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

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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

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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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Authors: Iqbal, Z., Birchwood, M., Chadwick, P., & Trower, P.
Affiliations: University of Birmingham (GB)
University of Exeter (GB)
Corresponding author: Birchwood, Max
ORCID: Iqbal, Zaffer
Birchwood, Max
Chadwick, Paul
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: bronze
doi.org
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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Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model

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