Attachment and Social Functioning in Patients with a Psychosis Spectrum Disorder: A Mediation Study

Schizophr Bull Open. 2025 Aug 18;6(1):sgaf015. doi: 10.1093/schizbullopen/sgaf015. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: Insecure attachment may increase the risk of impaired social functioning in patients with a psychosis spectrum disorder. However, the pathways by which insecure attachment determines social functioning remain underexplored.

AIMS: To investigate the effects of insecure (anxious and avoidant) attachment styles on social functioning (defined as satisfaction with role performance) and the role of three candidate mediators (ie, psychotic, depressive, and anxiety symptoms) in patients with psychosis.

METHODS: Cross-sectional study as part of the UP’s multicenter cohort study on recovery from psychotic disorders. Structural equation modeling was used to estimate direct and indirect paths of attachment styles and psychotic, depressive, and anxiety symptoms in relation to social functioning. Analyses were performed using data from a complete Psychosis Attachment Measure sample, N = 287.

RESULTS: The final model showed a mediation effect only for depressive symptoms, which appeared stronger for the association between anxious attachment and social functioning (-0.10, 95% CI -0.19 to -0.02) than for the association between avoidant attachment and social functioning (-0.04, 95% CI -0.08 to -0.01).

CONCLUSIONS: Our results suggest that insecure attachment and depressive symptoms are relevant to improving social functioning in individuals with psychosis.

PMID:41031188 | PMC:PMC12477596 | DOI:10.1093/schizbullopen/sgaf015