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The mediating role of depression in pathways linking positive and negative symptoms in schizophrenia. A longitudinal analysis using latent variable structural equation modelling

Published online by Cambridge University Press:  08 March 2019

Giuseppe Carrà
Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Cristina Crocamo*
Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Francesco Bartoli
Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Matthias Angermeyer
Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
Traolach Brugha
Department of Health Sciences, University of Leicester, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, LeicesterLE1 7RH, UK
Mondher Toumi
Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
Paul Bebbington
Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK
Author for correspondence: Cristina Crocamo, E-mail:



The interaction between positive, negative and depressive symptoms experienced by people with schizophrenia is complex. We used longitudinal data to test the hypothesis that depressive symptoms mediate the links between positive and negative symptoms.


We analyzed data from the European Schizophrenia Cohort, randomly sampled from outpatient services in France, Germany and the UK (N = 1208). Initial measures were repeated after 6 and 12 months. Depressive symptoms were identified using the Calgary Depression Scale for Schizophrenia (CDSS), while positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Latent variable structural equation modelling was used to investigate the mediating role of depression assessed at 6 months in relation to the longitudinal association between positive symptoms at baseline and negative symptoms at 12 months.


We found longitudinal associations between positive symptoms at baseline and negative symptoms at 12 months, as well as between both of these and CDSS levels at 6 months. However depression did not mediate the longitudinal association between PANSS scores; all the effect was direct.


Our findings are incompatible with a mediating function for depression on the pathway from positive to negative symptoms, at least on this timescale. The role of depression in schizophrenic disorders remains a challenge for categorical and hierarchical diagnostic systems alike. Future research should analyze specific domains of both depressive and negative symptoms (e.g. motivational and hedonic impairments). The clinical management of negative symptoms using antidepressant treatments may need to be reconsidered.

Original Articles
Copyright © Cambridge University Press 2019

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