The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia

Yin Ju Lien, Hsin An Chang, Yu Chen Kao*, Nian Sheng Tzeng, Chien Wen Lu, Ching Hui Loh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables—namely cognitive insight, self-stigma, insight into treatment, and medication compliance—that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.

Original languageEnglish
Pages (from-to)27-38
Number of pages12
JournalEuropean Archives of Psychiatry and Clinical Neuroscience
Issue number1
Publication statusPublished - 2018 Feb 1


  • Insight
  • Medication compliance
  • Quality of life
  • Recovery
  • Schizophrenia
  • Self-stigma

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Pharmacology (medical)


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