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Cited by 184Schizophrenia research and treatmentMental Health and PsychiatryAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Negative Cognition, Depressed Mood, and Paranoia: A Longitudinal Pathway Analysis Using Structural Equation Modeling

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Fowler, D., Hodgekins, J., Garety, P., Freeman, D., Kuipers, E., Dunn, G., Smith, B., Bebbington, P. E.·2012·Schizophrenia Bulletin
DOI 10.1093/schbul/sbr019PMC PMC3446231
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Abstract

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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Fig. 1. Negative cognition and paranoia. *P < .05, **P < .01, ***P < 0.001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; C1, negative cognition at T1; C2, negative cogniton at T2; C3, negative cognition at T3; Positive and Negative Syndrome Scale (PANSS) 0, PANSS at baseline; PANSS 3, PANSS at 3 months; PANSS 12, PANSS at 12 months; Scale for the Assessment of Positive Symptoms (SAPS) 0, SAPS at baseline; SAPS 3, SAPS at 3 months; SAPS 12, SAPS at 12 months; NegSelf 0, Brief Core Schema Scales (BCSS) negative self at baseline; NegSelf 3, BCSS negative self at 3 months; NegSelf 12, BCSS negative self at 12 months, Beck Depression Inventory (BDI)_Cog 0, BDI-II negative cognition subscale at baseline; BDI_Cog 3, BDI-II negative cognition subscale at 3 months; BDI_Cog 12, BDI-II negative cognition subscale at 12 months; BDI … 0, BDI-II items at baseline; BDI … 3, BDI-II at 3 months; BDI … 12, BDI-II at 12 months.
Fig. 1. Negative cognition and paranoia. *P < .05, **P < .01, ***P < 0.001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; C1, negative cognition at T1; C2, negative cogniton at T2; C3, negative cognition at T3; Positive and Negative Syndrome Scale (PANSS) 0, PANSS at baseline; PANSS 3, PANSS at 3 months; PANSS 12, PANSS at 12 months; Scale for the Assessment of Positive Symptoms (SAPS) 0, SAPS at baseline; SAPS 3, SAPS at 3 months; SAPS 12, SAPS at 12 months; NegSelf 0, Brief Core Schema Scales (BCSS) negative self at baseline; NegSelf 3, BCSS negative self at 3 months; NegSelf 12, BCSS negative self at 12 months, Beck Depression Inventory (BDI)_Cog 0, BDI-II negative cognition subscale at baseline; BDI_Cog 3, BDI-II negative cognition subscale at 3 months; BDI_Cog 12, BDI-II negative cognition subscale at 12 months; BDI … 0, BDI-II items at baseline; BDI … 3, BDI-II at 3 months; BDI … 12, BDI-II at 12 months.CC BY-NC · PubMed Central
Fig. 2. Depressed mood and paranoia. *P < .05, **P < .01, ***P < .001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; M1, depressed mood at T1; M2, depressed mood at T2; M3, depressed mood at T3.
Fig. 2. Depressed mood and paranoia. *P < .05, **P < .01, ***P < .001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; M1, depressed mood at T1; M2, depressed mood at T2; M3, depressed mood at T3.CC BY-NC · PubMed Central
Fig. 3. Negative cognition and depressed mood on paranoia combined cross sectional model. *P < .05, **P < .01, ***P < .001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; C1, negative cognition at T1; C2, negative cognition at T2; C3, negative cognition at T3; M1, depressed mood at T1; M2, depressed mood at T2; M3, depressed mood at T3.
Fig. 3. Negative cognition and depressed mood on paranoia combined cross sectional model. *P < .05, **P < .01, ***P < .001. P1, paranoia at T1; P2, paranoia at T2; P3, paranoia at T3; C1, negative cognition at T1; C2, negative cognition at T2; C3, negative cognition at T3; M1, depressed mood at T1; M2, depressed mood at T2; M3, depressed mood at T3.CC BY-NC · PubMed Central

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  1. 1993, The British Journal of Psychiatry, 22, S39
  2. 2005, The British Journal of Psychiatry, 48, s55

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Metadata

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.
ORCID
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
DOI
10.1093/schbul/sbr019
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
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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