Skip to main content Accessibility help
×
Home

Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model

  • Zaffer Iqbal (a1), Max Birchwood (a2), Paul Chadwick (a3) and Peter Trower (a4)

Abstract

Background

In paper I we reported that depression in the acute stage remitted in line with the psychosis and that 36% of patients developed post-psychotic depression (PPD).

Aims

We apply our cognitive framework to PPD and chart the appraisal of self and psychosis and their link with the later emergence of PPD.

Method

Patients with ICD–10 schizophrenia (n=105) were followed up over 12 months following the acute episode, taking measures of depression, working self-concept, cognitive vulnerability, insight and appraisals of psychosis.

Results

Before developing PPD, these patients felt greater loss, humiliation and entrapment by their illness than those who relapsed or did not become depressed, and were more likely to see their future selves in ‘lower status’ roles. Upon becoming depressed, participants developed greater insight, lower self-esteem and a worsening of their appraisals of psychosis.

Conclusions

Depression in psychosis arises from the individual's appraisal of psychosis and its implications for his/her perceived social identity, position and ‘group fit’. Patients developing PPD feel forced to accept a subordinate role without opportunity for escape. Implications for treatment are discussed.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cognitive approach to depression and suicidal thinking in psychosis
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Cognitive approach to depression and suicidal thinking in psychosis
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Cognitive approach to depression and suicidal thinking in psychosis
      Available formats
      ×

Copyright

Corresponding author

Max Birchwood, Department of Clinical Psychology, University of Birmingham, Harry Watton House, 97 Church Lane, Aston, Birmingham B6 5UG, UK

Footnotes

Hide All

See pp. 516–521, this issue.

Declaration of interest

As paper I.

