Prevalence of depression in persons with schizophrenia – A cross-sectional study from a tertiary psychiatric hospital

Authors

  • Reshma Susan Mathew Amala Institute of Medical Sciences, Thrissur, Kerala
  • Indu V Nair Government Mental Health Centre, Thiruvananathapuram, Kerala

DOI:

https://doi.org/10.30834/KJP.36.1.2023.364

Keywords:

Depression, Schizophrenia, CDSS, PANSS

Abstract

Background: It is important to be aware of depressive symptoms in schizophrenia because of the impact it has on its course and outcome. There are only a few studies that have evaluated depression in schizophrenia in Indian settings and no data is available from Kerala. The objective of this study was to find the prevalence and associated factors of depression in persons with schizophrenia. Methods: This was a cross-sectional study in which 225 patients with a diagnosis of schizophrenia according to DSM-5 who availed outpatient or inpatient services from a tertiary psychiatric hospital were included. Socio-demographic data were collected using a structured proforma. The symptom domains of schizophrenia were assessed using the Positive and Negative Syndrome Scale (PANSS). Depression was measured using the Calgary Depression Scale for Schizophrenia (CDSS). A cut-off score of ?6 on the CDSS was used to identify clinically significant depressive symptoms. Results: This study found the prevalence of depression in schizophrenia to be 30% (95 % CI - 29.94, 30.06). Higher education, being married, greater insight, a past history of suicide attempt, positive symptoms and general psychopathology symptoms were found to be associated with depression in schizophrenia. A positive correlation between PANSS positive subscale and CDSS scores was identified. Conclusions: Depression was seen in almost one-third of the patients with schizophrenia. Screening and management of depressive symptoms can help in improving the quality of care provided to patients with schizophrenia.

References

Elvevåg B, Goldberg TE. Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol 2000;14:1-21.

Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: cause, consequence, or trans-diagnostic issue?. Schizophrenia bulletin 2017;43:240-4.

Bourdon KH, Rae DS, Locke BZ, Narrow WE, Regier DA. Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey. Public Health Rep 1992;107:663–8.

Siris SG. Depression in schizophrenia: perspective in the era of “Atypical” antipsychotic agents. Am J Psychiatry 2000;157:1379–89.

Birchwood M, Mason R, MacMillan F, Healy J. Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med 1993;23:387–95.

Lindenmayer J-P, Kay SR. Depression, affect and negative symptoms in schizophrenia. Br J Psychiatry 1989;155(S7):108–14.

Lysaker PH, Bell MD, Bioty SM, Zito WS. The frequency of associations between positive and negative symptoms and dysphoria in schizophrenia. Compr Psychiatry 1995;36:113–7.

Mauri MC, Paletta S, Maffini M, Moliterno D, Altamura AC. Suicide attempts in schizophrenic patients: clinical variables. Asian J Psychiatry 2013;6:421–7.

Dutta R, Murray RM, Allardyce J, Jones PB, Boydell J. Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophr Res 2011;126:11–9.

Reine G, Lançon C, Tucci SD, Sapin C, Auquier P. Depression and subjective quality of life in chronic phase schizophrenic patients. Acta Psychiatr Scand 2003;108:297–303.

Harvey P, Vanover K, Davis R, Penn D, Pinkham A. F250. Depression in schizophrenia: correlations with objective and subjective quality of life outcomes. Schizophrenia Bulletin 2018 ;44(S1):320.

Lako IM, Bruggeman R, Knegtering H, Wiersma D, Schoevers RA, Slooff CJ, et al. A systematic review of instruments to measure depressive symptoms in patients with schizophrenia. J Affect Disord 2012;140:38–47.

Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021;20:4-33.

Lako IM, Taxis K, Bruggeman R, Knegtering H, Burger H, Wiersma D, et al. The course of depressive symptoms and prescribing patterns of antidepressants in schizophrenia in a one-year follow-up study. Eur Psychiatry 2012;27:240–4.

El-Bahy M, Mohamed WMY. Prevalence of depression in schizophrenic patients evaluated by the Calgary Depression Scale in Shebin El-Kom, Menoufiya. Middle East Curr Psychiatry 2013;20:191–6.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–76.

Addington J, Shah H, Liu L, Addington D. Reliability and validity of the Calgary Depression Scale for Schizophrenia (CDSS) in youth at clinical high risk for psychosis. Schizophr Res 2014;153:64–7.

Rahim TA. Rate of depression among patients with schizophrenia. Zanco J Med Sci 2016;20:1180-85.

