Adverse Childhood Experiences, Attachment, Guilt, and Mental Health as Predictors of Positive Dyadic Coping Following Perinatal Loss Among Women

Background: Perinatal loss is a highly stressful life event that can profoundly affect women’s emotional well-being and couple functioning. This study examined the role of adverse childhood experiences (ACEs), insecure romantic attachment (attachment anxiety and attachment avoidance), guilt, and mental health problems (MHP) in predicting positive dyadic coping (PDC) among women who had experienced perinatal loss. Methods: A total of 162 Spanish women completed online questionnaires assessing attachment (experiences in close relationships–revised scale (ECR-R)), ACEs (adverse childhood experiences questionnaire (ACEQ)), as well as guilt and MHP using ad hoc Likert-type items. Data were analyzed using correlation analyses, hierarchical regression, fuzzy-set Qualitative Comparative Analysis (fsQCA), and mediation models (SPSS, PROCESS). Results: Hierarchical regression analysis showed that lower attachment anxiety and attachment avoidance were the strongest predictors of PDC, with the final model explaining 68.8% of the variance. fsQCA indicated that no single condition was necessary for either high or low PDC; however, several sufficient configurations accounted for most cases of high PDC, particularly those characterized by low attachment avoidance combined with low attachment anxiety, low guilt, or the absence of ACEs. Configurations associated with low PDC were primarily characterized by higher attachment avoidance and attachment anxiety, often combined with greater psychological distress or guilt. Mediation analyses revealed that insecure attachment, particularly attachment anxiety, mediated the association between ACEs and PDC, suggesting that ACEs influenced coping primarily through indirect pathways rather than direct pathways. Conclusions: Overall, these findings highlight the central role of attachment processes and emotional regulation in promoting PDC following perinatal loss and support the utility of integrative, non-linear approaches for understanding adjustment to perinatal bereavement.