Most clinicians believe that poor insight in patients with schizophrenia, though problematic for treatment adherence, may be protective with respect to suicide. The assumption is that patients who do not believe that they are ill are less likely to be suicidal.

Summary by Dr. Xavier Amador  

American Journal of Psychiatry
1996 (153):9, 1185-1188 

Suicidal Behavior in Schizophrenia and Its Relationship to Awareness of Illness
Amador XF; Friedman JH; Kasapis C; Yale SA; Flaum M & Gorman JM.

RELEVANCE FOR EARLY INTERVENTION

Most clinicians believe that poor insight in patients with schizophrenia, though problematic for treatment adherence, may be protective with respect to suicide. The assumption is that patients who do not believe that they are ill are less likely to be suicidal. Alternatively, those patients with schizophrenia who recognize and acknowledge the illness will be more suicidal.

This study found that only awareness of particular symptoms was correlated to increased suicidal thoughts and behavior. Contrary to clinical lore, awareness of having an illness was not associated with increased suicidal thoughts or behavior. Patients who have poor insight into having an illness and are not taking their prescribed medication are just as likely to become suicidal as any other person with schizophrenia.

Estimates are that as many as one out of every ten persons with this illness will kill themselves. This study suggests that poor insight into having an illness is not a protective factor as previously believed and argue against the strategy of leaving such patients who refuse treatment to fend for themselves.