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Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of a social ranking model
Open accessAbstract
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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“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
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Metadata
- Authors
- Iqbal, Z., Birchwood, M., Chadwick, P., & Trower, P.
- Affiliations
- University of Birmingham (GB)
- University of Exeter (GB)
- Corresponding author
- Birchwood, Max
- 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
- 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
- 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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