Insight and suicidality in first‐episode psychosis: understanding the influence of suicidal history on insight dimensions at first presentation
Abstract
Aim: Lack of insight is a cardinal feature of psychosis with crucial implications for outcome. Concerns have been raised regarding a link between insight and suicidality. This study aimed to test the relationship between suicidal behaviour preceding first‐episode psychosis (FEP) and insight dimensions at treatment onset. Methods: A total of 112 FEP inpatients were recruited. Suicidal events prior to admission were recorded. Insight was assessed multidimensionally with the S chedule for the A ssessment of I nsight – E xpanded version shortly after admission. Suicidal and non‐suicidal patients were compared regarding scores on ‘total insight’ and three insight domains: ‘awareness of mental illness’, ‘relabeling of psychotic experiences as abnormal’ and ‘compliance’. This analysis was also adjusted for a set of sociodemographic, clinical, neurocognitive and psychopathological variables. Results: Bivariate analyses demonstrated a direct association between previous suicidality and all insight domains. However, these associations did not survive multivariable regression models, which demonstrated gender (female), shorter duration of untreated psychosis (DUP) and psychopathological symptoms – depression and disorganization – to mediate the influence of suicidal history on insight, and therefore to underlie the latter. Conclusions: Insight dimensions in FEP patients are influenced by having suicidal antecedents through some mediating variables such as gender, DUP and depression. Further prospective studies are needed to clarify the potential implications of these findings on the management of insight in FEP. As suicidal history is associated with greater levels of both depression and insight at first presentation, these three variables might be useful in predicting further suicidal events.
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Clinical and cognitive insight are associated with heightened suicidality.
“Consistent with the”
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 [95]
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“The risk of suicide in FEP is related to other risk factors, the measurement of which fell beyond the scope of this study.(46,48) The strength of this study is the large, representative, populationbased cohort of consecutively enrolled FEP patients with a fairly equal gender distribution.”
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“…age at psychosis onset (Mork et al., 2012), being male (Hawton et al., 2005), longer “duration of untreated psychosis” (DUP) (Challis et al., 2013; Lopez-Moriñigo et al., 2014), higher premorbid intelligence quotient (IQ) (Pluck et al., 2012) and family history of self-harm (Pluck et al., 2012)…”
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“In addition, there is a debate suggesting that insight may represent a risk factor for suicide in patients with schizophrenia (López-Moríñigo et al., 2012; López-Moríñigo et al., 2014).”
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“shorten the duration of untreated psychosis via leading the patient to receive psychiatric attention earlier.(57) Also, the duration of care was significantly shorter in”
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“First of all, a history of suicide attempt before the first episode of schizophrenia has been associated with better insight at the time of the first psychotic episode [15], whereas insight at that time was not associated with later suicide attempts beyond the association with depression [19], suggesting that suicide…”
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“These may delay treatment and destabilize the patient’s condition, leading to a poorer prognosis, particularly in men with acute schizophrenia,(27) whereas women tend to form a ‘suicidal-depressive-insightful’ subgroup characterized by shorter DUP and better cognitive performance.(28) However, these findings come from…”
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“Previous studies suggested that greater neurocognitive functioning is associated with an increased risk for SB in patients with psychosis14–16 and with greater insight into or awareness of the disorder.(17,18) However, other studies showed the opposite: impaired neurocognitive and social cognitive functioning19–21 are…”
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“…misuse, diminished psychosocial function and increased suicide risk (Amador and David 2004; Ekinci and Ekinci 2013; Lincoln et al. 2007; López-Moríñigo et al. 2012, López-Moríñigo et al. 2014; Massons et al. 2017; Mohamed et al. 2009; Quee et al. 2011; Villa et al. 2018; Wiffen et al. 2012).”
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“, 2010), and it is one of the leading causes of premature death in FEP patients (López-Moríñigo et al., 2014; Nordentoft et al., 2013).”
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Impact of Awareness of Symptoms on Risk in Suicidality in Schizophrenia Patients
Pan, Y. (2024) · Lecture Notes in Education Psychology and Public Media · doi:10.54254/2753-7048/46/20230792
Agustín, R., Miñano, M. J., Ortuño, N., Cobo, J., & Palao, D. J. (2026) · Forensic Sciences · doi:10.3390/forensicsci6030061
- Authors
- López‐Moríñigo, J. D., Wiffen, B., O'Connor, J., Dutta, R., Di Forti, M., Murray, R. M., & David, A. S.
- Affiliations
- Department of Psychosis Studies, Institute of Psychiatry King's College London London UK
- King's College London (GB)
- Venue
- Early Intervention in Psychiatry
- Publisher
- Wiley
- Published
- 2013-03-14
- Volume
- 8
- Issue
- 2
- Pages
- 113-121
- ISSN
- 1751-7885 (ISSN-L)
- 1751-7893
- OpenAlex
- W1532864077
- Cited by
- 26
- References
- 50
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 1 · 2013: 1
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Early Intervention in Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0510-10129)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- insight, suicidality, first-episode psychosis, medication adherence, duration of untreated psychosis, depression, gender differences, suicide risk prediction
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Psychotic Disorders, Self-Assessment, Suicide, Attempted, Case-Control Studies, Young Adult
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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