Negative Cognition, Depressed Mood, and Paranoia: A Longitudinal Pathway Analysis Using Structural Equation Modeling
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The role of negative cognition and effect in maintaining psychotic symptoms is increasingly recognized but has yet to be substantiated though longitudinal analysis. Based on an a priori theoretical model, we hypothesized that negative cognition and depressed mood play a direct causal role in maintaining paranoia in people with psychosis and that the effect of mood is mediated by negative cognition. We used data from the 301 patients in the Prevention of Relapse in Psychosis Trial of cognitive behavior therapy. They were recruited from consecutive Community Mental Health Team clients presenting with a recent relapse of psychosis. The teams were located in inner and outer London and the rural county of Norfolk, England. The study followed a longitudinal cohort design, with initial measures repeated at 3 and 12 months. Structural equation modeling was used to investigate the direction of effect between negative cognition, depressed mood, and paranoia. Overall fit was ambiguous in some analyses and confounding by unidentified variables cannot be ruled out. Nevertheless, the most plausible models were those incorporating pathways from negative cognition and depressed mood to paranoid symptoms: There was no evidence whatsoever for pathways in the reverse direction. The link between depressed mood and paranoia appeared to be mediated by negative cognition. Our hypotheses were thus corroborated. This study provides evidence for the role of negative cognition in the maintenance of paranoia, a role of central relevance, both to the design of psychological interventions and to the conceptualizations of psychosis.
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Psychological and emotional problems may be consequences of, or contributors to, persistent psychotic experiences.
“whether they are the consequences of, or contributors to, PEs [81][82][83]”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [82]
Depressed mood is causally related to paranoid thoughts, mediated by negative cognition, in structural equation modelling of longitudinal data.
“Finally, structural equation modelling of longitudinal data has found that depressed mood is causally related to paranoid thoughts; an effect that is mediated by negative cognition [37].”
From A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking (2017) · cites this paper as [37]
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- Authors
- Fowler, D., Hodgekins, J., Garety, P., Freeman, D., Kuipers, E., Dunn, G., Smith, B., & Bebbington, P. E.
- Affiliations
- University of East Anglia (GB)
- King's College London (GB)
- Warneford Hospital (GB)
- University of Manchester (GB)
- University College London (GB)
- Corresponding author
- Fowler, D.
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-04-07
- Volume
- 38
- Issue
- 5
- Pages
- 1063-1073
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC3446231
- OpenAlex
- W2131974041
- Cited by
- 184
- References
- 58
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 12 · 2022: 16 · 2021: 12 · 2020: 9 · 2019: 14 · 2018: 20 · 2017: 18 · 2016: 13 · 2015: 14 · 2014: 15 · 2013: 16 · 2012: 6
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Schizophrenia Bulletin (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- Wellcome Trust (062452)
- National Institute for Health and Care Research
- Menzies Centre for Australian Studies, King's College London, University of 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 › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- negative thinking, depressive mood
- MeSH terms
- Adult, Affect, Attitude, Cognition Disorders, Culture, Delusions, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Models, Psychological, Prognosis, Psychiatric Status Rating Scales, Psychotic Disorders, Schizophrenia, Paranoid, Statistics as Topic, Models, Statistical
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