Abstract
Background: Anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders, but the relationship between ASEs, and depression has been studied to a limited extent. Lower self-esteem has been shown to be associated with depression in early psychosis. Our hypothesis is that ASEs in early phases of schizophrenia are linked to lower levels of self-esteem, which in turn is associated with depression.Aim: The aim is to examine the relationship between ASEs, self-esteem and depression in first-episode schizophrenia spectrum disorders.Method: ASEs were assessed in 55 patients with first-episode schizophrenia by means of the Examination of anomalous Self-Experience (EASE) instrument. Assessment of depression was based on the Calgary Depression Scale for Schizophrenia (CDSS). Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES). Symptom severity was assessed using the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS). Substance misuse was measured with the Drug Use Disorder Identification Test (DUDIT), and alcohol use was measured with the Alcohol Use Disorder Identification Test (AUDIT). Data on childhood adjustment were collected using the Premorbid Adjustment Scale (PAS). Data on childhood trauma were collected using the Norwegian version of the Childhood Trauma Questionnaire, short form (CTQ-SF).Results: Analyses detected a significant association between current depression and ASEs as measured by the EASE in women, but not in men. The effect of ASEs on depression appeared to be mediated by self-esteem. No other characteristics associated with depression influenced the relationship between depression, self-esteem and ASEs.Conclusion: Evaluating ASEs can assist clinicians in understanding patients' experience of self-esteem and depressive symptoms. The complex interaction between ASEs, self-esteem, depression and suicidality could be a clinical target for the prevention of suicidality in this patient group.
Highlights
Schizophrenia and Anomalous Self-experienceStudies show that anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders (Haug et al, 2012a; Nelson et al, 2013; Nordgaard and Parnas, 2014), and precede their onset (Parnas et al, 1998; Møller and Husby, 2000; Nelson et al, 2012)
An earlier study found a link between ASEs and suicidality among patients with schizophrenia (Skodlar and Parnas, 2010), and we have in previous reports from the current study shown that ASEs are linked to suicidality (Haug et al, 2012b) in addition to a longer duration of untreated psychosis (DUP) (Haug et al, 2015b), social dysfunction (Haug et al, 2014) and childhood trauma, the latter only in women (Haug et al, 2015a)
In previous studies men have been showing lower levels of depression and higher levels of self-esteem than women (Thorup et al, 2007; Romm et al, 2011), and in previous reports from the current study we have shown that ASEs are linked childhood trauma only in women (Haug et al, 2015a)
Summary
Schizophrenia and Anomalous Self-experienceStudies show that anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders (Haug et al, 2012a; Nelson et al, 2013; Nordgaard and Parnas, 2014), and precede their onset (Parnas et al, 1998; Møller and Husby, 2000; Nelson et al, 2012). The sense of self (identity feeling) can be described on three hierarchical but interconnected levels: the narrative, the reflective, and the prereflective identity level (Sass and Parnas, 2003). The prereflective self is the most basic level of self-awareness, implicit, preverbal, and inseparable from subjective experience per se. Anomalous self-experiences (ASEs) aggregate in schizophrenia spectrum disorders, but the relationship between ASEs, and depression has been studied to a limited extent. Lower self-esteem has been shown to be associated with depression in early psychosis. Our hypothesis is that ASEs in early phases of schizophrenia are linked to lower levels of self-esteem, which in turn is associated with depression
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