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Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis

Published online by Cambridge University Press:  09 July 2009

M. Birchwood ,
R. Mason ,
F. MacMillan  and
J. Healy
M. Birchwood*
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints' Hospital, Birmingham
R. Mason
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints' Hospital, Birmingham
F. MacMillan
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints' Hospital, Birmingham
J. Healy
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints' Hospital, Birmingham
*
1Address for correspondence: Professor Max Birchwood, Archer Centre, All Saints' Hospital, Lodge Road, Winson Green, Birmingham B18 5SD.
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Synopsis

This paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.

Type
Original Articles
Information
Psychological Medicine , Volume 23 , Issue 2 , May 1993 , pp. 387 - 395
Copyright
Copyright © Cambridge University Press 1993

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References

Barnes, T. R., Curson, D. A., Liddle, P. F. & Patel, M. (1989). The nature and prevalence of depression in chronic schizophrenic inpatients. British Journal of Psychiatry 154, 486–491.CrossRefGoogle Scholar
Beck, A. T., Rush, A. J., Shaw, B. F. & Emergy, G. (1979). Cognitive Therapy of Depression. Guilford Press: New York.Google Scholar
Birchwood, M. J. (1991). A new paradigm for psychotherapy for individuals with schizophrenia: the individual-illness interaction. Bulletin of the Royal College of Psychiatrists 15, 38–39.Google Scholar
Birchwood, M. J., Smith, J., Macmillan, F., Hogg, B., Prasad, R., Harvey, C. & Bering, S. (1989). Predicting relapse in schizophrenia. Psychological Medicine 19, 649–656.CrossRefGoogle ScholarPubMed
Birchwood, M. J., Macmillan, J. F. & Smith, J. (1992). Early intervention. In Innovations in the Psychological Management of Schizophrenia (ed. Birchwood, M. J. and Tarrier, N.), pp. 115–146. Wiley: Chichester.Google Scholar
Brier, A. & Strauss, J. S. (1983). Self control in psychotic disorders. American Journal of Psychiatry 40, 1141–1145.Google Scholar
Brown, G. & Harris, T. (1978). The Social Origins of Depression. Tavistock Publications: London.Google ScholarPubMed
Caldewell, C. B. & Gottesman, I. (1990). Schizophrenics kill themselves too. Schizophrenia Bulletin 16, 571–590.CrossRefGoogle Scholar
Crown, S., Lucas, C. J., Stringer, P. & Supramanium, S. (1977). Personality correlates of study difficulty and academic performance in university students. II. Conscience and self-esteem. British Journal of Medical Psychology 50, 275–281.CrossRefGoogle ScholarPubMed
Drake, R. E. & Cotton, P. G. (1986). Depression, hopelessness and suicide in chronic schizophrenia. British Journal of Psychiatry 148, 554–559.CrossRefGoogle ScholarPubMed
Estroff, S. E. (1989). Self identity and subjective experiences of schizophrenia: in search of the subject. Schizophrenia Bulletin 15, 189–196.CrossRefGoogle ScholarPubMed
Falloon, I. R. H. & Talbot, R. E. (1981). Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine 11, 329–339.CrossRefGoogle ScholarPubMed
Hirsch, S. R. & Jolley, A. G. (1989). The dysphoric syndrome in schizophrenia and its implications for relapse. British Journal of Psychiatry (suppl. 5), 46–50.CrossRefGoogle Scholar
Hirsch, S. R., Jolley, A. G., Barnes, T. R. E., Liddle, P. F., Curson, D. A., Patel, A., York, A., Berru, S. & Patel, M. (1989). Dysphoric and depressive symptoms in chronic schizophrenia. Schizophrenia Research 2, 259–264.CrossRefGoogle ScholarPubMed
Johnson, D. A. W. (1981). Studies of depressive symptoms in schizophrenia. British Journal of Psychiatry 139, 89–101.Google Scholar
Johnson, D. A. W. (1988). The significance of depression in the prediction of relapse in chronic schizophrenia. British Journal of Psychiatry 152, 320–323.CrossRefGoogle ScholarPubMed
Knight, A. & Hirsch, S. R. (1981). Revealed depression and drug treatment of schizophrenia. Archives of General Psychiatry 40, 893–896.Google Scholar
Leff, J., Tress, K. & Edwards, B. (1988). The clinical course of depressive symptoms in schizophrenia. Schizophrenia Research 1, 25–30.CrossRefGoogle ScholarPubMed
Levenson, H. (1973). Multidimensional locus of control in psychiatric patients. Journal of Consulting and Clinical Psychiatry 41, 832–841.CrossRefGoogle ScholarPubMed
McGlashan, T. H. & Carpenter, W. T. (1976). An investigation of the postpsychotic depressive syndrome. American Journal of Psychiatry 133, 14–19.Google ScholarPubMed
McGlashan, T. H. & Carpenter, W. T. (1981). Does attitude towards psychosis relate to outcome? American Journal of Psychiatry 138, 797–801.Google Scholar
McGlashan, T. H., Levy, S. T. & Carpenter, W. T. (1975). Integration and sealing over: clinically distinct recovery styles from schizophrenia. Archives of General Psychiatry 32, 1269–1272.Google Scholar
Quinn, D. & Norris, H. (1986). Multidimensional health locus of control: a new perspective on the psychopathology of anxiety and depression. Psychological Reports 58, 903–914.CrossRefGoogle ScholarPubMed
Roy, A. (1981). Depression in the course of chronic undifferentiated schizophrenia. Archives of General Psychiatry 38, 296–297.CrossRefGoogle ScholarPubMed
Roy, A., Thompson, R. & Kennedy, S. (1983). Depression in chronic schizophrenia. British Journal of Psychiatry 142, 465–470.CrossRefGoogle ScholarPubMed
Scheff, T. J. (1975). Schizophrenia as ideology. In Labelling Madness (ed. Scheff, T. J.), pp. 21–67. Prentice Hall: Englewood Cliffs, NJ.Google Scholar
Shepherd, G. (1984). Institutional Care and Rehabilitation. Longman: London/New York.Google Scholar
Siris, S. G. (1991). Diagnosis of secondary depression in schizophrenia. Schizophrenia Bulletin 17, 75–98.CrossRefGoogle ScholarPubMed
Soskis, D. A. & Bowers, M. B. (1969). The schizophrenia experience: a follow-up study of attitude and posthospital adjustment. Journal of Nervous and Mental Disease 149, 443–449.CrossRefGoogle ScholarPubMed
Strauss, J. S. (1989). Subjective experiences of schizophrenia: towards a new dynamic – II. Schizophrenia Bulletin 15, 179–188.Google Scholar
Taylor, K. E. & Perkins, R. E. (1991). Identity and coping with mental illness in long-stay rehabilitation. British Journal of Clinical Psychology 30, 73–85.CrossRefGoogle Scholar
Van Putten, T. & May, P. R. A. (1978). ‘Akinetic depression’ in schizophrenia. Archives of General Psychiatry 35, 1101–1107.CrossRefGoogle ScholarPubMed
Wallston, K. A., Wallston, B. S. & De Vellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Education Monographs 6, 161–170.CrossRefGoogle ScholarPubMed
Warner, R. W., Taylor, D., Powers, M. & Hyman, J. (1989). Acceptance of the mental illness label by psychotic patients: effects on functioning. American Journal of Orthopsychiatry 59, 398–409.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. & Sartorius, N. (1974). The Description and Classification of Psychiatric Symptomology: An Instruction Manual for the PSE and CATEGO. Cambridge University Press: London.Google Scholar