Depression during psychosis prodrome predicts depression, self-harm
MedWire News: Study findings suggest that comorbid depression during the prodromal phase of psychosis is a key contributor to the development of future depression and suicidal thinking.
“Efforts to predict and reduce depression and deliberate self-harm in psychosis may need to target this early phase to reduce later risk,” say Rachel Upthegrove (University of Birmingham, UK) and colleagues.
For the study, the team examined the course of depression and suicidal thinking prior to, during, and in the 12 months following the first episode of psychosis (FEP) using standardized measures of prodromal depression, self-harm, and duration of untreated psychosis.
Of the 92FEP patients included in the study, 80% experienced clinically significant depression and 63% experienced both depression and suicidal thoughts in one or more phases.
Specifically, more depressive episodes occurred in the 6 months prior to the first psychotic episode (56%) or during the acute phase of the illness (59%), compared with the follow-up period (39%).
The most common pathways were depression at each stage (22%), no depression throughout (20%), depression in the acute phase with no prodromal depression, but with or without depression in the follow-up (20%), and depression in the prodromal and acute phases, with no depression at follow-up (17%).
“We interpret these data to mean that there is an ongoing vulnerability to depression, that begins in adolescence, is manifest during the prodrome, and can re-emerge at future points,” say Upthegrove et al.
Prodromal depression and depression in the acute phase significantly predicted depression in the follow-up period. Depression in the prodromal phase was the most significant predictor for future depression and acts of self-harm.
In total, 56.6% of patients reported clear thoughts of self-harm at baseline, which decreased to 27% at the 12-month follow-up. Patients who had depression in the prodromal phase were 5.27-fold more likely to report self-harm at baseline.
“The new finding presented here is that prodromal depression, not the severity of positive or negative symptoms, is predictive for depression in the early course, underlining the validity of the independence of the depressive dimension in the structure of psychosis,” write the authors in the journal Acta Psychiatrica Scandinavica.
The team adds that the findings support the concept of an affective pathway involved in the development of psychosis, and “suggest that this may be a primary mechanism involved in the majority of FEP.”
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By Ingrid Grasmo