Insight into mental disorders and suicidal behavior: a qualitative and quantitative multimodal investigation

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology
• Behavioral Neuroscience

Background:

• Insight into mental disorders is a complex construct.
• Suicidal behavior remains a significant public health concern.
• Understanding the relationship between insight and suicidal behavior is crucial for risk assessment and intervention.

Purpose of the Study:

• To investigate the association between insight into mental disorders and suicidal behavior.
• To review existing literature and conduct a meta-analysis on this topic.
• To compare insight levels in suicide attempters versus patient controls.

Main Methods:

• Systematic literature search of MEDLINE databases (English and French) up to January 2014.
• Inclusion of studies measuring insight in patients with suicidal behavior, based on STROBE checklist.
• Cross-sectional study comparing insight scales (MDIS, HDRS-24) in depressed suicide attempters and controls.
• Meta-analysis of 7 selected studies.

Main Results:

• A small majority of reviewed studies (25 in psychotic disorders) indicated a positive association between insight and suicidal risk.
• Suicide attempters showed better insight into depression on HDRS-24 compared to controls (P = .06).
• Meta-analysis of 7 studies confirmed significantly better insight scores in suicide attempters (Hedges g = -0.16).

Conclusions:

• A significant but weak association exists between insight into mental disorders and suicidal behavior.
• Methodological and conceptual limitations in current research were identified.
• Development of new, potentially test-based, measures for assessing insight is suggested.