Table 1. Relationship between age and insight into illness in schizophrenia spectrum disorders.
| Authors, year, journal |
N | Dxa | Mean age (SD), rangeb |
Statusc | Measure of insight into illness |
Cross-sectional association |
Significant (Y/N) |
Longitudinal follow-up |
Longitudinal association |
Significant (Y/N) |
Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Gerretsen et al., 2013a, Hum Brain Mapp | 52 | 2 | 41.5 (14.5), 23–77 | U | PANSS G12 | r = 0.12, p = 0.395, n.s. | N | N/A | N/A | – | |
| Gerretsen et al., 2013b, Schizophr Res | 50 | 1 | 65.2 (5.5), 60–79 | U | PANSS G12, BIS | PANSS G12, r = 0.05, p = 0.729, n.s.; BIS, r=−0.23,p = 0.117, n.s. | N | N/A | N/A | – | |
| Mingrone et al., 2013, Compr Psychiatry | 158 | 2 | 40.1 (10.8), ? | O | SUMD items 1–3 | SUMD 1,r=0.08, n.s.; SUMD 2, r=0.03, n.s.; SUMD 3, r=0.01, n.s. | N | N/A | N/A | – | |
| Braw et al., 2012, Eur Psychiatry | 66 | 3 | SZ, 26.8 (8.4), <60; bipolar, 43.9 (12.4), <60 | O | SUMD items and subscales, PANSS G12 | SUMD 1, r=−0.36, p< 0.01; SUMD 2, n.s.; SUMD 3, r=−0.30, p< 0.05; SUMD awareness of anhedonia asociality, r= −0.64, p< 0.001; PANSS G12, r= −0.32, p< 0.01 | Y | N/A | N/A | – | Differences in insight between bipolar and schizophrenia patients disappeared when age was used as a covariate. |
| Schennach et al., 2012, Eur Psychiatry | 399 | 3 | 35.4 (11.1), <65 | H | PANSS G12 | r= −0.01, p = 0.77 | N | Mean 64.7 days (SD = 46.5) | F-test, p = 0.88, n.s. | N | Age was not associated with changes in insight from admission to discharge among those characterized as “improved,” “worsened,” “unchanged,” or “no lack of insight.” |
| Xiang et al., 2012, Compr Psychiatry | 139 | 2 | 33.4 (9.8), <50 | O | ITAQ | r=−0.01, n.s. | N | N/A | N/A | – | |
| Ayesa-Arriola et al., 2011, Early Interv Psychiatry | 164 | 4, 1 | 27.3 (7.8), <60 | B | SUMD items 1–3 | t-test, n.s. | N | N/A | N/A | – | No difference in age between “good” and “poor” (>1) insight groups. |
| Gilleen et al., 2011, Schizophr Bull | 31 | 2 | 38.3 (10.4), 21–62 | B | SAI-E, SUMD item 1 | Weak association between age and SAI informant-rated treatment compliance | Y | N/A | N/A | – | |
| Lysaker et al., 2011, Compr Psychiatry | 65 | 1 | 46.3 (8.9), ? | O | SUMD items 1–3 | n.s. | N | N/A | N/A | – | |
| Parellada et al., 2011, Schizophr Bull | 53 | 4, 1 | 15.43 (1.95), <17 | B | SUMD items and subscales | N/A | – | 2 years | Baseline age and insight at 2 years: SUMD 1, r=−0.49, p< 0.01; SUMD 2, r= −0.33, p< 0.05; SUMD 3, r= −0.46, p<0.01; symp. awareness, r=−0.39, n.s.; symp. attribution, r=−0.17, n.s. | Y | |
| Buchy et al., 2010, Early Interv Psychiatry | 165 | 4, 3 | 22.5 (4.0), 14–30 | B | SUMD item 1 | F= 0.76, p = 0.56, n.s. | N | N/A | N/A | – | Five insight groups did not significantly differ in age. |
| Nakamae et al., 2010, Psychiatry Clin Neurosci | 47 | 2 | 53.0 (13.0), ? | H | SUMD general items | R2 n.s. | N | N/A | N/A | – | Age did not predict insight into illness. |
| Wiffen et al., 2010, Schizophr Res | 303 | 1 | Median 30.6, 18–62 | U | SAI-E | F= 2.31, p = 0.08, n.s. | N | 6 months | F = 2.77, p = 0.04 | Y | Age predicted insight improvement. |
