• 110 • Shanghai Archives of Psychiatry, 2018, Vol. 30, No.

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
•ORIGINAL RESEARCH ARTICLE•

The Association of Insight and Change in Insight with Clinical

Symptoms in Depressed Inpatients
Hongbo HE*, Qing CHANG, Yarong MA

Background: Lack of insight has been extensively studied and was found to be adversely correlated with
impaired treatment compliance and worse long term clinical outcomes among patients with schizophrenia,
while not much is known about this phenonmenon in patients with severe depression.
Aim: To explore the correlates of insight and its relation to symptom changes among the most seriously ill
patients with affective disorders, those who require hospitalization.
Methods: Patients hospitalized in a large psychiatric hospital in south China with either major depressive
disorder (MDD)(N=55) or bipolar depression (BD) (N=85) based on ICD-10 diagnostic criteria were assessed
with the Insight and Treatment Attitudes Questionnaire (ITAQ) one week after admission and at the time
of discharge. Clinical symptoms were measured at the same time with the Hamilton Rating Scale for
Depression (HAMD-17) and the Depression subscale of the Symptom Check list-90 (SCL-90). Length of stay
(LOS), duration of illness, duration of untreated mood disorder, number of previous episodes of depression
and previous admissions for depression were documented during interviews with patients and their families
and from a review of medical records. Bivariate correlations and multiple regression analysis were used to
examine the relationship of sociodemographic characteristics, clinical symptomatology and clinical history,

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to insight at the time of admission. The relationships between change in clinical symptoms and change in
insight from admission to discharge were also examined.
Results: Stepwise multiple regression models suggested that any previous admissions for depression and
higher anxiety factor scores on the HAMD-17 are significant independent predictors of insight accounting
for 22.9% of the variance. Multiple regression analysis residual change scores (change scores adjusted for
baseline values) on the ITAQ showed that improved insight over average stays of 51 days were inversely
related to the residual psychomotor retardation factor on the HAMD-17 accounting for 9.1% of the
variance.
Conclusions: More severe anxiety symptoms and previous hospitalization for depression were associated
with greater insight into illness at admission. Reduction of motor retardation symptoms during treatment
was associated with greater improvement in insight to the time of discharge. The patients who are sicker at
admission and who show more improvement in psycho-motor retardation show the greatest insight.

Key words: insight; clinical symptoms; depressive

[Shanghai Arch Psychiatry. 2018; 30(2): 110-118. doi: [Link]

1. Introduction psychiatric disorders.[1-4] A large body of research has

Research over the past few decades has found that lack found that level of insight or improvement of insight
of insight may adversely impact treatment compliance after acute treatment might be one of the most
and clinical outcomes among patients with diverse important predictors for the prognosis of patients

Department of Psychiatry, Guangzhou Huiai Hospital (The Affiliated Brain Hospital of Guangzhou Medical University), Guangzhou, China.
* correspondence: Hongbo He. Mailing address: The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Rd.,
Liwan District, Guangzhou, China. Postcode: 510370. E-Mail: hongbo_he@[Link]
Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2 • 111 •

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
with schizophrenia. Lack of insight into illness has patients were assessed in the week after admission and
long been recognized as a central characteristic of then again at the time of discharge. Before the study,
schizophrenia. Studies have heavily investigated the an inter-rater reliability exercise of all of the clinical
correlations between insight and clinical symptoms. rating instruments was conducted on 20 patients with
It has been demonstrated that there were significant symptomatic schizophrenia. Assessment of inter-rater
negative correlations between insight and the reliability for raters in this study was in the excellent
severity of positive symptoms [5, 6]and/or negative to good range for all the scales used, with intra-class
symptoms.[6-9] Some studies have also noted a negative correlations ranging from 0.90 to 0.96. There were 6
relationship, more specifically, between symptoms of raters after scale rater training and all of the raters were
disorganization and insight.[8,10, 11] Some studies also psychiatrists. The study was approved by the Huiai
found a positive relationship between the degree hospital ethics committee.
of insight and depressive symptoms in patients with Sociodemographic data including age, gender,
schizophrenia.[12, 13] education, and duration of illness were derived from
Although less studied, impaired insight has medical records. Past mood-disorder diagnoses or
also been found in bipolar disorder (BP) and major hospitalization for depressive disorder or for psychoses
depressive disorders (MDD). A two year follow up were garnered from diagnostic interviews and reviews
study for BP-1 patients have suggested that insight of the medical record. All of the medical records were
in patients with BP-1 is comparatively intact during collected by clinicians.
recovery stages but is particularly impaired during
the acute phases of the disease[14] and that frequent
episodes of mood disturbance may cause insight to 2.2 Measures
deteriorate.[15] Impaired insight also was found in the Clinical symptoms were measured using the Hamilton
majority of outpatients with depressive disorder.[16] Rating Scale for Depression (HAMD-17) [18] and by
Similar to schizophrenia, lack of improvement in insight the depression, anxiety and psychosis subscales of
was found to be associated with poor outcome in mood the Symptom Check List-90 (SCL-90).[19] The HAMD-
disorder, thus it would be meaningful to extensively 17 total scores range from 0 to 52 with higher scores
explore the important correlations between insight and indicating more severe depression. Several researchers
clinical symptoms to determine the critical symptoms have investigated the psychometric properties of
for insight recovery. the scale and the factor structure of the Hamilton is

