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 remains 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 (i.e., psychotic, depressive and anxiety symptoms) in patients with psychosis. Method 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 - -0.02) than for the association between avoidant attachment and social functioning (-0.04, 95% CI -0.08 - -0.01). Conclusion Our results suggest that insecure attachment and depressive symptoms are relevant to improve social functioning in individuals with psychosis.
Bussel et al. (Fri,) studied this question.