ArticleSchizophrenia bulletin2016
The "Insight Paradox" in Schizophrenia: Magnitude, Moderators and Mediators of the Association Between Insight and Depression.
Article in Schizophrenia bulletin, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Comorbid Major Depressive Disorder in Schizophrenia: A Systematic Review and Meta-Analysis.Schizophrenia bulletin · 2021Pooled it
- Poor Insight in Schizophrenia Patients in China: a Meta-Analysis of Observational Studies.The Psychiatric quarterly · 2020Pooled it
- Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial.BMC psychiatry · 2022Trial
- Changes in insight and outcome over the early course of first-episode psychosis. The OPTiMiSE trial.Schizophrenia research. Cognition · 2026Article
- The cost of high cognitive insight: chain mediation of stigma and dysfunctional sleep beliefs and attitudes in chronotype among patients with schizophrenia.Frontiers in psychiatry · 2026Article
- Clinical and cognitive insight in schizophrenia and their relationship with neurocognition and metacognition: a narrative review.Frontiers in psychiatry · 2026Review
- Insight Paradox in Patients With Schizophrenia: A Concept Analysis.International journal of mental health nursing · 2025Review
- The impact of socioeconomic factors on the incidence and characteristics of first-episode psychosis.Epidemiology and psychiatric sciences · 2025Article
- Suicidal acts and thoughts among persons with psychotic disorders in the Finnish SUPER study.European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
- How do psychedelics impact people with a history of non-affective psychosis? A qualitative study.Frontiers in psychiatry · 2025Article
- The Relationship Between Internalized Stigma with Self-reported Cognitive Dysfunction and Insight in Schizophrenia.Psychiatry and clinical psychopharmacology · 2024Article
- The Mediating Role of Anxiety/Depression Between Auditory Verbal Hallucinations and the Level of Insight in Schizophrenia.Psychiatry investigation · 2024Article
- The Relationship Between Suicidal Behavior, Neurocognitive Functions, and Insight in Patients with Schizophrenia.Psychiatry and clinical psychopharmacology · 2023Article
- Quality of life and its influencing factors in patients with schizophrenia.Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2023Article
- Associations Between Clinical Insight and History of Severe Violence in Patients With Psychosis.Schizophrenia bulletin open · 2023Article
- Rate and correlates of self-stigma in adult patients with early psychosis.Frontiers in psychiatry · 2023Article
- Cognitive insight and introspective accuracy in individuals with bipolar disorder: A scoping review.Neuroscience applied · 2023Review
- Subjective cognitive complaints in first episode psychosis: A focused follow-up on sex effect and alcohol usage.Schizophrenia research. Cognition · 2022Article
- Subjective Cognitive Complaints in Unaffected First-Degree Relatives of Schizophrenia Patients: Relation to Cognitive Performance, Psychotic Experiences, and Social Functioning.Indian journal of psychological medicine · 2022Article
- Associations between personal recovery and service user-rated versus clinician-rated clinical recovery, a cross-sectional study.BMC psychiatry · 2022Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The so-called "insight paradox" posits that among patients with schizophrenia higher levels of insight are associated with increased levels of depression. Although different studies examined this issue, only few took in account potential confounders or factors that could influence this association. In a sample of clinically stable patients with schizophrenia, insight and depression were evaluated using the Scale to assess Unawareness of Mental Disorder and the Calgary Depression Scale for Schizophrenia. Other rating scales were used to assess the severity of psychotic symptoms, extrapyramidal symptoms, hopelessness, internalized stigma, self-esteem, and service engagement. Regression models were used to estimate the magnitude of the association between insight and depression while accounting for the role of confounders. Putative psychological and sociodemographic factors that could act as mediators and moderators were examined using the PROCESS macro. By accounting for the role of confounding factors, the strength of the association between insight into symptoms and depression increased from 13% to 25% explained covariance. Patients with lower socioeconomic status (F = 8.5, P = .04), more severe illness (F = 4.8, P = .03) and lower levels of service engagement (F = 4.7, P = .03) displayed the strongest association between insight and depression. Lastly, hopelessness, internalized stigma and perceived discrimination acted as significant mediators. The relationship between insight and depression should be considered a well established phenomenon among patients with schizophrenia: it seems stronger than previously reported especially among patients with lower socioeconomic status, severe illness and poor engagement with services. These findings may have relevant implications for the promotion of insight among patients with schizophrenia.
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