Abstract

Poor insight into one's own psychiatric disorder is quite common in serious mental illnesses and is associated with a number of indicators of poor outcome. In contrast, awareness of having a mental disorder, of its symptoms, of its consequences, and/or of the need for treatment is associated with a number of positive prognostic indicators. Insight is also linked, however, to depression and suicidal ideation in schizophrenia and schizoaffective disorder. While insight has been associated with a lifetime history of suicide attempts in a mixed sample of patients with schizophrenic and schizoaffective, no published study has examined these diagnostic groups separately, or assessed the relationship between insight and suicidality in depressed and bipolar patients. These were the aims of the current investigation. Participants with schizophrenia, bipolar disorder, major depression, and schizoaffective disorder were interviewed at baseline and at 6-month follow-up. Higher levels of depression were associated with insight for all diagnostic groups. Participants with greater insight were more likely to have made a lifetime suicide attempt, a greater number of attempts, and an attempt in the year prior to the baseline interview and over the 6-month follow-up. Retrospective and prospective measures of suicidality (i.e., suicidal ideation and behaviors) were significantly related to insight. These findings suggest that having intact or good insight may be an indicator for negative mood and suicidal ideation among individuals with serious mental illness. Treatment implications are discussed.