Insight and Symptom Severity in an Inpatient Psychiatric Sample

Individuals with a severe mental illness, particularly a psychotic disorder, often lack insight into having a mental illness. This study sought to examine the differences in insight and symptom severity between individuals with psychotic, bipolar, and depressive disorders in an inpatient psychiatric sample. 199 participants were interviewed and medical records were consulted. Results show that participants with a psychotic disorder had significantly less insight into their illness, more debilitating symptoms, and reported less depression symptoms after controlling for education, race, marital status, homelessness, age, gender, and history of incarceration. Insight was shown to be a mediator between having a psychotic disorder and symptom severity. Subjective quality of life did not differ by diagnosis. Substance use was not associated with insight or overall symptom severity, while homelessness was associated with having a psychotic disorder and more severe symptoms. Fostering insight during an inpatient stay may be an important part of reducing symptom severity and preventing patient relapse. However, greater insight may increase depression and suicidality, indicating a need for mood management and safety planning along with psychoeducation of symptoms.