This thesis attempts to develop a cognitive-psychosocial reformulation of depression and suicide in schizophrenia. An overview of the literature pertaining to psychotic illness, postpsychotic depression and suicide, and unipolar theories of depression is provided as a precursor to introducing the rationale to the research, namely that the onset of postpsychotic depression (and its established link with suicide), is a phenomenon distinct from the symptoms and course of psychosis, and drug treatment. An integration of cognitive and psychosocial models is developed within the framework of social ranking theory or social Darwinism. This model is tested using a prospective follow-up study of 105 participants, using a battery of measures, at the acute psychosis stage, discharge and for three follow-up interviews over the subsequent year. Results, presented in the form of three academic papers, support the hypotheses that neither symptoms of psychosis, pharmacogenic side-effects or drug dosage, nor depression during the acute stage, predict the onset of postpsychotic depression, which occurred in 36% of the sample. Consistent with the framework, patients' subjective appraisals of psychosis as embodying loss, humiliation and entrapment predated the onset of depression, as opposed to traditional cognitive vulnerability factors. Finally, the implications of the findings are discussed with respect to future research, intervention and treatment.
|University of Birmingham
|Electronic Thesis or Dissertation
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