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Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms
Abstract
OBJECTIVE: This review explores the influence of anxiety and depression on the experience of positive psychotic symptoms, and investigates the possibility of a causal role for anxiety and depression in the emergence and persistence of psychosis. METHOD: A systematic literature search was undertaken, producing a number of papers which comment on the links between anxiety and depression, and the experience of delusions and hallucinations. In addition, evidence which could contribute to our understanding of the causal role of anxiety and depression was highlighted. RESULTS: The findings show that both anxiety and depression are associated in meaningful ways with the severity of delusions and hallucinations, the distress they elicit and their content. However, the cross-sectional nature of the majority of studies and the focus on certain symptom subtypes tempers the validity of the findings. Data from non-clinical samples, studies which track the longitudinal course of psychosis and those which examine the impact of anxiety and depression on the prognosis for people experiencing psychosis, offer some support for the possibility of an influential role for anxiety and depression. CONCLUSION: We conclude that anxiety and depression are related to psychotic symptom severity, distress and content and are also linked with sub-clinical experiences, symptom development, prognosis and relapse. These links may imply that anxiety and depression could be targets for therapeutic intervention. The article concludes with suggestions for further research, highlighting avenues which may circumvent the limitations of the body of work as it stands.
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“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 [3]
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What causes psychosis? An umbrella review of risk and protective factors
Radua, J., Ramella‐Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., Yenn Thoo, H., Oliver, D., Davies, C., Morgan, C., et al. (2018) · World Psychiatry · doi:10.1002/wps.20490 · Cited by 553
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Metadata
- Authors
- Hartley, S., Barrowclough, C., & Haddock, G.
- Affiliations
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- University of Manchester (GB)
- Corresponding author
- Hartley, S.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2013-02-04
- Volume
- 128
- Issue
- 5
- Pages
- 327-346
- ISSN
- 0001-690X (ISSN-L)
- OpenAlex
- W2132883301
- Cited by
- 234
- References
- 144
- Citations by year
- 2026: 13 · 2025: 27 · 2024: 25 · 2023: 17 · 2022: 27 · 2021: 21 · 2020: 22 · 2019: 21 · 2018: 19 · 2017: 14 · 2016: 10 · 2015: 11 · 2014: 4 · 2013: 3
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- University of Manchester
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- anxiety, depression, psychosis, positive psychotic symptoms, delusions, hallucinations, symptom severity, symptom distress, subclinical psychotic experiences, transition to psychosis, relapse, prognosis
- MeSH terms
- Anxiety, Delusions, Depression, Hallucinations, Humans, Psychotic Disorders, Comorbidity
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