BACKGROUND: There is evidence of a positive association between insight and depression among patients with schizophrenia. Self-stigma was shown to play a mediating role in this association. We attempted to broaden this concept by investigating insight as a potential moderator of the association between depressive symptoms amongst people with schizophrenia and stigmatizing views towards people with mental disorders in their close social environment. METHOD: In the initial sample of 120 pairs, data were gathered from 96 patients with a diagnosis of "paranoid schizophrenia" and 96 of their nearest relatives (80% response rate). In this cross-sectional study data were collected by clinical interview using the following questionnaires: "The Scale to Assess Unawareness of Mental Disorder," "Calgary Depression Scale for Schizophrenia," and "Brief Psychiatric Rating Scale." The stigmatizing views of patients' nearest relatives towards people with mental disorders were assessed with the "Mental Health in Public Conscience" scale. RESULTS: Among patients with schizophrenia depressive symptom severity was positively associated with the intensity of nearest relatives' stigmatizing beliefs ("Nonbiological vision of mental illness," τ = 0.24; P < .001). The association was moderated by the level of patients' awareness of presence of mental disorder while controlling for age, sex, duration of illness and psychopathological symptoms. CONCLUSIONS: The results support the hypothesis that the positive association between patients' depression and their nearest relatives' stigmatizing views is moderated by patients' insight. Directions for further research and practical implications are discussed.

Department of Human Perception Cognition and Action Max Planck Institute for Biological Cybernetics Tübingen Germany

Department of Social Psychiatry National Institute of Mental Health Klecany Czech Republic; Institute of Psychiatry Psychology and Neuroscience King's College London London UK; Department of Psychiatry and Narcology Belarusian Medical Academy of Postgraduate Education Minsk Belarus;

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Amador X. Insight and Psychosis : Awareness of Illness in Schizophrenia and Related Disorders. Oxford, NY: Oxford University Press, USA; 2004.

Mintz AR, Dobson KS, Romney DM. Insight in schizophrenia: a meta-analysis. Schizophr Res. 2003;61:75–88. PubMed

Lincoln TM, Lüllmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull. 2007;33:1324–1342. PubMed PMC

Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull. 2007;33:192–199. PubMed PMC

Johnson S, Sathyaseelan M, Charles H, Jeyaseelan V, Jacob KS. Insight, psychopathology, explanatory models and outcome of schizophrenia in India: a prospective 5-year cohort study. BMC Psychiatry. 2012;12:159. PubMed PMC

Kako Y, Ito K, Hashimoto N, et al. The relationship between insight and subjective experience in schizophrenia. Neuropsychiatr Dis Treat. 2014;10:1415–1422. PubMed PMC

Barrett EA, Sundet K, Faerden A, et al. Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis. Schizophr Res. 2010;123:257–262. PubMed

Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009;35:336–346. PubMed PMC

Cooke M, Peters E, Fannon D, et al. Insight, distress and coping styles in schizophrenia. Schizophr Res. 2007;94:12–22. PubMed PMC

López-Moríñigo JD, Ramos-Ríos R, David AS, Dutta R. Insight in schizophrenia and risk of suicide: a systematic update. Compr Psychiatry. 2012;53:313–322. PubMed

Belvederi Murri M, Respino M, Innamorati M, et al. Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis. Schizophr Res. 2015;162:234–247. PubMed

Misdrahi D, Denard S, Swendsen J, Jaussent I, Courtet P. Depression in schizophrenia: the influence of the different dimensions of insight. Psychiatry Res. 2014;216:12–16. PubMed

Kao YC, Liu YP. Suicidal behavior and insight into illness among patients with schizophrenia spectrum disorders. Psychiatr Q. 2011;82:207–220. PubMed

Barrett EA, Mork E, Færden A, et al. The development of insight and its relationship with suicidality over one year follow-up in patients with first episode psychosis. Schizophr Res. 2015;162:97–102. PubMed

Pješčić KD, Nenadović MM, Jašović-Gašić M, Trajković G, Kostić M, Ristić-Dimitrijević R. Influence of psycho-social factors on the emergence of depression and suicidal risk in patients with schizophrenia. Psychiatr Danub. 2014;26:226–230. PubMed

Staring AB, Van der Gaag M, Van den Berge M, Duivenvoorden HJ, Mulder CL. Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr Res. 2009;115:363–369. PubMed

Cavelti M, Kvrgic S, Beck EM, Rüsch N, Vauth R. Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Compr Psychiatry. 2012;53:468–479. PubMed

McGlashan TH, Carpenter WT., Jr Postpsychotic depression in schizophrenia. Arch Gen Psychiatry. 1976;33:231–239. PubMed

Kaiser SL, Snyder JA, Corcoran R, Drake RJ. The relationships among insight, social support, and depression in psychosis. J Nerv Ment Dis. 2006;194:905–908. PubMed

Lysaker PH, Vohs J, Hasson-Ohayon I, Kukla M, Wierwille J, Dimaggio G. Depression and insight in schizophrenia: comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles. Schizophr Res. 2013;148:18–23. PubMed

Valiente C, Provencio M, Espinosa R, Duque A, Everts F. Insight in paranoia: the role of experiential avoidance and internalized stigma. Schizophr Res. 2015;164:214–220. PubMed

Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005;187:9–20. doi:10.1192/bjp.187.1.9. PubMed

Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205–228. PubMed

Pompili M, Amador XF, Girardi P, et al. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry. 2007;6:10. PubMed PMC