| Wiffen et al., 2010, Clin Schizophr Relat Psychoses | 670 | 1 | 42 (14.0), 18–84 | U | PANSS G12 | F= 8.26, p< 0.0001 | Y | N/A | N/A | – | Oldest and youngest groups had less insight than midlife groups. |
| De hert et al., 2009, Eur Psychiatry | 1213 | 1 | 35.5 (11.9), 16–83 | H | PECC | Impaired insight into illness (AMI), r= 0.06, p = 0.042; impaired insight into symptom attribution (ASAMI), r= 0.08, p = 0.004; AMI parameter est. = 0.03, p = 0.263; ASAMI parameter est. = 0.004, p = 0.137 | Y | N/A | N/A | – | |
| Mohamed et al., 2009, Schizophr Bull | 1432 | 2 | 40.5 (11.1), 18–67 | B | ITAQ | r= 0.07, p< 0.01 | Y | N/A | N/A | – | |
| Parellada et al., 2009, Psychol Med | 110 | 4, 3 | 15.5 (?), 9–17 | B | SUMD items and subscales | n.s. | N | N/A | N/A | – | |
| Raffard et al., 2009, Psychiatry Res | 60 | 1 | 33.4 (9.5), 18–56 | O | SUMD items and subscales | SUMD 1, r= 0.00, n.s; SUMD 2, r= −0.14, n.s.; SUMD 3, r= −0.03, n.s.; symptom awareness, r=0.00, n.s.; symptom attribution, r= −0.06, n.s. | N | N/A | N/A | – | |
| Stefanopoulou et al., 2009, Psychiatr Q | 36 | 2 | 34.9 (9.8), 20–52 | H | ITAQ | n.s. | N | N/A | N/A | – | |
| Karow et al., 2008, Eur Arch Psychiatry Clin Neurosci | 59 | 1 | 34.7 (13.0), ? | H | BIS, SUMD, PANSS G12 | r=−0.17 to 0.08, n.s. | N | N/A | N/A | – | |
| Bassitt et al., 2007, Eur Arch Psychiatry Clin Neurosci | 50 | 2 | 31.7 (7.1), 18–50 | O | SUMD symptom awareness + symptom attribution | r= 0.05, p = 0.75, n.s. | N | N/A | N/A | – | |
| Sapara et al., 2007 Schizophr Res | 28 | 2 | 39.0 (10.5), 19–60 | O | SAI-E, BIS | r (controlling for duration of illness) = 0.25–0.23, p>0.20, n.s. | N | N/A | N/A | – | |
| Tirupati et al., 2007, Compr Psychiatry | 183 treated; 143 never treated | 2 | Treated patients, 44.4 (13.6), ?; never-treated patients, 46.9 (16.3), ? | O | PANSS G12 | Treated, r=0.37, p < 0.01; never treated, r= −0.05, n.s. | Y | N/A | N/A | – | |
| Haddock et al., 2006, Br J Psychiatry | 304 | 4, 3 | <22 years, 19.6 (1.6), ?; >21 years, 32.9 (9.9), ? | B | BIS | t-test, n.s. | N | 18 months | F = 3.88, p = 0.023 | Y | No difference in <22-year and >21-year groups in insight at baseline. There was an interaction between insight, age, and treatment at 18 months. |
| Lysaker et al., 2006, J Neuropsychiatry Clin Neurosci | 53 | 1 | 47.5 (9.1), ? | O | SUMD items 1–3 | n.s. | N | N/A | N/A | – | |
| McEvoy et al., 2006, Psychol Med | 251 | 4, 3 | 23.9 (4.7), 16–40 | B | ITAQ | r=0.16, p = 0.016 | Y | N/A | N/A | – | |
| Shad et al., 2006, Psychiatry Res | 14 | 4, 3 (antipsychotic naive) | 26.23 (7.5), ? | H | SUMD | Symptom awareness, β = 0.08; p = 0.78, n.s.; symptom attribution, β = 0.004; p = 0.99, n.s. | N | N/A | N/A | – | |
| Simon et al., 2006, Cogn Neuropsychiatry | 38 | 2 | 24 (7), 16–38 | H | SUMD items and subscales factor analysis | n.s. | N | N/A | N/A | – | |
| Donohoe et al., 2005, J Nerv Ment Dis | 30 | 2 | ? (?), <55 | O | BIS | t-test, n.s. | N | N/A | N/A | – | No difference in age between “poor” and “good” (>9) insight groups |
