The impact of mental illness on self-concept: relationship between engulfment, cognitive insight, and depression in schizophrenia

ABSTRACT

Background

The presence of good clinical and cognitive insight has been linked to depression in people diagnosed with schizophrenia. Clinical and cognitive insight, respectively, refer to the awareness of one’s symptoms and need for treatment and to being conscious of modifications in one’s reasoning processes. Engulfment, or over-identification to a sick role that becomes the patient’s central identity, has been found to mediate the relationship between clinical insight and depression. However, the relationship between engulfment, cognitive insight and depression has not been investigated. Consequently, this study examined the potential mediating role of engulfment in the association between cognitive insight and depression

Methods

The sample consisted of 140 participants diagnosed with enduring schizophrenia (for at least 3 years). Correlation and mediation analyses were conducted to examine associations between cognitive insight, engulfment and depressive symptomatology

Results

Our analyses revealed that cognitive insight was significantly and positively correlated with engulfment. This association was driven by the self-reflectiveness subscale of the Beck Cognitive Insight Scale. Engulfment was significantly correlated with depression. Finally, engulfment mediated the relationship between cognitive insight, and depression.

Discussion

In the context of good cognitive insight, engulfment should be a target for psychological interventions aimed at lowering the risk of depression.

KEYWORDS:

• Cognitive insight
• clinical insight
• psychosis
• identity
• engulfment

Acknowledgments

We wish to thank the members of our lab for their help in recruitment and data collection. We also wish to thank all the participants of this study.

Disclosure statement

M.L. reports having received financial assistance/compensation for research and educational events from Otsuka/Lundbeck Alliance, Janssen and MedAvante-Prophase. The other authors report no conflict of interest.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research (Grant No. 106434) to M.L. Salary awards include: the Fonds de recherche du Québec - Santé to M.L.; the James McGill Professorship to M.L. Genevieve Sauve was supported by a doctoral scholarship from the Fonds de Recherche du Québec – Santé. Susanna Konsztowicz was supported by a Vanier Canada Graduate Scholarship.