Insight in schizophrenia: a meta-analysis

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Abstract

There has been an increase in the study of insight in schizophrenia in the last 20 years. Insight is operationally defined according to five dimensions which include: the patient’s awareness of mental disorder, awareness of the social consequences of disorder, awareness of the need for treatment, awareness of symptoms and attribution of symptoms to disorder. Despite the development of psychometrically sound measurement tools, the results from previous studies have been inconclusive regarding the nature of the relationship between insight and symptomatology. A meta-analysis of 40 published English-language studies was conducted to determine the magnitude and direction of the relationship, or effect size, between insight and symptom domains in schizophrenia and to determine moderator variables that were associated with the variations in effect sizes across studies. Results indicated that there was a small negative relationship between insight and global, positive and negative symptoms. There was also a small positive relationship between insight and depressive symptoms in schizophrenia. Acute patient status and mean age of onset of the disorder moderated the relationship between insight and symptom clusters. The possible reasons for the effect sizes being modest, the examination of the role of moderator variables and directions for future research are provided.

Section snippets

Method

Based on a preliminary review of the literature, it was apparent that insight was conceptualized in terms of several dimensions. However, three basic components—awareness of mental illness, awareness of the consequences of mental disorder and awareness of the effects of medication—were measured in most studies Birchwood et al., 1994, Debowska et al., 1998. In addition, awareness of individual symptoms and attribution of symptoms to mental disorder were also considered important dimensions of

Funnel plot analysis

Prior to examining the results of the meta-analysis, an analysis of possible publication bias was conducted, using the funnel plot (Taylor and Tweedie, 2000). For each symptom domain, the total effect size was plotted by the sample size for each study. These graphs resulted in funnel shaped scatter plots, with both tails of the funnels well-formed, suggesting that the nonsignificant results were not missed and no publication bias existed.

Description of studies included in the analysis

A total of 40 studies provided data for computing the

Discussion

The purpose of this study was to estimate the magnitude and direction of the relationships between insight and symptom domains in schizophrenia and also, to determine moderator variables that were influencing the relationships in published English studies. The results from this meta-analysis indicated that the relationships between insight and symptom domains in schizophrenia were significant, yet modest. To summarize, the results indicated that there was a negative correlation between insight

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