Abstract
Depressive symptoms are highly prevalent in psychotic populations and result in significant functional impairment. Limited knowledge of whether depressive symptoms are invariant across stages of illness curtails our ability to understand how these relate to illness progression. Clarifying the latent structure of depressive symptoms across stages of illness progression would aid etiological conceptualizations and preventive models. In the present study, one-factor (including all items) and two-factor (depression/hopelessness and guilt/self-depreciation) solutions were specified through confirmatory factor analysis (CFA). Measurement invariance analyses were undertaken across schizophrenia (SCZ; n = 312) and clinical high-risk (CHR; n = 175) groups to estimate whether the same construct is being measured across groups. Clinical correlates of the factors were examined. Results indicated that CHR individuals had a greater proportion of mood disorder diagnoses. Metric invariance held for the one-factor solution, and scalar invariance held for the two-factor solution. Notably, negative symptoms did not correlate with depressive symptoms in the SCZ group, though strong correlations were observed in CHR individuals. Positive symptoms were comparably associated with depressive symptoms in both groups. Results suggest depressive symptoms are more prevalent in CHR individuals. Targeting these symptoms may aid future efforts to identify risk of conversion. Further, some depressive symptoms may be systematically more endorsed in CHR individuals. Separating into depression/hopelessness and guilt/self-depreciation scores may aid comparability across stages of illness progression, though this issue deserves careful attention and future study.
Highlights
Depressive symptoms are highly prevalent in psychotic populations, in both first episode and chronic phases of illness[1,2]
Expectedly, the SCZ group had a greater proportion of males, higher neuroleptic usage, and greater age compared to clinical high-risk (CHR) individuals
There were no significant associations between antipsychotic dosage, depressive symptoms, and negative symptoms across groups (p = 0.08–0.76), except for an association between total Calgary Depression Scale for Schizophrenia (CDSS) score and antipsychotic dosage in the SCZ group (r = 0.12, p = 0.04)
Summary
Depressive symptoms are highly prevalent in psychotic populations, in both first episode and chronic phases of illness[1,2] These have been closely linked to psychotic symptom severity, distress, and content, as well as to symptom development, illness prognosis, and relapse[3]. One might expect depression to be a significant secondary negative symptom source in CHR individuals given that rates of depression are high in this population (e.g., 41% of CHR individuals are estimated to be diagnosed with a comorbid depressive disorder)[7] If this is the case, there are important resulting treatment implications, as a focus on depression may be critical for prevention at the earliest stages of the prodrome and as a means of halting functional deterioration
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