Bouvet C, Bouchoux A
Laboratoire CLIPSYD (EA 4430), UFR SPSE, université Paris-ouest, 200, avenue de la République, 92001 Nanterre cedex, France.
EA 4430, UFR SPSE, université Paris-ouest, 200, avenue de la République, 92001 Nanterre cedex, France.
Encephale. 2015 Oct;41(5):435-43. doi: 10.1016/j.encep.2014.07.006. Epub 2014 Sep 17.
Recent studies on insight in people with schizophrenia showed that insight level is linked with treatment compliance. Therefore, many therapies are aimed at increasing the insight level, such as psycho-education. However, insight level is also probably linked with depression level. So, improving insight is at risk of increasing the level of depression. Nevertheless, results on this topic are not consensual in the scientific literature. Presumably, this could be due to the concept of insight itself, although we could hypothesise that some confounding variables are implied in the interaction between insight and depression, such as internalized stigma.
to test the hypothesis that the relationship between insight and depression is mediated by internalized stigma in people with schizophrenia.
Sixty-two patients with schizophrenia (DSM-IV or ICD-10) recruited in mental health services in Île de France (75% male), aged 20 to 64 years (m=38.71, σ=0. 43), filled in questionnaires assessing internalized stigma (ISMI), depression (CDSS and BDI) and insight (SAIQ, Q8, IS), after giving their written informed consent. Correlations between insight, depression and different variables were made (Hypothesis 1). Then we ran multiple regressions and partial correlations to test the internalized stigma mediation (Hypothesis 2).
Insight, internalized stigma and depression are statistically significantly correlated with each scales used (except Q8). Insight is correlated with depressed mood (correlations between IS and CDSS: r=0.27, P=0.04, and BDI, r=0.40, P=0.001). We also found negative correlations between SAIQ and CDSS (r=-0.35, P=0.005) and the BDI (r=-0.4265, P=0.000) which means that good insight is linked with depression. This result validates our hypothesis 1. The statistic tests reveal other complementary results: the association between insight and depression is mediated by the level of internalized stigma: when ISMI is controlled, the correlation between insight and depression decreased moderately with CDSS and with small intensity with SAIQ, but clearly. So, ISMI is probably a mediating variable between IS and BDI-CDSS. In conclusion, internalized stigma could be a mediating variable between insight and depression. This validates our second hypothesis.
Our results suggest that the relationship between insight and depression is mediated by internalized stigma. Patients with good insight who internalize stigma seem to be more depressed than those who don't. This result could have important consequences in clinical practice: improving insight level should be completed by a specific attention to the level and evolution of internalized stigma to avoid increasing depression. Further studies need to be conducted to confirm these results.
近期关于精神分裂症患者自知力的研究表明，自知力水平与治疗依从性相关。因此，许多治疗方法旨在提高自知力水平，如心理教育。然而，自知力水平可能也与抑郁程度有关。所以，提高自知力有增加抑郁水平的风险。尽管如此，该主题的研究结果在科学文献中并不一致。据推测，这可能是由于自知力本身的概念，尽管我们可以假设在自知力与抑郁的相互作用中存在一些混杂变量，如内化耻辱感。
检验精神分裂症患者中自知力与抑郁之间的关系由内化耻辱感介导这一假设。
在法兰西岛的心理健康服务机构招募了62例精神分裂症患者（符合DSM-IV或ICD-10标准）（75%为男性），年龄在20至64岁之间（m = 38.71，σ = 0.43），在获得他们的书面知情同意后，填写评估内化耻辱感（ISMI）、抑郁（CDSS和BDI）和自知力（SAIQ、Q8、IS）的问卷。对自知力、抑郁和不同变量之间进行相关性分析（假设1）。然后我们进行多元回归和偏相关性分析以检验内化耻辱感的中介作用（假设2）。
自知力、内化耻辱感和抑郁与所使用的每个量表均有统计学显著相关性（Q8除外）。自知力与抑郁情绪相关（IS与CDSS之间的相关性：r = 0.27，P = 0.04；与BDI之间的相关性：r = 0.40，P = 0.001）。我们还发现SAIQ与CDSS（r = -0.35，P = 0.005）和BDI（r = -0.4265，P = 0.000）之间存在负相关，这意味着良好的自知力与抑郁有关。这一结果验证了我们的假设1。统计检验还揭示了其他补充结果：自知力与抑郁之间的关联由内化耻辱感水平介导：当控制ISMI时，自知力与抑郁之间的相关性在与CDSS相关时适度降低，与SAIQ相关时降低幅度较小但明显。所以，ISMI可能是IS与BDI - CDSS之间的中介变量。总之，内化耻辱感可能是自知力与抑郁之间的中介变量。这验证了我们的第二个假设。
我们的结果表明，自知力与抑郁之间的关系由内化耻辱感介导。内化耻辱感良好的自知力患者似乎比未内化耻辱感的患者更抑郁。这一结果在临床实践中可能具有重要意义：提高自知力水平时应特别关注内化耻辱感的程度和演变，以避免增加抑郁。需要进一步研究来证实这些结果。