Pompili M, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R. Suicide and awareness of illness in schizophrenia: an overview. Bull Menninger Clin. 2004;68:297–318. PubMed

Bourgeois M, Swendsen J, Young F, et al. Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial. Am J Psychiatry. 2004;161:1494–1496. PubMed

Lysaker PH, Clements CA, Plascak-Hallberg CD, Knipscheer SJ, Wright DE. Insight and personal narratives of illness in schizophrenia. Psychiatry. 2002;65:197–206. PubMed

Rüsch N, Zlati A, Black G, Thornicroft G. Does the stigma of mental illness contribute to suicidality? Br J Psychiatry. 2014;205:257–259. PubMed

Farrelly S, Jeffery D, Rüsch N, Williams P, Thornicroft G, Clement S. The link between mental health-related discrimination and suicidality: service user perspectives. Psychol Med. 2015;45:1–10. PubMed

Oexle N, Ajdacic-Gross V, Kilian R, et al. Mental illness stigma, secrecy and suicidal ideation [published online ahead of print November 26, 2015]. Epidemiol Psychiatr Sci. doi:10.1017/S2045796015001018 PubMed PMC

Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry. 1997;154:199–204. PubMed

Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–879. PubMed

Subotnik KL, Nuechterlein KH, Irzhevsky V, Kitchen CM, Woo SM, Mintz J. Is unawareness of psychotic disorder a neurocognitive or psychological defensiveness problem? Schizophr Res. 2005;75:147–157. PubMed

Irzhevsky VP, Thostov AS. MMA. Svjaz narushenija osoznanija psihicheskoy bolezni i kharacteristik emocionalno-volevoy sfery u pacientov s shizophreniey [Relationship between unawareness of illness and emotional-volitional domain in schizophrenia patients]. Uchenye Zap Univ Im PF Lesgafta. 2009;1:47–52.

Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res. 1990;3:247–251. PubMed

Addington D, Addington J, Maticka-Tyndale E, Joyce J. Reliability and validity of a depression rating scale for schizophrenics. Schizophr Res. 1992;6:201–208. PubMed

Addington D, Addington J, Atkinson M. A psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Schizophr Res. 1996;19:205–212. PubMed

Kim SW, Kim SJ, Yoon BH, et al. Diagnostic validity of assessment scales for depression in patients with schizophrenia. Psychiatry Res. 2006;144:57–63. PubMed

Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10:799–812.

Mosolov SN, Potapov AV, Ushakov YV, et al. Standartizirovannye cliniko-funkcionalnye kriterii terapevticheskoy remissii pri shizofrenii: razrabotka i validizacija [Standardized clinical and functional criteria for therapeutic remission in schizophrenia: development and validation]. P.B.Gannushkin Journal of Psychiatry and Psychopharmacotherapy. 2012;14:9–19.

Rakus A, Stanislav D, Sirota LA, Vanin AE, Gor’kov VA. [Mathematical aspects of clinico-pharmacokinetic prediction of the effectiveness of treatment]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1984;84:406–410. PubMed

Serebriyskaja L, Enikolopov SJV. Stigmatizacija psihicheski bolnyh [Stigmatisation of mentally ill]. Zhurnal Nevrol i psikhiatrii Im SS Korsakova. 2001;3:11–16.

Serebriyskaja L. Psihologicheskie faktory stigmatizacii psihicheski bolnyh [Psychological factors of stigmatization of mentally ill]. PhD thesis. Moscow, Russia: State Scientific Institution “The Mental Health Research Center”; 2005.

Serebriĭskaia L. Socialnye predstavlenija o psihicheski bolnyh v kontekste stigmatizacii [Social views on psychiatric patients and psychiatry in the context of stigmatization]. Zhurnal Nevrol i psikhiatrii Im SS Korsakova. 2005;3:47–54. PubMed

Semrau M, Evans-Lacko S, Koschorke M, Ashenafi L, Thornicroft G. Stigma and discrimination related to mental illness in low- and middle-income countries. Epidemiol Psychiatr Sci. 2015;24:382–394. PubMed PMC

Cavelti M, Rüsch N, Vauth R. Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. J Nerv Ment Dis. 2014;202:521–529. PubMed

Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatr Dis Treat. 2015;11:145–151. PubMed PMC

Glick ID, Stekoll AH, Hays S. The role of the family and improvement in treatment maintenance, adherence, and outcome for schizophrenia. J Clin Psychopharmacol. 2011;31:82–85. PubMed

McDonell MG, Short RA, Berry CM, Dyck DG. Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality. Fam Process. 2003;42:91–103. PubMed

Yanos PT, Roe D, Lysaker PH. Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother. 2011;61:577–595. PubMed PMC

Yanos PT, Roe D, West ML, Smith SM, Lysaker PH. Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychol Serv. 2012;9:248–258. PubMed PMC

Roe D, Hasson-Ohayon I, Mashiach-Eizenberg M, Derhy O, Lysaker PH, Yanos PT. Narrative enhancement and cognitive therapy (NECT) effectiveness: a quasi-experimental study. J Clin Psychol. 2014;70:303–312. PubMed PMC

Pijnenborg GHM, van Donkersgoed RJM, David AS, Aleman A. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr Res. 2013;144:109–117. PubMed

Experience of stigma in the public life of relatives of people diagnosed with schizophrenia in the Republic of Belarus