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Cited by 226Schizophrenia research and treatmentMental Health and PsychiatrySuicide and Self-Harm Studies

Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model

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Iqbal, Zaffer, Birchwood, Max, Chadwick, Paul, Trower, Peter·2000·British Journal of Psychiatry
DOI 10.1192/bjp.177.6.522
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Abstract

BACKGROUND: In paper I we reported that depression in the acute stage remitted in line with the psychosis and that 36% of patients developed post-psychotic depression (PPD). AIMS: We apply our cognitive framework to PPD and chart the appraisal of self and psychosis and their link with the later emergence of PPD. METHOD: Patients with ICD-10 schizophrenia (n=105) were followed up over 12 months following the acute episode, taking measures of depression, working self-concept, cognitive vulnerability, insight and appraisals of psychosis. RESULTS: Before developing PPD, these patients felt greater loss, humiliation and entrapment by their illness than those who relapsed or did not become depressed, and were more likely to see their future selves in 'lower status' roles. Upon becoming depressed, participants developed greater insight, lower self-esteem and a worsening of their appraisals of psychosis. CONCLUSIONS: Depression in psychosis arises from the individual's appraisal of psychosis and its implications for his/her perceived social identity, position and 'group fit'. Patients developing PPD feel forced to accept a subordinate role without opportunity for escape. Implications for treatment are discussed.

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  • Clinically significant changes in depression can occur in the context of psychosis in the absence of marked changes in positive and negative symptoms.

    “The finding that clinically significant changes in depression can occur in the context of psychosis in the absence of marked changes in positive and negative symptoms is consistent with previous research evidence suggesting that 'post-psychotic' depression emerges independently of positive symptom severity, relapse and negative symptoms (Birchwood et al., 2000; Iqbal et al., 2000).”

    From Acceptance and Commitment Therapy for depression following psychosis: An examination of clinically significant change (2015) · cites this paper as Iqbal et al., 2000

    The “Experience of psychosis” section reports that the post-psychotic depression group did not experience the most relapse, supporting the distinction between depression and relapse. The paper’s passages do not establish that depression emerges independently of positive-symptom severity or negative symptoms; they do not report the relevant symptom comparisons. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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Research works printed but not linked: 1

  1. Siris, S. G. Siris, S. G. (1995) (1995) Depression and schizophrenia. In Depression and schizophrenia. In Schizophrenia Schizophrenia (eds S. R. Hirsch & D. R.Weinberger), (eds S. R. Hirsch & D. R.Weinberger), pp. 128^145. Oxford: Blackwell. pp. 128^145. Oxford: Blackwell.

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Authors
Iqbal, Z., Birchwood, M., Chadwick, P., & Trower, P.
Affiliations
  • University of Birmingham (GB)
  • University of Exeter (GB)
Corresponding author
Birchwood, Max
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2000-12
Volume
177
Issue
6
Pages
522-528
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.177.6.522
OpenAlex
W2027572551
Cited by
226
References
45
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 6 · 2020: 7 · 2019: 7 · 2018: 5 · 2017: 7 · 2016: 5 · 2015: 12 · 2014: 11 · 2013: 12 · 2012: 14
FWCI
3.96
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 6241 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
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 › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
psychosis, schizophrenia, suicidal ideation, self-concept, self-esteem, insight, social identity, relapse, cognitive vulnerability
MeSH terms
Adolescent, Adult, Aged, Depressive Disorder, Humans, Middle Aged, Psychotic Disorders, Schizophrenic Psychology, Self Concept, Suicide, Thinking, Disease Progression

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