Depression in schizophrenia: the influence of the different dimensions of insight

Improving insight in patients with schizophrenia appears necessary to enhance medication adherence and clinical outcome, but in some patients acquiring insight can paradoxically increase hopelessness, depression and suicidal behavior. The aim of this study is to explore the association of two dimensions of insight (cognitive and clinical) with depression, hopelessness and clinical variables in patients with psychosis. Using a cross-sectional design, 61 remitted outpatients meeting DSM-IV criteria for schizophrenia or schizoaffective disorders were included. Insight was assessed using the "Scale to Assess Unawareness of Mental Disorder" (SUMD), the PANSS-item G12 and the Beck Cognitive Insight Scale (BCIS). Overall, 41.2% of the sample had a history of suicide attempts. Patients in the high clinical insight group had significantly higher depression scores, higher hopelessness scores, greater histories of suicide attempts and were more likely to have received psychoeducation. Compared to patients with low cognitive insight, those with high overall cognitive insight were significantly more depressed and had more often received psychoeducation. Greater insight may have negative consequences in terms of depressive symptoms and therefore presents a challenge to clinicians in assessing the individual risks and benefits of strategies intended to enhance awareness of mental disorder.