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The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia

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Abstract

Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables—namely cognitive insight, self-stigma, insight into treatment, and medication compliance—that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.

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Acknowledgements

The authors would like to express their sincere thanks to Prof. Ritsher, the original ISMI scale designers, for their permission to administer the ISMI scale in our study. We also thank all participants who kindly volunteered to take part in this study. This study was supported by Grants from the National Science Council, Taiwan (NSC 101-2314-B-003-002, 102-2410-H-003-016). This article was subsidized by the National Taiwan Normal University (NTNU), Taiwan, ROC. This manuscript was edited by Wallace Academic Editing.

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  1. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan

    Yin-Ju Lien

  2. Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan

    Hsin-An Chang & Nian-Sheng Tzeng

  3. Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan

    Hsin-An Chang, Yu-Chen Kao & Nian-Sheng Tzeng

  4. Department of Psychiatry, Tri-Service General Hospital Songshan Branch, 131 Jiankang Road, Songshan District, Taipei, 10581, Taiwan

    Yu-Chen Kao & Chien-Wen Lu

  5. School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Ching-Hui Loh

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Lien, YJ., Chang, HA., Kao, YC. et al. The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 268, 27–38 (2018). https://doi.org/10.1007/s00406-017-0829-3

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