Francisco J Acosta1, Santiago Navarro2, Beatriz Cabrera3, Yolanda Ramallo-Fariña4, Natalia Martínez2. 1. Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service, The Canary Islands, Spain; Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, Madrid, Spain; Insular University Hospital of Gran Canaria, Canary Islands, Spain. Electronic address: fjacostaartiles@hotmail.com. 2. Mental Health Unit of Ciudad Alta, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, Canary Islands, Spain. 3. Mental Health Unit of Puerto, Service of Psychiatry, Doctor Negrín University Hospital of Gran Canaria, Canary Islands, Spain. 4. Canary Foundation of Health Research (FUNCANIS), Canary Islands, Spain; Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, Madrid, Spain.
Abstract
BACKGROUND: Suicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting relevant psychological aspects, such as beliefs about illness and coping styles. METHOD: We assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables. RESULTS: Neither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group. CONCLUSIONS: Insight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.
BACKGROUND: Suicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting relevant psychological aspects, such as beliefs about illness and coping styles. METHOD: We assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables. RESULTS: Neither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group. CONCLUSIONS: Insight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.
Authors: Massimiliano Buoli; Bruno Mario Cesana; Simone Bolognesi; Andrea Fagiolini; Umberto Albert; Gabriele Di Salvo; Giuseppe Maina; Andrea de Bartolomeis; Maurizio Pompili; Claudia Palumbo; Emi Bondi; Luca Steardo; Pasquale De Fazio; Mario Amore; Mario Altamura; Antonello Bellomo; Alessandro Bertolino; Marco Di Nicola; Guido Di Sciascio; Andrea Fiorillo; Emilio Sacchetti; Gabriele Sani; Alberto Siracusano; Giorgio Di Lorenzo; Alfonso Tortorella; A Carlo Altamura; Bernardo Dell'Osso Journal: Eur Arch Psychiatry Clin Neurosci Date: 2021-10-15 Impact factor: 5.270