Sands JR, Harrow M. Depression during the longitudinal course of schizophrenia. Schizophr Bull 1999;25:157–72.

Bartels SJ, Drake RE. Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Compr Psychiatry 1988;29:467–83.

Freudenreich O, Tranulis C, Cather C, Henderson D, Evins A, Goff D. Depressive symptoms in schizophrenia outpatients—prevalence and clinical correlates. Clin Schizophr Relat Psychoses 2008;2:127–35.

Rajkumar RP. Depressive symptoms during an acute schizophrenic episode: frequency and clinical correlates. Depression research and treatment 2015.

Clark RE, Bartels SJ, Mellman TA, Peacock WJ. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophr Bull 2002;28:75–84.

Craddock N, Owen MJ. The Kraepelinian dichotomy – going, going … but still not gone. Br J Psychiatry 2010;196:92–5.

Aki H, Tomotake M, Kaneda Y, Iga J-I, Kinouchi S, Shibuya-Tayoshi S, et al. Subjective and objective quality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia. Psychiatry Res 28;158:19–25.

Acosta FJ, Aguilar EJ, Cejas MR, Gracia R, Caballero-Hidalgo A, Siris SG. Are there subtypes of suicidal schizophrenia? A prospective study. Schizophr Res 2006;86:215–20.

Bottlender R, Strauß A, Möller HJ. Prevalence and background factors of depression in first admitted schizophrenic patients. Acta Psychiatr Scand 2000;101:153–60.

Delahanty J, Ram R, Postrado L, Balis T, Green-Paden L, Dixon L. Differences in rates of depression in schizophrenia by race. Schizophr Bull 2001;27:29-37

Addington DE, Addington JM. Attempted suicide and depression in schizophrenia. Acta Psychiatr Scand 1992;85:288–91.

Rajkumar S, Padmavathi R, Thara R, Menon SM. Incidence of Schizophrenia in an Urban Community in Madras. Indian J Psychiatry 1993;35:18.

Brugnoli R, Novick D, Haro JM, Rossi A, Bortolomasi M, Frediani S, et al. Risk factors for suicide behaviors in the observational schizophrenia outpatient health outcomes (SOHO) study. BMC Psychiatry 2012;12:83.

Saarinen PI, Lehtonen J, Lonnqvist J. Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull 1999;25:533–42.

Misdrahi D, Denard S, Swendsen J, Jaussent I, Courtet P. Depression in schizophrenia: the influence of the different dimensions of insight. Psychiatry Res 2014;216:12–6.

Gilleen J, Strelchuk D, Palmer E. 186. Insight into schizophrenia and its relationship with clinical symptoms: a meta-analysis involving 20515 Patients. Schizophr Bull 2017;43(S1):S98.

Lincoln TM, Lullmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia- a systematic review. Schizophr Bull 2006;33:1324–42.

Belvederi Murri M, Amore M, Calcagno P, Respino M, Marozzi V, Masotti M, et al. The “Insight Paradox” in schizophrenia: magnitude, moderators and mediators of the association between insight and depression. Schizophr Bull 2016;42:1225–33.

Emsley RA, Oosthuizen PP, Joubert AF, Roberts MC, Stein DJ. Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. J Clin Psychiatry 1999;60:747–51.

Rabany L, Weiser M, Levkovitz Y. Guilt and depression: two different factors in individuals with negative symptoms of schizophrenia. European psychiatry. 2013 ;28:327-31.

Sommers AA. “Negative Symptoms”: conceptual and methodological problems. Schizophr Bull 1985;11:364–79.

Krynicki C, Upthegrove R, Suckling J, Dazzan P, Joyce E, Lawrie S, Husain N, Chaudhry I, Dunn G, Jones P, Lisiecka D. T46. Targeting the immune system to treat depression and negative symptoms in schizophrenia. Schizophrenia Bulletin 2018 ;44(S1):S131.

Xu Y-M, Li F, Liu X-B, Zhong B-L. Depressive symptoms in Chinese male inpatients with schizophrenia: prevalence and clinical correlates. Psychiatry Res 2018;264:380–4.

Downloads

Published

2023-06-05

How to Cite

Mathew, R. S., and I. V. Nair. “Prevalence of Depression in Persons With Schizophrenia – A Cross-Sectional Study from a Tertiary Psychiatric Hospital”. Kerala Journal of Psychiatry, vol. 36, no. 1, June 2023, pp. 30-38, doi:10.30834/KJP.36.1.2023.364.

Issue

Section

Research Report