The relationship between attachment and functioning for people with serious mental illness: a systematic review

Abstract

Aims

Functional impairment is a hallmark feature of severe mental health problems (SMI). Attachment theory is a key psychological theory of interpersonal functioning and difficulties in attachment are common in SMI and may help explain functioning problems in SMI. This systematic review aimed to synthesise and critically appraise existing literature exploring associations between adult attachment style and functioning in SMI samples.

Method

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines we systematically searched five databases using strings of terms relating to both attachment and social functioning. Inclusion criteria were samples diagnosed with SMI and validated measure tools.

Results

Ten studies met inclusion criteria. Considerable heterogeneity was found across studies in relation to construct measurement, sample size, and gender distribution. However, as predicted there was some evidence to suggest that secure attachment is associated with better functioning, and insecure attachment (specifically anxious style) is associated with impairments in functioning.

Conclusion

Findings highlight the importance of considering attachment in relation to functional outcome when working with people with SMI, particularly when assessing, formulating, and delivering psychological interventions.

Keywords:

• Attachment
• serious mental illness
• functioning
• SMI
• avoidant attachment
• anxious attachment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Elisabeth Pearse

Katherine Berry is a Professor in Clinical Psychology at the University of Manchester and Co-director of the Complex Trauma and Resilience Research Unit (C-TRU) at Greater Manchester Mental Health NHS Foundation Trust. Her work has focused on understanding the psychosocial causes of and treatment for psychosis.

Sandra Bucci

Elisabeth Pearse is a clinical psychologist at Greater Manchester Mental Health NHS Foundation Trust and specialises in psychosis.

Jessica Raphael

Jessica Raphael is a Senior Research Associate at Greater Manchester Mental Health NHS Foundation Trust and specialises in the development of psychological service models for acute mental health wards.

Katherine Berry

Sandra Bucci, Professor of Clinical psychology, The University of Manchester, Manchester Academic Health Science Network; Honorary Consultant Clinical Psychologist, Greater Manchester Mental Health NHS Foundation Trust; Co-Director, Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust.