Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis
Abstract
Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings.
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A meta-analysis of 50 cross-sectional studies found a weak relationship between clinical insight and depression, but longitudinal studies suggested a stronger, more complex relationship which plays out differently depending on circumstances.
“A metaanalysis of 50 cross-sectional studies found a weak relationship between clinical insight and depression, but reported that longitudinal studies suggested a stronger, more complex relationship which plays out differently depending upon the circumstances of the individual person's life 87 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [87]
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- Authors
- Belvederi Murri, M., Respino, M., Innamorati, M., Cervetti, A., Calcagno, P., Pompili, M., Lamis, D. A., Ghio, L., & Amore, M.
- Affiliations
- University of Genoa (IT)
- European University of Rome (IT)
- Azienda Ospedaliera Sant'Andrea (IT)
- Emory University (US)
- ORCID
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 162
- Issue
- 1-3
- Pages
- 234-247
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2096974104
- Cited by
- 142
- References
- 154
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 10 · 2023: 16 · 2022: 18 · 2021: 12 · 2020: 12 · 2019: 15 · 2018: 10 · 2017: 12 · 2016: 13 · 2015: 2
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- schizophrenia, insight
- MeSH terms
- Awareness, Depressive Disorder, Humans, Schizophrenia, Schizophrenic Psychology
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