Is Adult Attachment Associated with Engagement with Services? A Systematic Literature Review

G. McGonagle, Sandra Bucci, Filippo Varese, Jessica Raphael, Katherine Berry

Research output: Contribution to journalArticlepeer-review

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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, eleven 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.
Original languageEnglish
JournalJournal of Mental Health
Early online date14 May 2019
Publication statusE-pub ahead of print - 14 May 2019


  • psychosis
  • schizophrenia
  • attachment
  • alliance
  • engagement
  • help-seeking


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