Awareness of mental illness and personality dimensions: Predictors of attempts of suicide?

Background: Suicide has been shown to represent the major single cause of premature death among patients with schizophrenia spectrum disorders. Insight has been proposed to increase such risk. However, this subject has not been sufficiently investigated and inconclusive results have been reported.

Objective: Investigate the relationship between insight, personality variables and suicide attempts in patients along one year after their first psychotic episode.

Method: 65 patients in their first episode of functional psychosis were included in this study. Demographical and clinical data, information on the insight with the Schedule for Assessment of Insight and personality traits were studied using Personality Assessment Schedule. The data were collected at the baseline. At 6 and 12 months data about suicide attempts were assessed.

Results: “Unawareness of mental illness” (P=0.05) and passive-depend (P=0.04) predicted attempts of suicide in the first six months. At twelve months the predictors were “unawareness of the need for treatment” (P=0.03), “awareness of the social consequences of the illness” (P=0.01) and severity of symptoms (P=0.00).

Conclusions: The influence of insight in suicide attempts is not the same throughout the first year of the illness. Specifically, at 6 months “unawareness of mental illness” and passive-dependent personality dimension predicted suicide, while at one year “unawareness of the need for treatment”, “awareness of the social consequences of the illness” and severity of symptoms predicted it. These results have important implications for the treatment.