The relationship between depressive symptoms and negative symptoms in people with non-affective psychosis: a meta-analysis
Open accessAbstract
The negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first large systematic review and meta-analysis to quantify the relationship between these two categories of symptoms, as measured in studies to date. PsycInfo, Embase and Medline were systematically searched to identify eligible studies. Inclusion criteria ensured the studies measured both depression and negative symptoms using validated measures in a sample of over 8000 participants with non-affective psychosis diagnoses. The search led to 2020 records being screened and 56 included in the meta-analysis and review. Both meta-analyses and meta-regressions were conducted to explore the main effect and potential moderating variables. A clear pattern emerges showing that higher ratings of negative symptoms are associated with higher levels of depressive symptoms, with a small effect [standardised effect size = 0.19,p< 0.05). This did not vary greatly with the measures used (SES = 0.19–0.26) and was not moderated by demographic variables or quality ratings. Interestingly, higher depressive symptoms predict a significant relationship with co-occurring negative symptoms. However, higher negative symptoms predict that it is less likely there will be a relationship with co-occurring depressive symptoms. Heterogeneity was high across these analyses. The findings support the adoption of a symptom-specific approach to understanding the interplay between negative and depressive symptoms in psychosis, to improve assessment and intervention.
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Depression and anxiety are strongly associated with positive symptoms, negative symptoms, psychotic relapses and impaired social function, and are among the best symptom predictors of quality of life outcomes in people with SSDs.
“Depression and anxiety are strongly associated with positive symptoms,2,3,5–7,9 negative symptoms,2,8 psychotic relapses3,9 and impaired social function,3,5,9 and are among the best symptom predictors of quality of life outcomes in people with SSDs.2–9”
From Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion (2022) · cites this paper as [8]
The Meta-Analysis Findings report an association between depressive and negative symptoms in people with non-affective psychosis, but describe it as small, not strong (pooled effect size 0.194). This source does not establish the sentence’s claims about anxiety or depression and anxiety as leading predictors of quality of life. (LLM, conf=0.90)
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- Authors
- Edwards, C. J., Garety, P., & Hardy, A.
- Affiliations
- King's College London (GB)
- Corresponding author
- Edwards, Clementine Jane
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-09-18
- Volume
- 49
- Issue
- 15
- Pages
- 2486-2498
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2973841303
- Cited by
- 54
- References
- 108
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 13 · 2023: 7 · 2022: 6 · 2021: 7 · 2020: 3 · 2019: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (NF-SI-0510-10121)
- King's College London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- depressive symptoms, negative symptoms, non-affective psychosis, schizophrenia, apathy, lack of motivation, symptom co-occurrence, symptom assessment
- MeSH terms
- Depression, Depressive Disorder, Humans, Psychotic Disorders, Symptom Assessment
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