“Then one day I broke down”. The experience of depression and social anxiety in adolescents with first-episode psychosis.

Abstract

Introduction: Young people recovering from first episode psychosis experience a high degree of emotional distress and co-morbidity. Depression and social anxiety are highly prevalent following first episode psychosis and have been associated with poorer outcome, increased risk of suicide and lower quality of life. However, there is little research examining how these emotional difficulties relate to the course of psychotic symptoms and subsequent adaptation and recovery. The primary aim of this research was to establish a grounded theory of the experience of mood and anxiety related difficulties in young people who experience a first episode psychosis. Secondly, the research aimed to establish the underlying psychological factors contributing to the relationship between psychosis and affective dysfunction. Method: The study used a mixed-methods design with primacy given to the qualitative component (QUAL+quan). Young people (n=10) who had experienced a first-episode of psychosis were interviewed and completed measures of depression, social anxiety and recovery. Interviews were transcribed and analysed using a social constructivist version of grounded theory. Quantitative measures were integrated with the qualitative data, providing a framework for re-examining inferences made in the qualitative analysis. Results: The overarching theme to emerge was the experience of a developmental trajectory of psychosis. Seven key categories were identified: The build up; coping; breaking point; facing diagnosis; impact of illness; getting stuck and; moving on. Isolation, low mood and anxiety were universal outcomes and appeared to be mediated by maladaptive forms of coping and mood regulation in addition to psychological appraisals and negative illnessrelated experiences. Conclusions: The findings suggest that depression and social anxiety are not co-morbid features of psychosis but are intrinsically linked to the underlying processes involved in coping with and adapting to psychosis. Strengths and limitations of the research are discussed and implications for clinical practice and further research are reviewed.