Psychological Medicine

Original Articles

Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis

M. Birchwooda1 c1, R. Masona1, F. MacMillana1 and J. Healya1

a1 Department of Clinical Psychology and Academic Unit, All Saints' Hospital, Birmingham


This paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.


c1 Address for correspondence: Professor Max Birchwood, Archer Centre, All Saints' Hospital, Lodge Road, Winson Green, Birmingham B18 5SD.