Footnotes

References

Hide All
Addington, D., Addington, J. & Maticka-Tyndale, E. (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry, 163 (suppl. 22), 3944.
Addington, D., Addington, J. & Patten, S. (1998) Depression in people with first-episode schizophrenia. British Journal of Psychiatry, 172 (supp. 33), 9092.
Andreason, N. C. (1982) Negative symptoms of schizophrenia: definition and reliability. Archives of General Psychiatry, 39, 784788.
And reason, N. C. (1986) The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.
Beck, A. T. (1967) Depression: Clinical, Experimental and Theoretical Aspects. New York: Harper and Row.
Birchwood, M. J. & Iqbal, Z. (1998) Depression and suicidal thinking in psychosis: a cognitive approach. In Outcomes and Innovation in Psychological Management of Schizophrenia (Wykes, T., Tarrier, N. & Lewis, S.), pp. 81100. Chichester: John Wiley & Sons.
Birchwood, M. J., Smith, J., Macmillan, J. F., et al (1989) Predicting relapse in schizophrenia: the development of an ‘early signs’ monitoring system using patients and families as observers. Psychological Medicine, 19, 649656.
Birchwood, M. J., Mason, R., Macmillan, F., et al (1993) Depression, demoralisation and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychological Medicine, 23, 387395.
Birchwood, M. J., Smith, J., Drury, V., et al (1994) A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89, 6267.
Birchwood, M. J., Spencer, E. & McGovern, D. (2000a) Schizophrenia: early warning signs. Advances in Psychiatric Treatment, 6, 93101.
Birchwood, M. J., Iqbal, Z., Chadwick, P., et al (2000b) Cognitive approach to depression and suicidal thinking in psychosis. I. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177, 516521.
Blatt, S. J., D'Afflitti, P. & Quinlan, D. M. (1976) Experience of depression in normal young adults. Journal of Abnormal Psychology, 85, 383389.
Bleuler, E. (1950) Dementia Praecox or the Group of Schizophrenias, 1911 (English translation: Zinkin, J.). New York: International Universities Press.
British Medical Association & Royal Pharmaceutical Society of Great Britain (1996) British National Formulary. London: BMA & Pharmaceutical Press.
Brown, G. W., Bifulco, A. & Andrews, B. (1990) Self-esteem and depression. IV. Effect on course and recovery. Social Psychiatry and Psychiatric Epidemiology, 25, 244249.
Chadwick, P. D., Birchwood, M. & Trower, P. (1996) Cognitive Therapy for Delusions, Voices and Paranoia. Chichester: John Wiley & Sons.
Crown, S., Lucas, C. J., Stringer, P., et al (1977) Personality correlates of study difficulty and academic performance in universitystudents. II: Conscience and self-esteem. British Journal of Medical Psychology, 50, 275281.
Davidson, I. & Strauss, J. S. (1992) Sense of self in recovery from severe mental illness. British Journal of Medical Psychology, 65, 131145.
Drake, R. E., Gates, C. & Cotton, T. (1986) Suicide among schizophrenics: a comparison of attempters and completed suicides. British Journal of Psychiatry, 149, 784787.
Drury, V., Birchwood, M., Cochrane, R., et al (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593601.
Gilbert, P. (1992) Depression: The Evolution of Powerlessness. Hove: Lawrence Erlbaum Associates.
Gilbert, P. (1995) Power, social rank and depression: comments on Price and Gardner. British Journal of Medical Psychology, 68, 211215.
Hirsch, S. R. & Jolley, A. G. (1989) The dysphoric syndrome in schizophrenia and its implications for relapse. British Journal of Psychiatry, 155 (suppl. 5), 4650.
Lazarus, R. & Folkman, J. (1984) Stress, Appraisal and Coping. New York: Springer.
Leff, J. (1990) Depressive symptoms in the course of schizophrenia. In Depression in Schizophrenia (ed. DeLisi, L. E.), pp. 323. Washington, DC: American Psychiatric Press.
Leff, J., Tress, A. & Edwards, B. (1988) The clinical course of depressive symptoms in schizophrenia. Schizophrenia Research, 1, 2530.
Marcus, H. & Nurius, P. (1986) Possible selves. American Psychologist, 41, 954969.
Marcus, H. & Wurf, E. (1987) The dynamic self-concept: a social psychological perspective. Annual Review of Psychology, 38, 299337.
Mortensen, P. B. & Juel, K. (1993) Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry, 163, 183189.
Ogilvie, D. M. (1987) The undesired self: a neglected variable in personality research. Journal of Personality and Social Psychology, 52, 379385.
Rooke, O. & Birchwood, M. (1998) Loss, humiliation and entrapment as appraisals of schizophrenic illness: a prospective study of depressed and non-depressed patients. British Journal of Psychology, 37, 259268.
Rosenberg, M. (1965) Society and the Adolescent Self-Image. Princeton: Princeton University Press.
Roy, A. (1981) Depression in the course of chronic undifferentiated schizophrenia. Archives of General Psychiatry, 38, 296297.
Roy, A. (1986) Suicide in schizophrenia. In Suicide (ed. Roy, A.), pp 97112. Baltimore, MD: Williams and Wilkins.
Siris, S. G. (1995) Depression and schizophrenia. In Schizophrenia (eds Hirsch, S. R. & Weinberger, D. R.), pp. 128145. Oxford: Blackwell.
Van Putten, T. & May, P. (1978) ‘Akinetic depression’ in schizophrenia. Archives of General Psychiatry, 35, 11011107.
Williams, J. M. G. (1992) The Psychological Treatment of Depression. London: Routledge.
Wojcik, J. D., Gelenberg, A. J., LaBrie, R. A., et al (1980) Prevalence of tardive dyskinesia in an outpatient population. Comprehensive Psychiatry, 21, 370380.
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.
Zuroff, D. C., Moskowitz, D. S. & Cote, S. (1999) Dependency, self-criticism, interpersonal behaviour and affect: evolutionary perspectives. British Journal of Clinical Psychology, 38, 231250.

Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model

  • Zaffer Iqbal (a1), Max Birchwood (a2), Paul Chadwick (a3) and Peter Trower (a4)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model

  • Zaffer Iqbal (a1), Max Birchwood (a2), Paul Chadwick (a3) and Peter Trower (a4)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *