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Keywords:

  • depression;
  • longitudinal studies;
  • schizophrenia;
  • suicide

Objective:  To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide.

Method:  We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts.

Results:  Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years.

Conclusion:  Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.