Javier-David Lopez-Morinigo1, Olesja Ajnakina1, Benjamin DR Wiffen1, Kevin Morgan2, Gillian A Doody3, Peter B Jones4, Robin M Murray1,5, Paola Dazzan1,5, Craig Morgan5,6, Rina Dutta7, Anthony S David1,5; 1Institute of Psychiatry, Psychology and Neuroscience. King's College London. (London, UK), 2Department of Psychology, University of Westminster. (London, UK), 3Division of Psychiatry. University of Nottingham. (Nottingham, UK), 4Department of Psychiatry, University of Cambridge. (Cambridge, UK), 5National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. (London, UK), 6King’s College London. Institute of Psychiatry, Psychology and Neuroscience. Department of Psychological Medicine (London, UK), 7Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK
Background: The role of insight dimensions – illness recognition (IR), symptoms relabelling (SR), treatment compliance (TC) - in suicide risk in first-episode psychosis (FEP) remains unclear. Methods: The AESOP (n=181) and GAP (n=112) FEP cohorts were followed-up over 10- and 5 years. Survival analysis modelled time to first suicidal event in relation to baseline insight levels (Schedule for Assessment of Insight), whilst adjusting for demographic, clinical, psychopathological and neuropsychological variables. Results: AESOP: those with previous suicide attempts scored higher on IR (7.6±1.9 vs. 5.9±3.0, p<0.01) and total insight (TI) (17.2±5.0 vs. 13.4±6.7, p=0.03). IR (r=0.23, p<0.01), SR (r=0.18, p=0.04) and TC (r=02.6, p<0.01) correlated with depression. Univariable analyses: IR (HR=1.14, 95%CI 0.98-1.34, p=0.09), TC (HR=1.30, 95%CI 0.99-1.71, p=0.06) and TI (HR=1.06, 95%CI 0.99-1.13, p=0.08) were linked with suicidal behaviour. Multivariable regression models: depression (HR=1.55, 95%CI 1.22-1.97, p<0.01) predicted suicidal behaviour. GAP: SR (6.4±3.1 vs. 4.5±3.4, p=0.03) and TI (16.8±6.4 vs. 12.8±7.4, p=0.03) were higher in those with suicidal antecedents. IR (r=0.32, p<0.01) and SR (r=0.27, p=0.01) correlated with depression. Univariable analyses: TC (HR=1.36, 95%CI 1.01-1.83, p=0.04) and TI (HR=1.06, 95%CI 0.99-1.14, p=0.08) were associated with suicidal behaviour. Multivariable regression models: previous suicide attempts (HR 5.17, 95%CI 1.32-20.29, p=0.02) and depression (HR 1.16, 95%CI 1.00-1.35, p=0.04) predicted suicidal behaviour. Conclusions: Suicide attempts prior to FEP and depression at that point, both of which were associated with baseline insight levels and risk of suicidal behaviour over the follow-up, appear to explain the apparent relationship between insight and suicidality in FEP.
