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Coping defence and depression in adolescents hearing voices

Background: The level of self-initiated coping defences in the face of auditory hallucinations reflects the degree to which the psychotic experiences are exceeding the person's resources. As it has been suggested that individuals who feel overwhelmed by their psychotic experiences are also more likely to develop depression, greater levels of self-initiated coping defences should predict onset of depression in the context of auditory hallucinations. Method: Eighty adolescents (mean age 12.9 years, SD=3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty per cent were receiving professional care, but 50% were not in need of care. Baseline measurement of self-initiated coping defences and psychopathology were used as predictors of depression at follow-up. Results: Baseline level of self-initiated coping was strongly associated with baseline severity of positive psychotic symptoms. Coping at baseline, with the exception of active problem solving, predicted an increase in the level of depression over the follow-up period (OR=3.0, 95% CI: 1.4, 6.4), independent of baseline psychopathology, demographic characteristics, receipt of professional care and appraisals and attributions related to the voices. Conclusions: The results suggest that individuals who have a tendency to feel overwhelmed by the experience of voices, as evidenced by a more defensive style of response, are more likely to develop depression. Declaration of interest: Funded by the Dutch Prevention Fund.