Self‐Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach

Lien, Yin Ju; Chang, Hsin‐An; Kao, Yu Chen; Tzeng, Nian Sheng; Yeh, Chin Bin; Loh, Ching‐Hui

doi:10.1111/sltb.12384

Cited by 21 publications

(13 citation statements)

References 73 publications

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“…No global figure on SP was previously reported; therefore, direction comparisons were not made. It is noteworthy that different demographic characteristics, illness stage, comorbidities, and treatments were associated with the epidemiology of suicidality including SI and SP [ 16 , 47 , 48 ]; therefore, direct comparisons of the findings between this meta-analysis and other studies should be made with caution.…”

Section: Discussionmentioning

confidence: 99%

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

et al. 2021

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Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2−40.9%), and 29.9% (95% CI: 24.2−35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.

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Section: Discussionmentioning

confidence: 99%

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

et al. 2021

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“…The degree of identification with one's illness (i.e., patient role) becomes particularly problematic in the presence of stigma, either endorsed by patients [63,64] or by their relatives [65]. These dynamics may pave the way to demoralization [66,67], hopelessness and suicidal ideation [4,68,69], unless individuals are helped to come to terms with, and make sense of their illness. To this end, a person-centered approach, focused on the development of metacognitive abilities and relying on a narrative approach has yielded promising results for the improvement of insight without lowering self-esteem [36,70].…”

Section: Discussionmentioning

confidence: 99%

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

et al. 2020

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Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.

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“…Metacognition impairments have been explored in individuals with schizophrenia in a large set of processes including reasoning and memory biases ( 5 ), beliefs ( 6 ), autobiographical memory ( 7 ), or insight into illness ( 8 ), to name but a few. This latter metacognitive ability, also named clinical insight ( 8 ), has been particularly studied in schizophrenia mainly because poor awareness into illness is highly prevalent in this population ( 9 ), leading to poor prognosis, and in association with self-stigma to higher risk of suicide ( 10 ) and depression ( 11 ). In this study we will focus on metacognitive awareness of cognitive functioning corresponding to the adequacy between the subjective report of cognitive functioning and objective cognitive performances.…”

Section: Introductionmentioning

confidence: 99%

Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

et al. 2020

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Conclusion: A significant proportion of patients with schizophrenia can accurately estimate their cognitive skills. Self-awareness of cognitive deficits in individuals with schizophrenia is an heterogenous phenomenon and misestimation of cognitive functioning might have been overestimated, partly due to secondary psychoaffective factors. Caution is warranted before jumping to the conclusion that all individuals with schizophrenia misjudge their cognitive functioning.

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Self‐Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach

Cited by 21 publications

References 73 publications

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

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