A network analysis of pre-loss grief symptoms, mentalization, attachment styles, and preparedness for death in caregivers of terminally ill cancer patients

The onset of cancer radically impacts the patient and the caregiver, who deals with multiple losses during end-of-life caregiving. Previous research found that caregivers of terminally ill cancer patients could experience pre-loss grief symptoms. In this context, attachment styles, mentalization and preparedness for death seemed to influence the emotional and practical aspects of the grieving process. To highlight the psychological variables associated with pre-loss grief and preparedness for death, the present study aimed to investigate, through a network analysis approach, the relationships between pre-loss grief symptoms’ severity and the dimensions of attachment style, mentalizing, and preparedness for death. 102 caregivers of terminally ill cancer patients in residential care completed the Attachment Style Questionnaire, the Multidimensional Mentalizing Questionnaire (MMQ), the Prolonged Grief Disorder questionnaire (PG-12), and 3 items assessing the preparedness for death. From the results of the correlation analysis, a network analysis was carried out to visually explore the interrelationships between the variables. The results showed positive correlations between PG-12 symptoms’ severity and insecure dimensions of attachment styles and negative correlations with MMQ and preparedness for death. MMQ was positively correlated with preparedness for death. In the network structure, preoccupation with relationships and discomfort with closeness exhibited the strongest associations with PG-12. The dimensions of anxious and avoidant attachment were the most central variables, with the highest influence within the network structure, and most connected to the other network variables. Findings are consistent with past studies, which strongly emphasize that impairments in the grieving process arise primarily from attachment disorders and reflect intense separation distress. The results suggested that mentalization ability and preparedness for death could potentially act as protective factors on the preloss grief symptoms’ severity. In conclusion, the present study provided insights into the grieving process for palliative care providers to implement the supportive efficacy of the interventions for caregivers.