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In this study, we recruited depressive inpatients in a multidimensional but with poor replication across
large psychiatric hospital in south China. The aims of this samples.[20] The Chinese version of the HAMD-17 has
study were to examine the relationship between insight been shown to have adequate validity and reliability
and clinical depressive symptoms, clinical history, and with 5-factors[21] including: 1) anxiety (psychic anxiety,
the relationship between change in insight and change somatic anxiety, gastrointestinal somatic symptoms,
in clinical depressive symptoms, in a group of severely general somatic symptoms, hypochondriasis, loss of
depressed patients to explore the specific symptoms weight), 2) agitation (agitation, insight), 3) suicidality
associated with better insight. (depressive mood, suicide, genital symptoms), 4)
psycho-motor retardation (feelings of guilt, lack of work
and other activities, motor retardation) and 5) insomnia
2. Methods (early insomnia, middle insomnia, late insomnia). The
insight item was excluded from the agitation factor
2.1 Participants and data collection in the analyses used in this paper to prevent spurious
A total of 140 subjects were recruited from the correlations with the measure of insight (the ITAQ).[2]
Guangzhou Psychiatric Hospital, the largest psychiatric Insight was assessed by the Insight and Treatment
hospital in south China. Inclusion criteria: The subjects Attitudes Questionnaire (ITAQ).[2] The ITAQ consists of
were diagnosed by consecutive recruitment at 11 items (scored on a 0-2 scale) that assess the patient’s
admission with either major depressive disorder (MDD) view of whether they have a psychiatric illness and
(n=55) or bipolar depressive disorder (BPDD) (n=85) their need for treatment. The items are summed and
based on the International Classification of Disease (ICD- the total, can range from 0 to 22 with higher scores
10)[17] diagnostic criteria. The samples were recruited reflecting greater insight.
randomly from inpatient psychiatric treatment from July
2012 to June 2013. Exclusion criteria: Individuals with The ITAQ, HAMD-17, and the three SCL-90 subscales
mental retardation, organic brain disorders, or drug were all assessed both in the week after admission and
abuse as a primary diagnosis were excluded. Diagnosis at the time of discharge.
according to ICD-10 criteria was established by two
experienced psychiatrists based on clinical interviews 2.3 Statistical analyses
and systemic review of medical records. There was no The analysis proceeded in 2 stages, including correlation
loss since all participants were inpatients. analysis and multiple regression analyses. Firstly,
All of the participants provided written informed bivariate correlations were calculated separately
consent. After providing written informed consent, between baseline ITAQ scores and sociodemographic,
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Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
Figure 1. The flowchart of the study

4352 patients admitted to ten general units of the Huiai Hospital from July 2012 to June 2013

3620 excluded
• 1875 not 16-65 years of age
• 729 patients had persistent agitation or cognitive impairment that
made it impossible to administer survey
• 496 declined to participate in the study
• 357 patients had severe physical disease
• 163 did not met ICD-10 criteria for a mental disorder

732 inpatients enrolled in main study

• 334 patients were diagnosed with schizophrenia.

• 198 patients were diagnosed with bipolar current manic episode
• 60 patients were diagnosed with other mental disorders.

140 inpatients with either major depressive disorder (MDD) (n=55) or bipolar depressive disorder (BPDD)
(n=85) completed the assessment.

