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J Clin Psychiatry. 2018 May/Jun;79(3). pii: 17m11638. doi: 10.4088/JCP.17m11638.

Mediation Analyses of Insight, Quality of Life, Depression, and Suicidality: Results From the FACE-SZ Cohort.

Author information

1
Department of Adult Psychiatry, Versailles Hospital, 177 rue de Versailles, 78157 Le Chesnay, France. paul.roux@uvsq.fr.
2
FondaMental Foundation, Créteil, France.
3
Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France.
4
HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.
5
Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France; University of Bordeaux, France.
6
CNRS UMR 5287-INCIA, France.
7
Academic Department of Adult Psychiatry, La Colombière Hospital, CHRU Montpellier, University of Montpellier 1, INSERM 1061, Montpellier, France.
8
NutriNeuro, UMR INRA 1286, University of de Bordeaux, Bordeaux, France.
9
Strasbourg University Hospital, Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France.
10
INSERM U955, Translational Psychiatry team, Créteil, France, Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Department of Adult Psychiatry, University Hospitals H Mondor, Créteil, France.
11
CMP B, Clermont-Ferrand University Hospital, EA 7280, Faculty of Medicine, Auvergne University, Clermont-Ferrand, France.
12
University Claude Bernard Lyon 1, Le Vinatier Hospital, Pole Est BRON, France.
13
AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, INSERM U894, Faculty of Medicine, Paris Diderot University of Sorbonne Paris Cité, Paris, France.
14
Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France.
15
Academic Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France.
16
Department of Psychiatry, Nimes University Hospital, Nimes, France.

Abstract

OBJECTIVE:

The relationship between greater insight and increased risk of suicide in patients with schizophrenia is debated. The purpose of this study was to assess whether quality of life (QoL) and depression mediated the association between insight and suicidality.

METHODS:

Between March 2010 and December 2015, 527 community-dwelling adults with stable schizophrenia according to DSM-IV criteria were included in a multicenter cross-sectional study, the FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ) Study. Structural equation modeling was used for mediation analyses among insight, QoL, depression, and suicidality, controlling for the global level of schizophrenic symptoms.

RESULTS:

The model provided a good fit for the data (χ²₃ = 1.4, P = .708, Tucker-Lewis index = 1, comparative fit index = 1, root mean square error of approximation = 0, standardized root mean square residual = 0.008) and explained 27% of the variance in suicidality. Poorer QoL and greater severity of depression mediated 68.4% of the positive association between insight and suicidality (full mediation). Poorer QoL mediated 48% of the positive effect of insight on depression (partial mediation). The severity of depression mediated 91.2% of the negative relationship between QoL and suicidality (full mediation).

CONCLUSIONS:

Insight appears to be an indirect risk factor for suicide in patients with schizophrenia, with the link being mediated by poorer QoL and worse underlying depression, mainly by a sequential pathway but also by a less important parallel pathway.

PMID:
29701937
DOI:
10.4088/JCP.17m11638
[Indexed for MEDLINE]

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