Insight and Its Trajectory: Predicting the Risk of Psychiatric Hospitalizations Among First-Episode Psychosis During the First Year of Coordinated Specialty Care

Abstract Background This study explored how baseline insight predicts psychiatric hospitalization risk among 186 individuals with first-episode psychosis in coordinated specialty care (CSC). We hypothesized that insight, a potentially modifiable factor, moderates the relationship between CSC enrollment and outcomes, with a high baseline and stable high insight predicting greater reductions in hospitalizations and lengths of stay (LOS). Design Insight was assessed using the G12 item of the positive and negative syndrome scale, categorizing participants into low (G12 ≥ 4; n = 87) or high (G12 < 4; n = 99) insight groups at baseline. Six longitudinal trajectories were identified: stable high (n = 48), increasing (n = 41), declining (n = 31), stable low (n = 27), high-low-high (n = 20), and low-high-low (n = 19). Hospitalization data were collected for 12 months pre- and post-CSC enrollment. Results Participants with high baseline insight demonstrated a 95% greater relative reduction in hospitalizations (relative risk reduction = 1.95, P = .002), indicating that insight moderated the relationship between CSC enrollment and hospitalization outcomes. Longitudinally, the stable high insight group exhibited the most substantial reductions in hospitalizations (risk ratio [RR] = 0.12, P < .001) and LOS (RR = 0.04, P < .001), outperforming the stable low and fluctuating insight groups. Conclusion Insight moderates the relationship between CSC enrollment and hospitalization outcomes, predicting clinical improvements in early psychosis. Interventions targeting insight may enhance CSC benefits by reducing hospitalizations and improving recovery trajectories.