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clinical history, baseline values of the HAMD-17, and evenly split between men (N=66, 47.1%) and women
SCL-90 subscales. After using multiple regression for (N=74, 52.9%). The majority (N=85, 60.7%) were
adjustment, residual change scores represented the diagnosed with bipolar depression and 39.3% (N=55)
change from baseline to discharge adjusted for the with unipolar depression. Most (N=87, 62.1%) displayed
baseline measurements including ITAQ, HAMD-17, and some psychotic features. The mean(SD) number of
SCL-90. And then bivariate correlation analyses were previous episodes of depression was 1.67(1.3), range
used to examine the relationship between the residual 0-6, and approximately 44.6% (N=62) subjects had
change ITAQ scores and baseline variables, along with previous admissions for depression. Overall, baseline
residual scores of HAMD-17 and SCL-90. Spearman admission HAMD-17 mean scores reflected moderate
correlation was used for non-normally distributed severity of depressive symptoms (23.17 (16.4),
variables, while Pearson correlation was used for range7-49). The ITAQ mean(SD) score was 8.58 (6.3),
normally distributed ones (see Table 2 and Table 3). range 0-22.
Secondly, multiple regression analyses were used to Bivariate correlation analyses (Table 2) showed that
measure the association between baseline/residual ITAQ indicators of more severe past or current illness were
scores and statistically significant variables in correlation significantly and positively correlated with the total ITAQ
analysis. Dependent variables included HAMD-17 factor score at admission including: any previous admission for
Anxiety, and SCL-90 depression subscale for baseline depression (r=0.33, P<0.001), the number of previous
ITAQ (see Table 4). And for residual ITAQ change scores episodes of depression (r=0.24, P=0.004), the number of
(see Table 5), dependent variables including residual previous psychiatric hospitalizations (r=0.205, P=0.016),
HAMD-17, factor suicide, and factor retardation change the current anxiety factor score of the HAMD-17 (r=0.28,
scores. Statistical analyses were performed using SPSS P=0.001) and the depression subscale of SCL-90 at the
17.0. time of admission (r=0.26, P=0.004). Stepwise multiple
regression model showed any previous admissions
for depression (B=4.334, P<0.001) and the anxiety
3. Results factor score of HAMD-17 (B=0.344, P<0.01) to be the
The mean(SD) age of the sample was 32.53 (11.9) years, significant independent predictors of insight accounting
range 15-62 years (Table 1). The sample was nearly for 22.9% of the variance (Table 4).
Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2 • 113 •

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
Table 1. Insight and clinical and socio-demographic characteristics of the subjects (n=140) a, the item on
insight in the HAMD-17 was not included in agitation factor
n(%) Mean(SD) Range
Clinical characteristics
Bipolar disorder 85(60.7)
Psychotic features 87(62.1)
Any previous admission for depression 62(44.6)
Number of previous episodes of depression 1.67(1.3) 0~6
Duration of illness (month) 75.44(89.1) 0~504
Duration of untreated mood disorder (weeks) 52.63(155.8) 1~1560
Length of stay (LOS) (days) 51.01(34.0) 2~182
Number of previous hospitalizations for psychosis (times) 1.72(1.7) 1~14
Baseline clinical scale and change at follow up
ITAQ (admission) 8.58(6.3) 0~22
The change in ITAQ at discharge 5.43(5.1) -9~22
HAMD-17 (admission) 23.17(16.4) 7~47
The change in HAMD-17 at discharge -15.06(9.5) -43~9
Anxiety factor 6.12(4.5) 0~16
The change in anxiety factor -3.83(3.8) -15~7
Agitation factora 1.57(1.1) 0~4
The change in agitation factor -0.96(1.1) -4~2
Suicide factor 3.76(2.6) 0~10

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The change in suicide factor -3.01(2.5) -10~2
Retardation factor 4.81(3.1) 0~11
The change retardation factor -3.09(2.8) -10~4
Insomnia factor 3.73(1.9) 0~6
The change in insomnia factor -3.17(1.9) -6~1
SCL-90 scale
The depression subscale (admission) 14.09(11.3) 0~43
The change in depression subscale (discharge) -6.35(9.9) -35~12
The psychosis subscale (admission ) 7.64(7.9) 0~34
The change in psychosis subscale (discharge) -2.97(6.3) -24~14
The anxiety subscale (admission) 9.61(8.7) 0~38
The change in anxiety subscale (discharge) -4.69(7.3) -28~13
ITAQ,Insight and Treatment Attitudes Questionnaire;SCL-90,Symptom Check List-90;
HAMD, Hamilton Rating Scale for Depression

