Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia.

BACKGROUND: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship. METHODS: We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness). RESULTS: Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem. CONCLUSIONS: The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life.

Differential associations between insight and quality-of-life dimensions among individuals with schizophrenia.

PURPOSE/OBJECTIVE: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach. RESEARCH METHOD/DESIGN: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem). RESULTS: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience. CONCLUSION/IMPLICATIONS: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).