Can the ‘mediation’ approach help to understand the role of lack of insight in the relationship between symptoms and functioning in schizophrenia?

Abstract

Introduction

The relationship between Lack of insight (LoI) and other symptoms in schizophrenia is complex. LoI could be associated with severity of symptoms at one side and global functioning at the other. For this nature LoI is a candidate ‘mediator’ for the relationship between psychotic symptoms and global functioning.

Objectives

The aim of this study is to explore the possible role of LoI as a mediator between psychotic symptoms and global functioning in a sample of people with schizophrenia.

Methods

Seventy-three patients with a diagnosis of schizophrenia were included. The five-factor model of the PANSS by Wall work was used to assess psychopathology and G12 item as an estimate of LoI. Global assessment of functioning (GAF) was used to measure global disability. Pearson's r correlations and linear regressions for Sobel test for mediation were performed. PANSS factors were modeled as predictors of global functioning and LoI as the mediator.

Results

Correlations revealed the prerequisite relationships between LoI, positive, negative and disorganized PANSS factors and global functioning. Mediation analyses show that LoI partially mediates the relationship between positive and disorganized factor scores and global functioning. No mediation for negative factor score was observed.

Conclusions

Lack of insight mediates the relationships between positive and disorganized factors and global functioning. The partial mediation we report suggests that LoI on the one hand is an independent contributor to global function, but further shows an indirect effect of PANSS positive and disorganized factors to GAF total score.

Disclosure of interest

The authors have not supplied their declaration of competing interest.