Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Abstract

Background: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling. Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology. Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel. Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention.

Confidence in visual motion discrimination is preserved in individuals with schizophrenia

“… 37 , 38 Depressive symptomatology was also higher in patients than in controls in the current study. Patients reported mean clinical 57 and cognitive 58 – 60 insights that were comparable to those reported in previous studies including stabilized outpatients. In contrast, cognitive insight — measured as the difference between self-reflectiveness and self-certainty — was markedly lower in the controls we had recruited compared with previous studies.…”

Outcome prediction with a social cognitive battery: a multicenter longitudinal study

“…However, the intervals between evaluations in these previous studies were much shorter than the 1-year follow-up used in this study. This study confirms a previous report that patients followed in the FACE-SZ cohort showed a clinical (positive and negative symptoms, depression, insight, and suicidality) and functional improvement in the first year of follow-up 23 . Increased access to psychosocial rehabilitation interventions such as psychoeducation and cognitive remediation has been associated with an improvement in positive and negative symptoms, neurocognition and functioning in this cohort 24 .…”

Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China

“…The study also found that good insight was associated with a higher risk of suicide, similar to previous studies (33)(34)(35). Insight is defined as patients' "ability to recognize their own mental health status" and includes three dimensions: awareness of having psychotic symptoms, compliance with treatment, and views on social consequences such as hospitalization or unemployment due to mental disorder (36,37).…”