Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders?

Good clinical insight is predictive of clinical recovery in schizophrenia (i.e. symptomatic remission and functional improvement). However, the recent subjective recovery paradigm (i.e. the self-identity reconstruction process with and beyond psychosis) questioned the relevance of seeking patients' awareness of their medically-defined illness. This study aimed to assess the relationship between clinical insight and subjective recovery in individuals with psychotic disorders. Sixty-seven outpatients diagnosed with schizophrenia or schizoaffective disorder were assessed for clinical insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and for self-rated subjective recovery using the Recovery Assessment Scale (RAS). Among all dimensions of insight, only the unawareness of current symptoms was significantly associated with RAS total score, with illness duration as the only moderating factor. On the final regression model, unawareness of current symptoms was confirmed as the strongest of six factors explaining all together 44% of the subjective recovery variance, whereas clinical insight taken as an independent multidimensional construct did not significantly participate in explaining subjective recovery. Our study highlights the weak and only partial implication of clinical insight in subjective recovery, and invites clinicians to consider the patients' meaning making process of morbid experiences in order to build a self-directed and medically-supported recovery.