Bivariate correlation analyses of residual change only significant independent predictor of insight change
scores with change in the ITAQ over average hospital accounting for 9.1% of the total variance (Table 5).
stays of 51 days (Table 3) showed significant inverse
relationships with the residual total HAMD-17 change 4. Discussion
score (r=-0.36, P<0.001), the residual suicide factor
(r=-0.24; P =0.005) and the residual psycho-motor 4.1 Main findings
retardation factor (r=-0.32, P < 0.001). Stepwise multiple This study examined correlates of insight at the time of
regression analysis showed that the residual psycho- hospital admission and change in insight from admission
motor retardation factor (B=-0.98, P < 0.001) was the to discharge in a sample of patients diagnosed with
• 114 • Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
Table 2. Variables associated with insight measured by the baseline ITAQ using Bivariate Correlations
r p
†
Age(years) 0.060 0.482
‡
Gender 0.007 0.932
†
Education(years) 0.061 0.483
‡
Marital Status 0.029 0.737
¤‡
Diagnosis 0.115 0.180
‡
Psychotic features -0.145 0.090
‡
Any previous admission for depression 0.330 <0.001**
‡
Number of previous episodes of depression 0.244 0.004**
†
Duration of illness (month) 0.118 0.168
†
Duration of untreated mood disorder (weeks) -0.105 0.222
†
Length of stay (LOS) (days) 0.045 0.598
‡
Number of previous psychiatric hospitalizations 0.205 0.016*
†
HAMD-17 (admission) 0.097 0.256
Anxiety 0.280 0.001**
Agitation 0.003 0.971
Suicide 0.039 0.648
Retardation 0.024 0.783
Insomnia 0.011 0.895
†
SCL-90 (admission)
The depression subscale 0.259 0.004**

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The psychosis subscale 0.144 0.120
The anxiety subscale 0.180 0.052
¤
Diagnosis:1= bipolar disorder;2= depressive disorders.
†
Pearson correlation.
‡
Spearman correlation.
*p<0.05, **p<0.01

MDD or BPDD and found that more severe anxiety thus seems that someone who had more distress from
symptoms and previous hospitalization for depression anxiety was more willing to accept treatment than
were associated with greater insight into illness at someone who had suicidal symptoms or psychomotor
admission and that reduction of motor retardation retardation. This could be generating insight and
symptoms during treatment was associated with greater awareness of illness.
improvement in insight at the time of discharge. The present study also found that the previous
In the week after admission our sample was severely experience of hospitalization for depression was
depressed with HAMD-17 mean scores of 23.17, close to also a significant independent predictor of insight
that reported for major depressive episodes. [18] Baseline into depressive illness, no doubt because repeated
insight in our sample was most strongly and positively experiences of severe illness enhances awareness of
associated with the anxiety symptoms at admission. the severity of psychiatric problems. There were also
This finding was the similar to those of previous positive correlations between baseline ITAQ scores
studies [22-24] in affective disorder as well as in and the number of previous episodes of depression,
schizophrenia[6, 13] which found that depressive patients presumably for the same reason - experience teaches.
with poor insight demonstrated greater use of self- This finding was also consistent with a previous study
deception and reported fewer depressive and anxiety which also found that previous episodes of depression,
symptoms.[24] Meta-analytic evidence[6] in schizophrenia but not episodes of mania, correlated with increased
also suggests that there is a positive relationship insight.[27] The finding also supported the depressive
between insight and mood symptoms in schizophrenia realism hypothesis[28, 29] which posits that depressed
and in one study anxiety was specifically correlated, people have a more accurate view of reality than non-
albeit modestly with insight in schizophrenia.[25, 26] It depressed people.
Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2 • 115 •

