title: 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.
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK. Electronic address: martino.belvederi@gmail.com.
authors: Martino
authors: M
authors: Belvederi Murri
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy.
authors: Matteo
authors: M
authors: Respino
authors: Department of Human Sciences, European University of Rome, Italy.
authors: Marco
authors: M
authors: Innamorati
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy.
authors: Alice
authors: A
authors: Cervetti
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy.
authors: Pietro
authors: P
authors: Calcagno
authors: Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
authors: Maurizio
authors: M
authors: Pompili
authors: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
authors: Dorian A
authors: DA
authors: Lamis
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy.
authors: Lucio
authors: L
authors: Ghio
authors: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy.
authors: Mario
authors: M
authors: Amore
mesh_terms: D001364:Awareness; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology*; D006801:Humans; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology
keywords: Awareness of illness; Demoralization; Depression; Insight; Schizophrenia; Stigma