Ehrminger Mickaël, Urbach Mathieu, Passerieux Christine, Aouizerate Bruno, Berna Fabrice, Bohec Anne-Lise, Capdevielle Delphine, Chereau Isabelle, Clauss Julie, Dubertret Caroline, Esselin Aurélie, Faget Catherine, Fond Guillaume, Honciuc Roxana Mihaela, Jarroir Marine, Mallet Jasmina, Misdrahi David, Pignon Baptiste, Rey Romain, Schürhoff Franck, Yazbek Hanan, Brunet-Gouet Eric, Roux Paul
Fondation Fondamental, 94000 Créteil, France.
HandiRESP Laboratory (EA4047) Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, 78180 Montigny-le-Bretonneux, France.
J Clin Med. 2019 Aug 10;8(8):1196. doi: 10.3390/jcm8081196.
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.
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.
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.
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.
高达一半的精神分裂症患者在其一生中曾试图自杀。洞察力的提高与功能改善相关，但也与自杀倾向增加有关。洞察力与自杀倾向之间关系的方向尚不清楚，因此我们旨在使用结构方程模型提供新的见解。
对精神分裂症谱系障碍患者在基线时和12个月时测量其洞察力、生活质量（QoL）、抑郁和自杀倾向。通过潜在差异分数模型研究这些变量之间的关系，并控制氯丙嗪剂量、阳性和阴性症状以及一般精神病理学。
纳入738例患者，370例完成研究。基线时的洞察力水平可预测自杀倾向的变化，而基线时的自杀倾向水平不能预测洞察力的变化，这表明更好的洞察力是自杀倾向的基础并预示其恶化。我们的结果表明了这种时间顺序：更好的洞察力→更差的生活质量→抑郁增加→自杀倾向增加，同时洞察力也并行影响这三个变量。
更好的洞察力预示着生活质量、抑郁和自杀倾向的恶化。这些发现有助于我们全面理解洞察力对自杀倾向的纵向影响。我们主张在没有监测抑郁和预防自杀的情况下，不应提出以洞察力为目标的干预措施。
