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

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

1 ENS-PSL - École normale supérieure - Paris
2 Fondation FondaMental [Créteil]
3 FMTS - Fédération de Médecine Translationnelle de Strasbourg
4 LPN - Laboratoire de Psychopathologie et Neuropsychologie
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
6 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
7 Service de psychiatrie
8 UNISTRA - Université de Strasbourg
9 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
10 AMU - Aix Marseille Université
11 APHM - Assistance Publique - Hôpitaux de Marseille
12 HUSLS-LRB-FW - Département de Psychiatrie et de Médecine Addictologique [AP-HP HU Saint-Louis, Lariboisière, Fernand Widal]
13 Pôle de Psychiatrie
14 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
15 LSCP - Laboratoire de sciences cognitives et psycholinguistique

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; suicide; insight; quality of life; depression; structural equation modeling

Domains: Life Sciences [q-bio]; Human health and pathology; Psychiatrics and mental health

Mickael Ehrminger, Mathieu Urbach, Christine Passerieux, Bruno Aouizerate, Fabrice Berna, et al.. Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort. Journal of Clinical Medicine, 2019, 8 (8), pp.1196. ⟨10.3390/jcm8081196⟩. ⟨hal-02473655⟩