The Association Between Attachment Style and Symptomatic, Social, and Personal Recovery: A Comparison Between Male and Female Patients Remitted From Their First-Episode Psychosis

Background: Sex differences in recovery outcomes for psychosis have been observed. In patients with psychosis, rates of insecure attachment are significantly higher in patients of both sexes compared to the general population and have been linked to several aspects of recovery. However, the possible differential effect of attachment style on recovery between men and women with psychosis is currently unknown. Methods: This study was performed in a subsample of 299 patients remitted from their first-episode psychosis (FEP) within the Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment (HAMLETT) study. First, t-tests were used to explore sex differences in baseline attachment style. Second, stepwise regression analyses were used to examine the association between baseline attachment style and symptomatic, social and personal recovery at three and 48 months follow-up, and the possible moderation effect of sex on these associations. Third, stepwise regression analyses were repeated with longitudinal change in symptomatic, social and personal recovery between three and 48 months follow-up as outcome measure. Results: Male and female patients did not differ in baseline attachment style. Baseline attachment style was associated with recovery outcome at 3-months follow-up, whilst sex did not moderate this relationship. Baseline attachment style did not predict recovery outcome at 48-months follow-up, nor change in recovery outcome. Conclusions: Our findings suggest that attachment style is an important predictor of short-term recovery outcome in patients with FEP, whilst sex differences do not appear to significantly impact this relationship.