypothesis 5) and as a mediator (hypothesis 8).
Participants
One hundred and twenty one individuals were recruited from the University of Bedfordshire Luton Campus and the local community of Luton, through social
networks and snowballing. The minimum age of the participants was 18 years and the maximum was 53. The majority of them were female (79.3%), while 20.7% were male. In terms of ethnic background, 37.2% were white, 14.9% were Pakistani, 2.5% were Indian, 9.9% were Bangladeshi, 14.0% were Black African, 3.3% were Black Caribbean, 3.3% were Black Other, 2.5% were Chinese, and 12.4% were from various other backgrounds.
Of the participants, 58.7% were married, 8.3% were in long-term relationships but living in separate households, 28.9% were single, and 4.1% were divorced. In terms of the caregiver lost in childhood, 27.3 % had lost their mother, 40.5% had lost their father, while 32.2% had lost another close relative, usually a grandparent that was either exclusively or very heavily involved in the care of the child. Minimum time since loss was 6 years and maximum time was 36 years.
Measures
Four measures were chosen in this study: the Inventory of Complicated Grief (ICG; Prigerson et al., 1995), the Experience in Close Relationships Questionnaire- Revised (ECR; Fraley, Waller, & Brennan, 2000), the Parental Bonding Instrument (PBI; Parker, Tupling, & Brown, 1979), and the Separation Anxiety Symptom Inventory (SASI; Silove, Manicavasagar, O’Connell, Blaszczynski, Wagner, & Henry, 1993). These are all well-validated and well-used measures as described below.
Inventory of Complicated Grief
The ICG has high internal consistency (alpha = .95) and sufficient test–retest reliability (r = .80) as reported in a sample of bereaved college students (Schnider, Elhai, & Gray, 2007). Similar levels of reliability and validity were also found in studies with bereaved samples, including bereaved parents (Keesee, Currier, & Neimeyer, 2008). Reaction to bereavement and loss is different from
individual to individual. Among common s,ymptoms of bereavement response are depression and anxiety, while traumatic grief involves symptoms such as re- experiencing, avoidance and numbing although post-traumatic disorder symptoms are different (Prigerson et al., 1999). According to Silverman et al. (2001), people develop different emotional reactions to grief and some are affected by traumatic grief related to early life experiences.
Childhood traumas such as death of a parent or abuse produce more vulnerability to traumatic grief, whereas death of a child or other adult trauma seems more associated with later post-bereavement PTSD. Traumatic grief, which has only recently been recognized as a separate disorder, seems often to be associated with worse long-term outcome than either post-bereavement depression or PTSD (Silverman et al., 2000). Although the ICG may be completed at any time following a loss, for ethical reasons it should be completed at least 6 months post-loss (Prigerson & Maciejewski, 2006).
The Inventory of Complicated Grief is a questionnaire with 19 items showing the frequency of response of the experience. It uses a 5-point scale (0–4), ranging from never to always, and 25 is the borderline score. Respondents with ICG scores greater than 25 are significantly more impaired in social, general, menta,l and physical health functioning, and in bodily pain than those with ICG scores less than or equal to 25 (Prigerson et al., 1995).
The concurrent validity of the ICG has been assessed in relation to other scales. ICG total score showed a fairly high association with the Beck Depression Inventory (BDI) total score (r = 0.67, p < .001), the Texas Revised Inventory of Grief (TRIG) score (r = 0.87, p < .001), and the Grief Measurement Scale (GMS) score (r = 0.70, p < .001). Reliability: The internal consistency of the 19-item ICG was high (Cronbach’s alpha = .94) (Prigerson et al., 1995). In the current study,
scale reliability was α = .9.
Experience in Close Relationships Questionnaire-Revised
This questionnaire measures two dimensions of adult attachment, avoidance and anxiety, and is described in Study 1 (Method section). In the current study, scale reliability was α = .8 for adult attachment avoidance and α = .9 for adult attachment anxiety.
Separation Anxiety Symptom Inventory (SASI)
This is a 15-item self-report measure that assesses retrospective separation anxiety symptoms in adults. The items are set to assess subjective experience, feelings, and early memories suggesting separation anxiety, and are scored from 0 to 3 on a frequency Likert scale. The authors (Silove et al., 1993) report a strong internal (Cronbach’s alpha = .88) and test–retest reliability over 24 months (intraclass correlation coefficient = 0.89). In previous studies, mean transformed SASI scores of 4 or more have been associated with reports of past childhood separation anxiety disorder and/or school refusal, offering some evidence of the concurrent validity of the measure (Manicavasagar, Silove, & Hadzi-Pavlovic, 1998). In the current study, scale reliability was α = .9.
Parental Bonding Instrument (PBI)
This instrument is designed to assess the quality of bonding with mother and father experienced in childhood. The measure is ‘retrospective’, so adults or older adolescents (over 16 years) complete the measure for how they remember their parents during their first 16 years of life. The scale is divided in two subscales termed Care and Overprotection or ‘control’, and each needs to be completed for both mother and father separately. There are 25 items referring to each parent, including 12 Care items and 13 Overprotection items. Items are
scored on a 4-point Likert scale (Very like = 3, Moderately like = 2, Moderately unlike = 1, Very unlike = 0). Total scores can be generated for each parent, on each dimension as well as total care and total overprotection scores.
Also, based on those scores, parents can be put under one of four quadrants: “affectionate constraint” (high care and high overprotection), “affectionless control” (high overprotection and low care), “optimal parenting” (high care and low overprotection), and “neglectful parenting” (low care and low overprotection). Assignment to “high” or “low” categories is based on the cut-off scores.
The scale has been used with various clinical and non-clinical groups and has been found to have good internal consistency and re-test reliability. It has also been found to have construct and convergent validity and to be independent of mood effects. In the current study, scale reliability was α = .8 for all four subscales.
Procedure
I was fully aware of the sensitivity of my topic and therefore I approached the whole research process with extreme caution, as described in Study 1. For this study university students and colleagues were approached if they had experienced the loss of parent or caregiver.
After informing participants about the nature and aim of the study, written informed consent was obtained and questionnaires were passed on. Participants took about 15-20 minutes to complete them. Most completed and returned the questionnaire to me there and then, but some returned them later. After completion, a debrief form was provided with information about how to contact me, my supervisor, and local bereavement and counselling services should they
feel the need to do so. The data collection process was slow and with occasional hurdles as some participants took a long time to agree to participate, others left the questionnaires half-completed and needed to be chased, and others lost the questionnaires and had to be provided them again.