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The mediating role of depression in pathways linking positive and negative symptoms in schizophrenia. A longitudinal analysis using latent variable structural equation modelling

Published online by Cambridge University Press:  08 March 2019

Giuseppe Carrà Open the ORCID record for Giuseppe Carrà [Opens in a new window] ,
Cristina Crocamo Open the ORCID record for Cristina Crocamo [Opens in a new window] ,
Francesco Bartoli Open the ORCID record for Francesco Bartoli [Opens in a new window] ,
Matthias Angermeyer ,
Traolach Brugha Open the ORCID record for Traolach Brugha [Opens in a new window] ,
Mondher Toumi Open the ORCID record for Mondher Toumi [Opens in a new window]  and
Paul Bebbington Open the ORCID record for Paul Bebbington [Opens in a new window]
Giuseppe Carrà
Affiliation:
Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Cristina Crocamo*
Affiliation:
Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Francesco Bartoli
Affiliation:
Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
Matthias Angermeyer
Affiliation:
Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
Traolach Brugha
Affiliation:
Department of Health Sciences, University of Leicester, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, LeicesterLE1 7RH, UK
Mondher Toumi
Affiliation:
Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
Paul Bebbington
Affiliation:
Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK
*
Author for correspondence: Cristina Crocamo, E-mail: [email protected]
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Abstract

Background

The interaction between positive, negative and depressive symptoms experienced by people with schizophrenia is complex. We used longitudinal data to test the hypothesis that depressive symptoms mediate the links between positive and negative symptoms.

Methods

We analyzed data from the European Schizophrenia Cohort, randomly sampled from outpatient services in France, Germany and the UK (N = 1208). Initial measures were repeated after 6 and 12 months. Depressive symptoms were identified using the Calgary Depression Scale for Schizophrenia (CDSS), while positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Latent variable structural equation modelling was used to investigate the mediating role of depression assessed at 6 months in relation to the longitudinal association between positive symptoms at baseline and negative symptoms at 12 months.

Results

We found longitudinal associations between positive symptoms at baseline and negative symptoms at 12 months, as well as between both of these and CDSS levels at 6 months. However depression did not mediate the longitudinal association between PANSS scores; all the effect was direct.

Conclusions

Our findings are incompatible with a mediating function for depression on the pathway from positive to negative symptoms, at least on this timescale. The role of depression in schizophrenic disorders remains a challenge for categorical and hierarchical diagnostic systems alike. Future research should analyze specific domains of both depressive and negative symptoms (e.g. motivational and hedonic impairments). The clinical management of negative symptoms using antidepressant treatments may need to be reconsidered.

Keywords

Depressionlongitudinal studiesnegative symptomspositive symptomsschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 4 , March 2020 , pp. 566 - 574
Copyright
Copyright © Cambridge University Press 2019

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