title: Insight in schizophrenia and risk of suicide: a systematic update.
abstract: BACKGROUND
  Suicide has been shown to represent the major single cause of premature death among patients with schizophrenia spectrum disorders. Insight has been proposed to increase such risk. However, this subject has not been sufficiently investigated, and inconclusive results have been reported.
  
  
  OBJECTIVE
  The objective of this study is to systematically examine the role of insight in the risk of suicide attempts and completed suicide among patients with schizophrenia and related disorders.
  
  
  METHODS
  Articles assessing insight and suicidality in patients with schizophrenia spectrum disorders published between 1977 and 2010 were reviewed. A MEDLINE search strategy was used to identify studies using keywords. Application of meta-analytic techniques to selected studies was not possible because of important methodological differences between them.
  
  
  RESULTS
  Fifteen studies met predetermined selection criteria. Ten failed to demonstrate a positive association between insight and risk for suicide.
  
  
  CONCLUSIONS
  There is little evidence to support the suggestion that insight may represent a risk factor for suicide in patients with schizophrenia. If there is an association between such risk and insight, it appears to be mediated by other variables such as depression and, above all, hopelessness. Further studies with larger samples and longer follow-up periods in naturalistic conditions, in which insight should be evaluated from a multidimensional approach, are required to analyze this issue in depth, given the crucial implications that it may have on the development of a model for suicide prevention in schizophrenia.
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, United Kingdom. javier.morinigo@kcl.ac.uk
authors.forename: Javier D
authors.initials: JD
authors.lastname: López-Moríñigo
authors.forename: Ramón
authors.initials: R
authors.lastname: Ramos-Ríos
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.forename: Rina
authors.initials: R
authors.lastname: Dutta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012565:Schizophrenic Psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D000092864:Suicide Prevention