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
Table 3. Variables associated with insight measured by the residual ITAQ change scores using Bivariate
Correlations
r p
†
Age(years) -0.059 0.530
‡
Gender -0.076 0.417
†
Education(years) 0.109 0.251
‡
Marital Status -0.026 0.780
‡¤
Diagnosis -0.103 0.270
‡
Psychotic features 0.079 0.432
‡
Any previous admission for depression 0.034 0.716
‡
Number of previous episodes of depression 0.088 0.349
†
Duration of illness (month) -0.087 0.352
†
Duration of untreated mood disorder (weeks) -0.105 0.222
†
Length of stay (LOS) (days) 0.045 0.598
‡
Number of previous hospitalizations for psychosis (times) -0.040 0.671
§†
The residual HAMD-17 change scores -0.356 <0.001**
The residual anxiety factor scores -0.060 0.493
The residual agitation factor scores -0.129 0.141
The residual suicide factor scores -0.242 0.005**
The residual retardation factor scores -0.320 <0.001**
The residual insomnia factor scores -0.067 0.448
§†
The residual SCL-90 change scores

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The residual depression subscale of the SCL-90 change scores -0.081 0.427
The residual psychosis subscale of the SCL-90 change scores 0.005 0.965
The residual anxiety subscale of the SCL-90 change scores -0.100 0.334
§
The residual change scores adjusted for the baseline variable values.
¤
Diagnosis:1= bipolar disorder;2= depressive disorders.
†
Pearson correlation.
‡
Spearman correlation.
*p<0.05, **p<0.01

Table 4. Variables associated with insight measured by the baseline ITAQ using stepwise multiple regression
Dependent variable a
Independent variables
B Beta t p
Any previous admission for depression 4.334 0.349 4.010** 0.000
Anxiety factor of HAMD-17 0.344 0.258 2.957** 0.004
2 2
Stepwise model (initial and final steps shown). R = 0.166 for initial step; R = 0.229 for final step.
a
Dependent variable: baseline ITAQ scores *P<0.05 **P<0.01

Table 5. Variables associated with insight measured by the residual ITAQ change scores using stepwise
multiple regression
Dependent variable a
Independent variables
B Beta t p
The residual retardation factor of HAMD-17 scores -0.982 -0.301 -2.963 0.004*
2
R = 0.091
a
Dependent variable: the residual ITAQ change scores
*P<0.05
• 116 • Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
Some of our findings differed from previous studies The lack of longer term follow-up is another limitation
that found significant relationships between gender, of our study.
age, diagnosis, marital status and insight.[14,16,30-32] In Insight levels were evaluated just at admission and
addition, we found no relationship between either discharge, while a more relevant finding would address
insight or change in insight and psychotic features the development of insight and its association with
confirming that, as others have found, some results outcomes over the long term.
differ across studies.
Several studies have examined the relationship
between change in insight and change in symptoms 4.3 Implications
in psychotic illnesses, and have generally shown that We found that at baseline hospitalized patients with
change in insight tends to be related to reductions major depressive episodes who had more serious
in some symptoms.[2,6,13,23] But most of these studies anxiety symptoms and more experience of past
involved patients with schizophrenia (SZ) or bipolar hospitalization for depression had better insight. In
disorder[2,5]rather than depression. Yen et al [23] found contrast, greater reduction in psycho-motor retardation
that a high proportion of patients with bipolar disorder symptoms was associated with greater increase
showed improvement in their total insight score after in insight from admission to discharge. This study
remission of manic symptoms. Improvement in insight thus suggests that it may be helpful for hospitalized
however, has been related to a worsening mood in patients with major depressive disorder to receive
schizophrenia, although depression can be a sign of psychosocial intervention as early as possible during
abatement of psychotic symptoms in that disorder.[7] the hospitalization as such interventions may reduce
Like previous studies [15, 33] our data showed small psychomotor retardation and thereby foster increased
but significant improvement in insight over time insight which may improve treatment adherence after
(the average residual change score of ITAQ was 0.0 discharge and improve longer term clinical outcomes.
(4.28), t=-12.579, p<0.001). The present study found
that, unlike baseline relationships where insight was Funding statement
associated with greater severity, there was a negative
correlation between change in clinical symptoms, This work was supported by funding to H.H. from the
especially psychomotor retardation symptoms, and Chinese National Key Clinical Program in Psychiatry
to Guangzhou Brain Hospital, Guangzhou, China (No.

