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

6. Amore M;Murri MB;Calcagno P;Rocca P;Rossi A;Aguglia E;Bellomo A;Blasi G;Carpiniello B;Cuomo A;dell'Osso L;di Giannantonio M;Giordano GM;Marchesi C;Monteleone P;Montemagni C;Oldani L;Pompili M;Roncone R;Rossi R;Siracusano A;Vita A;Zeppegno P;Corso A;Arzani C;Galderisi S;Maj M;Italian Network for Research on Psychoses;members of the Italian Network for Research on Psychoses involved in this study;Giulia Petrilli;Matteo Respino;Marco Papalino;Andrea Falsetti;Vita Maria Calia;Stefano Barlati;Giacomo Deste;Cesare Turrina;Federica Pinna;Alice Lai;Silvia Lostia di Santa Sofia;Maria Salvina Signorelli;Antonio Petralia;Mauro Pettorruso;Gaia Barone;Anatolia Salone;Giuseppe Piegari;Carmen Aiello;Francesco Brando;Luigi Giuliani;Mario Altamura;Raffaella Carnevale;Flavia Padalino;Laura Giusti;Anna Salza;Donatella Ussorio;Giulia Pizziconi;Valeria Santarelli;Francesca Pacitti;Andrea de Bartolomeis;Eleonora Gambaro;Eleonora Gattoni;Carla Gramaglia;Chiara De Panfilis;Paolo Ossola;Matteo Tonna;Claudia Carmassi;Barbara Carpita;Ivan Cremone;Anna Comparelli;Valentina Corigliano;Roberto Brugnoli;Giulio Corrivetti;Giammarco Cascino;Gianfranco Del Buono;Andrea Fagiolini;Simone Bolognesi;Arianna Goracci;Giorgio Di Lorenzo;Cinzia Niolu;Michele Ribolsi;Silvio Bellino;Paola Bozzatello;Claudio Brasso.

2020-01-01

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Abstract

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.