Insight and suicidality in psychosis: A cross-sectional study [2017]

• Suicidal behaviour in patients with psychosis represents a focus of concern.

• Suicide risk factors differ from the general population.

• There is no evidence to support a direct link of insight dimensions with suicidality.

• Depression and suicidal history predict further suicide attempts.

We aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders.

143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted.

Those subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of “disturbed thinking and loss of control over the situation” and “having a vague feeling that something is wrong”) were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality.

Suicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.

Carmen Massons, Javier-David Lopez-Morinigo, Esther Pousa, Ada Ruiz, Susana Ochoa, Judith Usall, Lourdes Nieto, Jesus Cobo, Anthony S. David, Rina Dutta
Psychiatry Research, Volume 252, June 2017