Insight and suicidality in first-episode psychosis: The mediating role of depression.

Understanding the relationship between insight, depression, and suicidality in first-episode psychosis (FEP) is crucial for improving clinical outcomes and preventing suicide during early treatment stages. This longitudinal cohort study examined 264 participants enrolled in coordinated specialty care (CSC) services for FEP to investigate how insight and depression at admission impact suicidality at 6 and 12 months, assess the mediating role of depression at admission between insight and suicidality, and evaluate the persistence of depression over time. Regression analyses assessed the relationships among these variables, while mediation analyses explored the mediating effect of depression at admission. Significant predictors of suicidality at 6 months were insight (OR 0.71, 95 % CI: 0.53-0.94), depression (OR 5.40, 95 % CI: 2.45-12.61), and previous suicide attempts (OR 2.91, 95 % CI: 1.21-7.00). At 12 months, insight (OR 0.70, 95 % CI: 0.52-0.92) and depression (OR 2.82, 95 % CI: 1.26-6.50) remained significant. Depression at admission mediated 27.32 % of the effect of insight on suicidality at 6 months and 19.76 % at 12 months. Despite a general decrease in depression, a subset of participants remained persistently depressed. The study highlights the significant mediating role of depression at admission in the relationship between insight and suicidality, identifying it as the strongest predictor of suicidality. Early detection and treatment of depression in FEP should be prioritized, and further research should focus on targeted interventions within CSC.