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.