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.
Highlights
Schizophrenia is a severe and persistent psychiatric disorder, characterized by heterogeneous symptomatology and cognitive impairments
Our model reflects that good insight predicts a decrease in quality of life (QoL) and that low QoL predicts a worsening of depression
This result could be explained by the fact that suicide and depression may be more closely intertwined than the other clinical dimensions included in the model, and it might not be possible to disentangle them properly in schizophrenia
Summary
Schizophrenia is a severe and persistent psychiatric disorder, characterized by heterogeneous symptomatology and cognitive impairments. It has been shown that better insight may be associated with increased depression and poorer QoL in schizophrenia [8,9,10,11]. By adopting an integrative perspective, Roux et al [18] proposed a refinement of this model in a cross-sectional study of the relationships between insight, depression, QoL and suicidality using mediation analyses with structural equation modeling (SEM). 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. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention
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