Are Depression and Psychosis Related?

While psychotic episodes are often preceded by depressive symptoms, not all depressive episodes develop into psychosis. For individuals with schizophrenia, a history of depressive symptoms is not uncommon. Research has shown that depression is associated with negative and positive symptoms of psychosis. Additionally, individuals with both schizophrenia and depression are at increased risk for poor mental health outcomes and even suicide. Although there has been evidence demonstrating a higher risk of psychosis in siblings of people with schizophrenia, less is known about depressive symptoms in these siblings. To explore the family risk for psychosis and depressive symptoms, R. Klaassen of Rivierduinen Mental Health in the Netherlands conducted a study involving 822 individuals with schizophrenia, 813 siblings, and 527 participants with no family or personal history of mental illness who served as controls.

Klaassen assessed the lifetime history of depressed mood, episodes of depression, and psychosis in all three groups. The results revealed that the participants with schizophrenia had the highest levels of lifetime depressive episodes and depressed mood, as was expected. The siblings had elevated risk for depressed episodes when compared to control participants. But there was no difference in history or risk of lifetime depressed mood between the controls and siblings. Klaassen also discovered a direct relationship between the frequency/length of depressed symptoms and negative psychotic symptoms, both clinical and subclinical. But only quantity of depressed symptoms was associated with positive psychotic symptoms in siblings and individuals with schizophrenia. And although Klaassen did find a family risk for depressed mood, there was no link discovered for episodes of depression over the lifetime.

Another finding that has clinical relevance is that the clients with schizophrenia and siblings all had increased risk for experiencing episodes of depression. These risks were statistically significant, indicating that family members of people with schizophrenia should be closely monitored for depression. Also, individuals with psychosis should be evaluated for depression as depressive symptoms can exacerbate psychotic symptoms and lead to a worse treatment and health outcome. Klaassen believes that this research expands upon the existing body of evidence showing that depression has a direct effect on the symptoms of psychosis in those with schizophrenia and immediate family members. Klaassen added, “These findings suggest that a co-occurring genetic vulnerability for both depressive and positive and negative psychotic symptomatology exists on a clinical and also on a subclinical level.”

Klaassen, R. M. C., et al. (2013). Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls. Psychological Medicine 43.4 (2013): 747-56. ProQuest.Web.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • billy


    March 27th, 2013 at 11:15 PM

    always going to be a risk when a family member has this problem. its a hit and go yes, but its better to be on guard.

  • Rashida


    March 28th, 2013 at 1:37 PM

    “…not all depressive episodes develop into psychosis. ”

    Thank goodness! When I read the title of the article it scared me a little because I have founght against depression my entire life. It is scary to think that as I get older that there could be something even more terrible lurking.

  • Aarthi


    March 28th, 2013 at 5:30 PM

    This is indeed an awesome finding and related well the comorbidity of symptoms of psychosis and depression. However, another possibility is that of how one sibling’s depression affects another in ways of interaction and the psychosocial aspects of this interplay. It would be interesting to assess the impact of such an interplay if existing on the severity or even the triggering of psychosis on the weakest link in the family. These are mere hypothesis, however, a deeper investigation can offer more light in this direction.

  • carolee


    March 29th, 2013 at 4:11 AM

    I agree with Billy. The more that we know about our own family and the things in our past that could be triggers the better prepared that we are. We know that cancer and certain diseases can be largely dictated by genetics so I see no reason why depression would not be the same. If you have a close family member who has experienced this in their lives then of course there will be a greater likelihood that you will too. This does not have to mean that it is definitely going to happen, but it is at least worth knowing that you should be prepared for it and do the things throughout life that one knows could ward it off.

  • Alida


    March 29th, 2013 at 11:55 PM

    Depression is like a virus that can spread rapidly. Having a family member with schizophrenia or depression does make one prone to depression, no doubt about that. Better coping skills need to be developed by people having a member with either schizophrenia or depression. It is like having a safety net because the chances of falling are higher. Only makes sense. More of a necessity than a luxury IMO.

  • c owens

    c owens

    March 31st, 2013 at 12:17 AM

    Is this a genetic thing or is depression communicable? They say share happiness and it will multiply, share sorrow and it will divide. Well now it seems like sadness could well spread!

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