Title:
A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia.

Abstract:
Suicide is the major cause of premature death among individuals with schizophrenia. Ironically, one factor that heightens suicide risk is insight into mental illness. Little is known, however, about how insight contributes to suicidality. Recent evidence suggests that negative outcomes related to insight might depend on whether or not the individual accepts the stigmatizing beliefs about the mental illness.
The present study examined the interactive effects of insight and internalized stigma on suicide risk in individuals with schizophrenia. We hypothesized that insight into mental illness and internalized stigma would increase suicide risk and that internalized stigma would moderate the effect of insight on suicide risk.
A cross-sectional design was used in this study. A convenience sample of 200 individuals with schizophrenia was recruited from an outpatient clinic in the Eastern catchment area in Alexandria, Egypt.
Eligible study participants were individuals with an illness duration not exceeding ten years, currently in outpatient treatment and follow-up, and post-acute or in a stable phase of their disorder. Individuals provided signed consent to participate and were interviewed to assess suicide risk, insight, internalized stigma of mental illness and depression.
Slightly more than 38% of the study participants were classified as having a severe suicide risk. As predicted, suicide risk was positively associated with insight (r=.55, p<.001), internalized stigma (r=.79, p<.001), and depression (r=.78, p<.001). However, the influence of insight was not significant after controlling for covariates in the regression model (β=-.02, ns). Internalized stigma and depression independently predicted suicide risk, explaining 74% of variance in suicide risk, F(change) (6, 191)=11.54, p<.001. Greater insight was significantly linked to increased levels of internalized stigma (r=.59, p<.001) and depression (r=.61, p<.001). Internalized stigma did not moderate the influence of insight on suicide risk.
The present study draws attention to the robust influence of internalized stigma in increasing suicide risk and suggests clinical approaches for managing internalized stigma and suicide risk among individuals with schizophrenia.