Mediation Analyses of Insight, Quality of Life, Depression, and Suicidality

Paul Roux (1) , David Misdrahi (2) , Delphine Capdevielle (3) , Bruno Aouizerate (4) , Fabrice Berna (5) , Lore Brunel (2) , Isabelle Chéreau (6) , Jean-Michel Dorey (7) , Caroline Dubertret (2) , Julien Dubreucq (8) , Catherine Faget-Agius (9) , Sandrine Fonteneau , Franck Gabayet (2) , Pierre Llorca (10) , Jasmina Mallet (2) , Romain Rey (2) , Raphaëlle Richieri (11) , Aurélie Schandrin (12) , Franck Schürhoff (13) , Arnaud Tessier (14) , Pierre Vidailhet (2) , Christine Passerieux (15) , Mathieu Urbach (2)

1 HANDIReSP - Laboratoire de recherches cliniques et en santé publique sur les handicaps psychique, cognitif et moteur
2 Fondation FondaMental [Créteil]
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
4 Centre hospitalier Charles Perrens [Bordeaux]
5 FMTS - Fédération de Médecine Translationnelle de Strasbourg
6 Service de psychiatrie
7 Psychiatrie
8 UGA UFRM - Université Grenoble Alpes - UFR Médecine
9 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
10 NPsy-Sydo - Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux
11 Laboratoire de santé publique évaluation des systèmes de soins et santé perçue
12 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
13 IMRB - Institut Mondor de Recherche Biomédicale
14 UP1 UFR09 - Université Paris 1 Panthéon-Sorbonne - École d'histoire de la Sorbonne
15 Neuropsychologie Cognitive et Prise en Charge des Troubles de la Communication Schizophreniques

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-IVcriteria 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 ( (chi32 =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.

Domaines: Neurosciences; Neurobiologie; Psychologie et comportements; Sciences cognitives

Paul Roux, David Misdrahi, Delphine Capdevielle, Bruno Aouizerate, Fabrice Berna, et al.. Mediation Analyses of Insight, Quality of Life, Depression, and Suicidality. Journal of Clinical Psychiatry, 2018, 79 (3), ⟨10.4088/JCP.17m11638⟩. ⟨hal-01814767⟩