schizophrenia is one of the severe forms of mental illness which demands enormous personal and economical costs . recent years have attracted considerable interest in the dual problem of depression in schizophrenia and its relation to insight . among the primary dimensions of insight , following are included : 1 ) the awareness of having an illness , its signs and symptoms . 3 ) the temporal projection of the insight , distinguishing between actual or retrospective insight , and assuming that insight may vary in extend across different stages of the psychotic process . nevertheless , beginning with bleuler , the observation is repeatedly made over the years that a substantial proportion of patients diagnosed with schizophrenia manifest some sort of  depressive - like  symptoms at certain points during their clinical course . meyer - gross has written about depression as being a reaction of despair to the psychotic process and a denial of the future . semradand eissler , however , has seen depression in schizophrenia as a moment of therapeutic opportunity , when insight and mastery might overcome more primitive defensive psychotic ego states as they receded . around 50 - 80% of the patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder . although a causal chain connecting poor insight with poor treatment adherence and thus with poorer outcome and functioning is straight forward , numerous studies investigating correlates and long - term impact of insight have provided differing results . in addition , higher levels of insight in schizophrenia have been associated with depression and hopelessness , but the causal direction of the relationship is unclear and the data are inconclusive . schizophrenia is a highly stigmatising disorder and many individuals with this diagnosis feel devalued and discriminated . societal , and sometimes medical , views include the belief that it is a chronic , debilitating condition from which individuals have little chance of recovering . this conceptualization can be threatening and distressing to those given the diagnosis , and is likely to contribute to the high level of depression experienced bymany people with schizophrenia . indeed , a number of cross - sectional studies support a relationship between higher insight and greater distress , including depression , hopelessness , and suicidality . 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 . as per moore et al . , patients with a greater unawareness of their illness had relatively less depressive symptomatology and relatively greater self deception . this relationship was particularly strong for unawareness of the social consequences of a mental disorder . these results suggest that the presence of depressive symptomatology in schizophrenia is related to insight . the aim of the study is to find out the correlation between insight and depression in schizophrenic population . the aim of the study is to find out the correlation between insight and depression in schizophrenic population . this study is a cross - sectional , single - centred , correlation study done in total of 60 subjects . subjects between 20 - 60 years of are , who are diagnosed to have schizophrenia as per icd-10 and who have given written consent to participate in the study . subjects who have other diagnosis such as mood disorder , schizoaffective disorder , mental retardation , epilepsy or detectable organic disease and co morbid substance abuse are excluded from the study . this is an outpatient - based study , patients , who have come for the follow - up are taken into the study . instruments : for insight assessment , schedule for assessment of insight ( sai ) , a three item rating scale , is used . the sai evaluates insight in three dimensions and is used to rate the insight in psychotic illness . for depressive symptoms subjects between 20 - 60 years of are , who are diagnosed to have schizophrenia as per icd-10 and who have given written consent to participate in the study . subjects who have other diagnosis such as mood disorder , schizoaffective disorder , mental retardation , epilepsy or detectable organic disease and co morbid substance abuse are excluded from the study . this is an outpatient - based study , patients , who have come for the follow - up are taken into the study . instruments : for insight assessment , schedule for assessment of insight ( sai ) , a three item rating scale , is used . the sai evaluates insight in three dimensions and is used to rate the insight in psychotic illness . for depressive symptoms the statistical analysis is done by using statistical package for social sciences ( spss ) 13.0 version . the sample has equal number of both urban and rural residents i.e. , 30 in each group . the age - wise distribution of the sample is as follows : below 30 years - 17 members , 30 to 40 years - 21 members , more than 40years - 22 members . the sample consists of 24 patients with duration of illness less than 2 years , 19 patients with duration of illness between 2 years to 5 years and 17 patients have duration of more than five years . the tables from one to five demonstrate the distribution of sample in different demographic variables such as age , gender , area of residence , marital status and educational status . table 1 gives the duration of illness in the sample population . in table 2 both the insight and depression are more in male population when compared to female population with better mean values . in table 3 both the depression and insight are more in urban population when compared to rural population . as per table 4 , married patients have lesser insight and lesser depressive ideas than the unmarried patients . in table 5 , the results are suggestive of higher values of both insight and depression in literates than in illiterates . from table 6 , the results are conclusive that as the age increases both insight and depression decreases in schizophrenic patients , as evidenced by the higher mean values of insight and depression in below 30 years age group . from table 1 , the results are conclusive that as the duration of illness increases both insight and depression decreases in schizophrenic patients , as evidenced by the higher mean values of insight and depression in the group of subjects with duration of illness less than two years . correlation between insight and depression table 8 shows the strength of correlation between insight and depression in different groups . in both males and females the correlation between insight and depression is strong , as given by the pearson coefficient more than 0.7 with significance at 0.01 level . the influence of age of patient on the correlation is also well - established , as with increase in the age of the patient the strength of correlation decreases . in less than 30 years age group , pearson coefficient is 0.612 at a 0.01 significance level , whereas in more than 40 years age group