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. 2019 Aug 10;8(8):1196.
doi: 10.3390/jcm8081196.

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Mickaël Ehrminger  1   2 , Mathieu Urbach  3   4 , Christine Passerieux  3   5   4 , Bruno Aouizerate  3   6   7 , Fabrice Berna  3   8   9 , Anne-Lise Bohec  3   10   11 , Delphine Capdevielle  3   12   13 , Isabelle Chereau  3   14   15 , Julie Clauss  3   8   9 , Caroline Dubertret  3   16   17   18 , Aurélie Esselin  3   5 , Catherine Faget  3   19   20 , Guillaume Fond  3   20   21 , Roxana Mihaela Honciuc  3   14   15 , Marine Jarroir  3   5 , Jasmina Mallet  3   16   17   18 , David Misdrahi  3   6   22 , Baptiste Pignon  3   23   24 , Romain Rey  3   10   11 , Franck Schürhoff  3   23   24 , Hanan Yazbek  3   12   13 , Eric Brunet-Gouet  3   5   4 , Paul Roux  3   5   4
Affiliations

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Mickaël Ehrminger et al. J Clin Med. .

Abstract

Background: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling.

Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology.

Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel.

Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention.

Keywords: Schizophrenia; depression; insight; quality of life; structural equation modeling; suicide.

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Conflict of interest statement

The authors declare no conflict of interest. B. Aouizerate has received speaker honoraria from Lundbeck, AstraZeneca, Eli Lilly and Janssen; he has also served on the advisory board for Janssen. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Specification of a bivariate latent difference score model (β: autoregressive path; γ: coupling path; 1: path coefficient fixed to 1)
Figure 2
Figure 2
Simplified diagram of the final model. Single-headed arrows are regression paths with unstandardized (and standardized) coefficients. Double-headed arrows are covariances with standardized coefficients. For readability, only significant paths are shown. R2 is the amount of explained variance of endogenous variables. Significance levels: *p < 0.05, **p < 0.01, *** p < 0.001.
See this image and copyright information in PMC

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