| Keshevan et al., 2004 Schizophr Res | 535 | 4, 1 | 16–45 | U | PANSS G12 | F = 0.10, p = 0.75, n.s. | N | N/A | N/A | No difference in insight impairment between age groups | |
| Nakano et al., 2004, Psychiatry Res | 37 | 2 | 53 (10), 33–75 | H | SAI-Japanese | SAI-J total, r= −0.21, n.s.; SAI 1 (treatment acceptance), r= −0.40, p< 0.05; SAI 2 (illness awareness), r = −0.11, n.s.; SAI 3 (symptom awareness/attribution), r= −0.17, n.s. | Y | N/A | N/A | – | |
| Shad et al., 2004, Neuroimage | 35 | 4, 1 | Good insight, 25.4 (7.8), N/A; poor insight, 26.1 (6.7), N/A | H | HDRS insight item | t = −0.31, p = 0.75, n.s. | N | N/A | N/A | – | |
| Arduini et al., 2003, Can J Psychiatry | 42 SZ; 22 bipolar | 3 | SZ, 37.4 (12.2), ?; bipolar, 36.7 (11.8), ? | H | SUMD items 1–3 | n.s. | N | N/A | N/A | – | |
| Rossell et al., 2003, Psychol Med | 78 | 2 | 33.7 (8.50), <55 | B | SAI-E | n.s. | N | N/A | N/A | – | |
| Yen et al., 2002, J Nerv Ment Dis | 44 SZ; 33 psychotic bipolar; 32 nonpsychotic bipolar | 3 | SZ, 33.8 (9.9), 19–61; psychotic bipolar, 33.5 (12.4), 16–64; nonpsychotic bipolar, 41.2 (11.1), 21–71 | O | SAI-E total | β =0.02, n.s. | N | N/A | N/A | – | Age did not predict insight into illness. |
| Goldberg et al., 2001, J Nerv Ment Dis | 211 | 3 | 41 (8.6), 21–69 | B | PANSS G12 | β =−0.01, n.s. | N | N/A | N/A | – | |
| Pyne et al., 2001, J Nerv Ment Dis | 177 | 2 | 34.5 (8.7), 18–54 | B | Awareness of mental illness Likert scale | OR = 2.98, p< 0.05 for illness denial if <30 years | Y | N/A | N/A | – | |
| Flashman et al., 2000, A J Psychiatry | 30 | 1 | Aware, 36.4 (14.9), ?; unaware, 33.9 (9.9), ? | B | SUMD | t = 0.55, p = 0.59, n.s. | N | N/A | N/A | – | |
| Laroi et al., 2000, Psychiatry Research | 21 | 1 | 36 (10.2), <60 | B | SUMD items and subscale total | n.s. | N | N/A | N/A | – | |
| Marks et al., 1995, Schizophr Res | 59 | 2 | 42.7 (10.8), ? | O | SAIQ | SAIQ tot, n.s.; worry, n.s.; need for treatment, r = 0.32, p<0.05; illness presence/outcome, r= 0.31, p< 0.05. Neither significant after controlling for length of illness | Y | N/A | N/A | – | |
| Weiler et al., 2000, Schizophr Res | 81 SZ; 14SA | 1 | SZ, 37.3 (8.4); SA, 35.6 (14.5) | H | ITAQ | n.s. | N | N/A | N/A | – | |
| Carroll et al., 1999 Schizophr Res | 110 | 2 | 35.6 (10.9), <64 | B | ITAQ | r=0.05, n.s. | N | N/A | N/A | – | |
| Schwartz et al., 1998, Compr Psychiatry | 66 | 2 | 42.0 (6.7), 21–53 | O | SUMD items 1–3 | R2 n.s. | N | N/A | N/A | – | Age did not predict nsight into illness. |
| Collins et al., 1997, Schizophr Res | 58 | 2 | 34.1 (8.0), ? | O | SAI | r=0.32, p = 0.01; β = 0.19, p = 0.091, n.s. | N | N/A | N/A | – | |
| Dickerson et al., 1997, Psychiatr Serv | 87 | 1 | 39.4 (9.9), <65 | O | PANSS G12 | n.s. | N | N/A | N/A | – | |
| Kim et al., 1997, Compr Psychiat | 63 | 2 | 38.2 (13.3), 20–61 | B | SAI | SAI-J total, r= −0.21, n.s.; SAI 1 (treatment acceptance), r= −0.28, p = 0.060; SAI 2 (illness awareness), r= −0.23, p = 0.113; SAI 3 (symptom awareness/attribution), r= −0.37, p = 0.010 | Y | N/A | N/A | – | |
