Mediating Roles of Insight and Resilience in the Relationship between Beliefs about Auditory Verbal Hallucinations and Functioning in Patients with Chronic Schizophrenia: A Preliminary Analysis

Objective: Although insight into illness is an important determinant of clinical outcomes in patients with schizophrenia, the specific factors involved in the development of insight remain unclear.The main aim of the present study is to explore how patients' experiences of auditory verbal hallucinations (AVHs) influence the development of insight into their illness.Methods: This study included 64 patients with chronic schizophrenia who had experienced AVHs.We examined whether the relationship between beliefs about voices (AVHs) and functioning was mediated by insight.In addition, we examined whether resilience or self-stigma mediated this relationship.Results: Mediation analysis showed that insight did not significantly mediate the relationship between beliefs about AVHs and functioning.However, the moderated mediation analysis incorporating resilience showed a significant interaction between resilience and beliefs about AVHs.Significant direct and indirect effects were found in the low-and moderate-resilience subgroups, but not in the high-resilience subgroup, indicating that resilience mediated the relationship among beliefs about AVHs, insight and functioning outcome.In contrast, the model incorporating self-stigma showed no significant associations.Conclusion: These findings suggest that resilience may have a buffering effect on the association among AVHs, insight, and functional outcome.Because this was a preliminary study with a small sample size, the negative findings for selfstigma do not rule out a similar mediating role for self-stigma; this possibility should be examined further in larger studies.