the same is 0.576 at a 0.05 significance level . the residents of urban area have more correlation than rural residents with pearson coefficients of 0.810 and 0.327 respectively and are significant at 0.01 and 0.05 . educational status of patients has also its influence as literates have more correlation than illiterates with pearson coefficients of 0.641 and 0.282 and are significant at 0.01 and 0.05 respectively . patients who are married have a strong correlation than unmarried with pearson coefficients of 0.633 and 0.451 and are significant at 0.01 and 0.05 respectively . patients in the early stages of illness have more correlation than at later stages , as evidenced by pearson coefficients of 0.703 , 0.229 , 0.201 in < 2 years , 2 - 5 years and > 5 years duration of illness groups respectively . the stigma and negative societal views can make the diagnosis of schizophrenia more distressing to the patient and the awareness of illness leads to depressive symptoms in the patient . however , main conceptualisation is that poor insight represents an individual response to the diagnosis of schizophrenia and it has a relation to suicidal ideation . studies have led to hypothesise that there is a chain of causality from insight , to demoralisation , to depression , to suicidality . in our study , there is a strong correlation between insight and depression in schizophrenic population with a pearson coefficient of 0.758 . our study results are in par with previous literature , which suggests that better insight is directly related to greater distress.[91116 ] in a study by rocca et al . , male gender was associated with an increased severity of depressive symptoms . in contrary to this study our results does nt document any difference in the two genders in strength of correlation as both have > 0.7 pearson coefficient . in our study people residing in urban areas have stronger correlation than those in rural areas , explicable by more literacy rate , more exposure and more deficit awareness of the schizophrenic illness . the distress associated with deficit awareness is due to the insight of the practical constraints brought about by these deficits . previous studies have reported that depressive symptoms are less frequent in schizophrenia patients in the chronic period than in the acute period . studies on first episode psychosis have shown comparable higher levels of insight at baseline ( 60% ) : 1 ) a higher insight during the baseline assessment in a first episode psychosis patient is positively correlated with a higher prevalence of depressive symptoms at this time . 2 ) a higher degree of insight predicts a higher risk for a subsequent post - psychotic depression , and a higher risk of suicide during the first four years after receiving the diagnosis of psychosis . 3 ) approximately 11% of the first episode psychosis patients , present self - harm episodes prior to their first diagnosis with an increased risk associated to male gender , low social class , depression , a longer duration of untreated psychosis and increased insight . in our study also , the results are suggestive of more correlation as well as higher mean values of insight and depression in early stages of schizophrenic illness . as the duration of illness increases the insight about the illness diminishes and the rate of occurrence of depressive symptoms also falls down . age of the patients also follows similar trend because most of the people experience the onset of schizophrenic illness when they are young . in this study , literate population have stronger correlation than the illiterate population , explicable by more deficit awareness but this finding is in contrary to the study of amador xf et al . , who documented that level of education and level of positive and negative symptoms of the illness are unrelated to insight suggesting that deficits in illness awareness are not a consequence of educational background . in this study , married subjects have lesser mean values of insight and depression than unmarried but the correlation between insight and depression is strong in married subjects . this can be explained by the different coping mechanisms used by the patients of schizophrenia . preference for positive reinterpretation and growth  coping style correlated with lower distress and with lower symptom awareness in married subjects who generally have a better social support . social support - seeking  coping style correlated with greater awareness of illness in unmarried schizophrenic subjects . , it suggests that poor insight may protect against depression in the early stages of recovery from schizophrenia . the correlation between insight and depression is high in subjects with less duration of illness . there is a positive cross - sectional relationship between insight and depression , but the underlying processes need further clarification . this is a cross - sectional study and the patients are not followed to measure the impact of insight . the results may not be applied to a large scale population as the sample size is small .
background : schizophrenia is one of the severe forms of mental illness which demands enormous personal and economical costs . 
 recent years have attracted considerable interest in the dual problem of depression in schizophrenia and its relation to insight . 
 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 of a suicidal nature.aim of the study : the aim of the study is to find out the correlation between insight and depression in schizophrenic population.materials and methods : this study is a cross - sectional , single - centred , correlation study done in a total of 60 subjects . inclusion criteria - subjects between 20 - 60 years , who were diagnosed to have schizophrenia as per international clasification of diseases-10 and who have given written consent to participate in the study . exclusion criteria - subjects who have other diagnosis such as mood disorder , schizoaffective disorder , mental retardation , epilepsy or detectable organic disease and co 
 morbid substance abuse are excluded from the study . 
 schizophrenics who have acute exacerbation are also excluded . 
 instruments - for insight assessment , schedule for assessment of insight , a three item rating scale , is used . for depressive symptoms 
 assessment a nine item rating scale , calgary depression rating scale , is administrated.results:insight and depression are strongly correlated in schizophrenic population with a pearson correlation coefficient of 0.758 . 
 the correlation between insight and depression is high in subjects with less duration of illness.conclusion:better insight was significantly correlated with lower mood . 
 in addition , it suggests that poor insight may protect against depression in the early stages of recovery from schizophrenia . 
 the correlation between insight and depression is high in subjects with less duration of illness .