| Schwartz et al., 1997, Compr Psychiatry | 23 | 2 | 40.1 (8.1), 20–52 | H | Modified total SUMD score | r= 0.07, n.s. | N | N/A | N/A | – | |
| Almeida et al., 1996, Int J Geriatr Psychiatry | 40 | Late paraphrenia | ? (?), >55 years | B | SAI | n.s. | N | N/A | N/A | – | |
| Cuffel et al., 1996, J Nerv Merit Dis | 89 | 2 | 38.9 (7.1), <55 | O | Awareness of illness interview | r= 0.08, n.s. | N | N/A | N/A | – | |
| Fennig et al., 1995, Schizophr Res | 309 | 3 | ? (?), <60, 52.4% under 29 years old. | H | HDRS insight item | n.s. | N | N/A | N/A | – | |
| Macpherson et al., 1996, Br J Psychiatry | 64 | 2 | ? | H | SAI | r= −0.19, p = 0.14 | N | N/A | N/A | – | |
| Aga et al., 1995, Indian J. Psychiatry | 59 | 2 | 35.4 (10.5), 18–55 | H | SAI | t-test, n.s. | N | N/A | N/A | – | No difference in impaired insight between “low” (<66% max score) and “high” insight groups. |
| Cuesta et al., 1995, Am J Psychiatry | 52 | 3 | 30.8 (7.9), 19–45 | H | Lack of insight index (3 items from AMDP) | n.s. | N | N/A | N/A | – | |
| David et al., 1995. Br J Psychiatry | 150 | 3 | 26.4 (6.5), 16–50 | B | PSE | β = 0.12, p = 0.2, n.s. | N | N/A | N/A | – | Age did not predict insight into illness. |
| Kemp and Lambert, 1995, Schizophr Res | 29 | 2 | 28.4 (7.0), 16–45 | H | Modified SUMD symptom awareness and attribution | N/A | – | 3–6 weeks | n.s. | N | Age did not correlate with improvements in insight. |
| Lysaker and Bell, 1995, J Nerv Ment Dis | 44 | 1 | 45 (10), ? | B | PANSS G12 | N/A | – | 26 weeks | n.s. | N | Age did not correlate with changes in insight. |
| Amador et al., 1994, Arch Gen Psychiatry | 221 SZ; 49 SA | 1 | SZ, 34.4 (11.2), ?; SA, 33.6 (12.1), ? | U | SUMD items and subscales | n.s. | N | N/A | N/A | – | |
| Cuesta and Peralta, 1994, Schizophr Bull | 40 | 2 | 27.7 (7.5), 17–46 | H | Lack of insight index (3 items from AMDP) | n.s. | N | N/A | N/A | – | |
| Amador et al., 1993, Am J Psychiatry | 43 | 1 | 31.2 (8.8), ? | H | SUMD items and subscales | n.s. (no statistics provided) | N | N/A | N/A | – | |
| Young et al., 1993, Schizophr Res | 31 | 2 | 38.4 (7.3), 25–53 | B | SUMD symptom awareness | t-test, n.s. | N | N/A | N/A | No difference in age between “low” and “high” insight groups | |
| David et al., 2007b, Br J Psychiatry | 91 | 3 | 31.4 (9.8), <65 | B | PSE | r<0.15, n.s. | N | N/A | N/A | – |
Dx, diagnosis; PANSS, Positive and Negative Syndrome Scale; BIS, Birchwood Insight Scale; SUMD, Scale to Assess Unawareness of Mental Disorder; ITAQ, Insight and Treatment Attitudes Questionnaire; SAI-E, Schedule for the Assessment of Insight—Expanded version; PECC, Psychosis Evaluation Tool for Common Use by Caregivers; HDRS, Hamilton Rating Scale for Depression; SAIQ, Self-Appraisal of Illness Questionnaire; PSE, Present State Examination.
a
1 = schizophrenia (SZ), schizoaffective (SA), and/or schizophreniform; 2 = schizophrenia only; 3 = unspecified/mixed psychoses; and 4 = first-episode psychosis.
b
?, indicates data not specified.
c
Hospitalized (H), out-patient (O), both (B), or unspecified (U).