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change in insight, i.e. greater reduction in symptoms
was associated with greater insight. The psycho-motor 201201001).
retardation symptoms in the 5-factor model used in this
study used included feelings of guilt, poor work and low
levels of other activities, as well as motor retardation. Conflicts of interest statement
Thus, reduction in the severity of these symptoms may The authors declare no conflicts of interest related to
benefit patients by both reducing current distress and by this manuscript
improving insight and perhaps facilitating adherence to
prescribed treatments after discharge. A previous study
of vascular depression similarly found that patients with Ethical approval
worsening psycho-motor retardation and agitation had The study protocol was approved by the Guangzhou
declining insight.[34] Perhaps more attention should be Huiai Hospital ethics committee.
paid to work and activities, guilt, retardation symptoms
not only through antidepressant pharmacotherapy
but also with Cognitive Behavioral Therapy (CBT),[35,36] Informed consent
Vocational rehabilitation, or social skills training[37] to All the patients and their guardians provided written
foster both recovery and the development of insight. informed consent to participate in the study.

4.2 Limitations Authors’ contribution

Several limitations of the present study should be noted. Dr. He designed the study and wrote the protocol. Dr.
Cross-sectional research design limited the possibility Chang collected the data and undertook the statistical
to draw the causal relationship between variables. The analysis and wrote the first draft of the manuscript and
core measure used in our study, the ITAQ, [2]has most worked with Dr. He and Dr. Ma on the final preparation.
often been used to measure treatment adherence All authors contributed to and have approved the final
in psychopharmacologic research of patients with manuscript.
schizophrenia. Our application of this measure to acute
affective disorder has not previously been validated.[38]
Shanghai Archives of Psychiatry, 2018, Vol. 30, No. 2 • 117 •

Shanghai Archives of Psychiatry: first published as 10.11919/[Link].1002-0829.217149 on 25 July 2018. Downloaded from [Link] on April 14, 2021 by guest. Protected by
抑郁症患者临床症状伴随的自知力与自知力变化之间的关系
何红波，常青，马亚荣
背景：自知力缺乏已经被广泛的研究并且发现与精神 病史与入院时自知力之间的相关性。对临床症状的变
分裂症患者受损的治疗依从性和长期临床治疗效果较 化和从入院到出院之间自知力的变化之间的关系也进
差相关，但是很少研究表明这种现象也存在于严重的 行了研究。
抑郁症患者中。
结果：多元逐步回归模型显示既往的抑郁症入院记录
目的：探讨情感障碍、需要住院治疗的最严重的情感 和 HAMD-17 中较高的焦虑因子分都是自知力的显著独
障碍患者的自知力及其与症状变化之间的关系。 立预测因素，占方差的 22.9%。ITAQ 的多元回归分析
残差变化得分（基线值矫正后的评分变化）显示平均
方法：根据 ICD-10 诊断标准从中国南部的一家大型精
神科医院纳入了住院抑郁症患者（MDD）（N = 55）或 住院超过 51 天对自知力的改善与精神发育迟滞因子负
双相抑郁症患者（BD）（N = 85），在他们住院一周 相关，占方差的 9.1%。
和出院时采用自知力与治疗态度问卷（ITAQ）进行评估。 结论：较严重的焦虑症状和抑郁症的既往住院史与入
同时也采用汉密尔顿抑郁量表（HAMD-17）和症状自 院时自知力方面的疾病有关。治疗期间运动迟缓症状
评量表抑郁量表（SCL-90）测量临床症状。在对病人 的减轻与出院时间对自知力较大的改善之间是相关的。
及其家属的访谈中，记录了住院时间、疾病持续时间、 入院时病情更严重并且精神发育迟滞改善更大的患者
未治疗情绪紊乱的持续时间、既往抑郁发作次数、和 表现出最大的自知力。
以往的抑郁症入院记录。采用二分类相关分析和多元
回归分析来研究社会人口学特征、临床症状、和临床 关键词：自知力；临床症状；抑郁

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Dr. Hongbo He obtained a bachelor’s degree from Tongji Medical University in 2000, a master’s
degree in neuropsychology from Jinan University in 2003, and a PhD in Neuroscience from Louisiana
State University Health Science Center in 2011. He has been the head of the Research and Education
Department and an attending doctor in the Department of Psychiatry, Guangzhou Brain Hospital (Now
Guangzhou Hui-Ai Hospital) since 2011. His research interests focus on mental health service research
and glutamatergic neuropsychopharmacology.