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Background: Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors., Aims: This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15-24 years., Method: This study used a matched case-control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse., Results: Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15-18 years, work stress in women aged 19-24 years., Conclusion: Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care., (© 2016 John Wiley & Sons Australia, Ltd.)

Aims: To investigate the relationship between internalized stigma, depression, social anxiety and unusual experiences in young people considered to be at risk of developing psychosis., Methods: A total of 288 participants meeting criteria for an at-risk mental state were recruited as part of a multisite randomized controlled trial of cognitive behavioural therapy for people meeting criteria for an at risk mental state (ARMS). The sample was assessed at baseline and 6 months using measures of at risk mental states, internalized stigma, depression and social anxiety., Results: The Personal Beliefs about Experiences Questionnaire was validated for use with an ARMS sample. Correlational analyses at baseline indicated significant relationships between internalized stigma and: (i) depression; (ii) social anxiety; (iii) distress associated with unusual psychological experiences; and (iv) suicidal thinking. Regression analysis indicates negative appraisals of unusual experiences contributed significantly to depression scores at 6-month follow up when controlling for baseline depression and unusual psychological experiences., Conclusions: These findings suggest that internalized stigma may contribute to the development and maintenance of depression in young people at risk of psychosis., (© 2013 Wiley Publishing Asia Pty Ltd.)

Background: Depression following first episode psychosis (FEP) is a frequent occurrence, with profound impact on recovery and outcome. Whilst many theories exist about the causes of depression here, research to date has been based on nosology imported wholesale from affective disorder, with little primary research on the subjective experience. This study aimed to explore the subjective experience and phenomenological features of post-psychotic depression in FEP., Method: A qualitative methodology, photo-elicitation, together with unstructured interviews, was used to characterise aspects of depression following FEP and analysed using contemporary framework analysis., Results: Depression was reported by participants as linked to the experience of and recovery from psychosis. The psychotic episode was a traumatic event followed by subjective doubt, shame and embarrassment. Loss and social isolation were central. Core biological symptoms did not feature., Limitations: Despite the relatively small sample size, this study was able to generate in-depth data that provides useful and novel insight. Whilst generalisability is incompatible with qualitative methodology, further research using the same methodology would generate a wider range of experiences and perspectives., Conclusions: Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes., (Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.)

Objectives: The current study examined shame in a clinical sample recovering from a first episode of psychosis by focusing on the contribution of different types of shame to post-psychotic trauma while controlling for current affective symptoms., Design: The study used a cross-sectional correlational design., Method: Fifty individuals who met the criteria for a psychotic disorder whose acute psychotic symptoms were in remission completed measures of internal and external shame associated with psychosis, general shame, post-psychotic trauma, and depression., Results: Post-psychotic trauma symptoms were correlated with internal and external shame associated with psychosis and general shame. However, the relation between post-psychotic trauma and external shame associated with psychosis remained after controlling for general shame and current affective symptoms. In addition, internal shame had a stronger association with depression. Thus, internal and external shame due to psychosis had different associations with different types of post-psychotic emotional dysfunction., Conclusions: The results support the importance of assessing shame as a multi-faceted construct and suggest that assessing shame directly associated with mental illness is a worthwhile endeavour., (© 2012 The British Psychological Society.)

Objectives: In unipolar depression, the action of early life events has been shown to be linked to a deficit in accessing details of such autobiographical events ('overgeneral memory'). In this study, we test whether a similar deficit can be observed in post-psychotic depression (PPD) in first-episode psychosis., Method: A group of 29 patients were followed up during the 12 months after their first onset, and monitored for PPD., Results: Of the sample group, 45% developed PPD, which was associated with overgeneral memory (p <.05; effect size = 1.05) and a heightened awareness of the diagnosis., Conclusions: Our findings raise the possibility that anomalies of psychosocial development may confer vulnerability to depression in psychosis.

Objective Embedded in attachment theory is its association with affect regulation, which provides a framework for affective dysregulation in the emerging psychosis. Method Fifty-one participants meeting criteria for ultra-high risk ( UHR) of developing psychosis were recruited from a youth mental health service within the United Kingdom. At intake baseline, prior to starting therapeutic intervention, all clients were assessed on measures of affective dysregulation and attachment. Results A large proportion of our sample ( N = 51) reported clinically significant levels of depression (78%), state anxiety (59%), and social anxiety (65%). Eighty per cent of the UHR sample was insecurely attached. Insecure attachment was significantly associated with elevated depression and social anxiety. Attachment styles were associated with anxiety, depression, and social anxiety. There was no support for a mediating role of social anxiety between attachment styles and depression. Conclusion Clinically significant levels of distress and anxiety experienced by the young people at high risk of psychosis. Clinical implications for the treatment of affective dysregulation in young people at UHR in relation to their attachment styles have been discussed. Practitioner points The treatment of affective dysregulation has implications on social integration, crucial to the recovery of young people in the emerging psychosis., Assessment of adult attachment difficulties may bring to the forefront specific negative internal working models (and interpersonal schemas) which may indicate vulnerability to social anxiety and depression., Young adults at ultra-high risk of psychosis with emotional difficulties may be better at help seeking and therefore over-represented in this sample., Cross-sectional data analysis makes it difficult to draw aetiological links between adult attachment and affective dysregulation. [ABSTRACT FROM AUTHOR]

Considerable focus has been given to the interpersonal nature of the voice-hearing relationship and how appraisals about voices may be linked with distress and depression (the 'cognitive model'). Research hitherto has focused on appraisals of voice power, but the supportive and affiliative quality of voices, which may act to mitigate distress, is not understood. We explored appraisals of voices' power and emotional support to determine their significance in predicting depression and suicidal thought. We adapted the concept of expressed emotion (EE) and applied it to measure voice hearers' perception of the relationship with their voice(s). In a sample of 74 voice hearers, 55.4% were moderately depressed. Seventy-eight who rated their voices as high in both power and EE had a large and significant elevation in depression, suggesting that co-occurrence of these appraisals impacts on depression. Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE. Those rating their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. These findings highlight the protective role that the supportive dimension of the voice/voice-hearer relationship may have. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Appraisals of social rank and EE impact on the depressive and suicidal status of voice-hearers., The emotionally supportive dimension of the voice-hearing relationship may have a protective role in the affective response of voice hearers., Therapeutic interventions should consider the emotionally supportive needs of voice-hearers [ABSTRACT FROM AUTHOR]

Objective: To examine whether abuse and dysfunctional parental affiliation in childhood are associated with voice appraisals of power and perceived expressed emotion, present-day shame cognitions, and depression and suicidal ideation. Method: Seventy-four voice-hearers participated. Depressive and suicidal status, childhood abuse and parental affiliation, shame cognitions and appraisals of voice power and perceived expressed emotion were assessed. Results: Overall, childhood emotional abuse was linked to greater voice power and lack of emotional support from parents was linked to lower support and affiliation with voices. Rejection from father and emotional abuse were the strongest and consistent predictors of internal and external shame cognitions. Depression was strongly correlated with parental emotional abuse. Conclusion: Our findings suggest that the voice/voice-hearer relationship operates as an emotional mirror reflecting elements of traumatic childhood affiliations, and that these affiliations are associated with present-day shame cognitions and depression. [ABSTRACT FROM AUTHOR]