Is adult attachment associated with engagement with services? A systematic literature review

Background: People with psychosis often experience difficulties engaging in mental health treatments.

Aims: This review sought to identify, summarise and critically evaluate studies that investigated associations between adult attachment and relationships with mental health services in the context of psychosis.

Method: A search was conducted on the following databases from 1980 to February 2019: Web of Science; PubMed; CINAHL; and PsycINFO. Of the 10,683 articles identified, 11 met inclusion criteria for the review. These articles were then quality appraised using the Effective Public Health Practice Project tool (EPHPP).

Results: There was some evidence of associations between insecure attachment (namely avoidant attachment) and therapeutic alliance, and insecure attachment and engagement with services. Secure attachment was also associated with self-reported attachment to services as a whole. There were a number of limitations across the studies; the majority of studies were cross-sectional and it was difficult to make comparisons between studies due to the range of different measures used to assess attachment and alliance.

Conclusion: Adult attachment security may be an important factor to consider in determining the way in which service users with psychosis engage with mental health services.