Insight and Suicidality in First Episode Psychosis: The Mediating Role of Depression

Understanding the relationship between insight, depression, and suicidality in first-episode psychosis (FEP) is crucial for improving clinical outcomes and preventing suicide during early treatment stages. This longitudinal cohort study examined 264 participants enrolled in coordinated specialty care (CSC) services for FEP to investigate how insight and depression at admission impact suicidality at 6 and 12 months, assess depression's mediating role between insight and suicidality, and evaluate the persistence of depression over time. Regression analyses assessed the relationships among these variables, while mediation analyses explored depression's mediating effect. Significant predictors of suicidality at 6 months included insight (OR 0.71, 95% CI: 0.53 - 0.94), depression (OR 5.40, 95% CI: 2.45 - 12.61), and previous suicide attempts (OR 2.91, 95% CI: 1.21 - 7.00). At 12 months, insight (OR 0.70, 95% CI: 0.52 - 0.92) and depression (OR 2.82, 95% CI: 1.26 - 6.50) remained significant. Depression mediated 27.32% of the effect of insight on suicidality at 6 months and 19.76% at 12 months. Despite a general decrease in depressive symptoms, a subset of participants remained persistently depressed. The study highlights the significant mediating role of depression in the relationship between insight and suicidality, with depression emerging as the strongest predictor of suicidality. Early detection and treatment of depression in FEP should be prioritized, and further research should focus on targeted interventions within CSC.