Relatives’ attachment anxiety mediates the association between perceived loss and expressed emotion in early psychosis

Autoři: Lídia Hinojosa-Marqués aff001;  Tecelli Domínguez-Martínez aff002;  Tamara Sheinbaum aff003;  Paula Cristóbal-Narváez aff004;  Thomas R. Kwapil aff005;  Neus Barrantes-Vidal aff001
Působiště autorů: Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain aff001;  Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico aff002;  Department of Psychology, University of Southern California, Los Angeles, California, United States of America aff003;  Unitat de Recerca, Docència i Innovació, Parc Sanitari Sant Joan de Déu, San Boi de Llobregat, Barcelona, Spain aff004;  Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America aff005;  Sant Pere Claver- Fundació Sanitària, Barcelona, Spain aff006;  Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223425


A common reaction experienced by family members of patients with psychosis is grief for the loss of their healthy relative. Importantly, high levels of perceived loss have been related to the manifestation of high expressed emotion (EE), which includes the negative attitudes expressed by relatives toward an ill family member. However, the mechanisms underlying the relationship between relatives’ perceived loss and EE attitudes in the early stages of psychosis are still not fully understood. In this regard, attachment theory has been suggested as a useful framework for understanding this link. The current study aimed to examine: (1) whether relatives’ perceived loss was associated with relatives’ EE dimensions (i.e., criticism and emotional over-involvement (EOI)), and (2) whether such associations were mediated by relatives’ attachment dimensions (i.e., anxiety and avoidance). Seventy-eight relatives of patients with early psychosis completed the Mental Illness Version of the Texas Inventory of Grief for the assessment of loss reactions. Attachment dimensions and EE attitudes were assessed by the Psychosis Attachment Measure and the Family Questionnaire, respectively. Findings indicated that relatives’ perceived loss was associated with EE dimensions. Relatives’ attachment anxiety, but not avoidance, mediated the relationship of perceived loss with both criticism and EOI. Findings highlight the importance of examining the role of relatives’ attachment characteristics for understanding how perceptions of loss might impact the manifestation of EE attitudes in the early stages of psychosis. Family interventions aimed at assisting relatives to improve their management of negative emotional reactions to loss are fundamental to prevent impairing loss reactions and the entrenchment of high-EE attitudes.

Klíčová slova:

Anxiety – Emotions – Memory – Mental health and psychiatry – Psychological stress – Psychometrics – Psychoses – Questionnaires


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