A clearer understanding of the ebb and flow of depression and suicidal thinking in the early phase of psychosis, and how this relates to other symptom dimensions, is essential for developing interventions to reduce risk. The studies presented here investigate whether depression and suicidal thinking are predictable, how they relate to the early course of psychotic symptoms and develop over time.

92 patients with first episode psychosis recruited from the Birmingham Early Intervention Service completed measures of depression, including an prodromal depression, psotove and negative symptoms, self-harm, duration of untreated psychosis, insight and illness appraisals. Follow up took place over 12 months.

Depression occurred in 80% of patients at one or more phase of illness; a combination of depression and suicidal thinking was present in 63%. Depression in the prodromal phase was the most significant predictor of future depression and acts of selfharm. Post psychotic depression unheralded by previous depressive episodes was rare. Depression and suicidal thinking in the acute and post psychotic phases is associated with higher levels of loss and shame, and subordination to persecutors and malevolent voices.

Depression early in the emergence of a psychosis is fundamental to the development of future depression and suicidal thinking, and related to the personal significance and impact of positive symptom dimensions. Efforts to predict and reduce depression and self-harm in psychosis may need to target this early phase to reduce later risk.