Different Outcomes of Persons with Schizophrenia in Developing and Developed Countries

Abstract

Background: Currently there is an axiom in international psychiatry that schizophrenia has a better course and outcome in developing countries than that in developed countries. Is the axiom of the outcome of schizophrenia reliable? Methods: Previous international outcome studies of schizophrenia in developing and developed countries were reviewed, and the results of a series of longitudinal follow-up studies of patients with schizophrenia in China were analyzed. Results: There were limitations of previous international collaborative studies (eg, WHO’s studies) in which withdrawals or attrition due to death and homelessness and outcome of never-treated patients were not included in follow-up analyses. The results of longitudinal studies in rural China indicated that compared with patients 14 years ago (55.2%), more patients’ family economic status (74.6%) was lower than the mean level. Compared with never-treated patients 14 years ago (51.4%), there were still 30.7% patients who never received any antipsychotic treatment. The outcome of these never-treated patients was poor than those once received medication. Many patients (8.2%) were homeless in the 14-year follow-up. The outcome of these homeless patients was poor than those with family caregivers. The rates of mortality and suicide in these patients were 8.3 times and 37.4 times higher respectively than that in general population. The outcome of patients with schizophrenia was quite similar in developing countries. Conclusion: The higher rates of mortality, homelessness and never-treated among people with schizophrenia in developing countries might challenge presumed axiom about schizophrenia outcome in these countries. It is time to reexamine presumed wisdom about schizophrenia prognosis in developing countries. Given the culture is an important factor affecting the outcome of persons with schizophrenia, further systematic and comprehensive assessments of the outcome (eg, nevertreated, mortality, homelessness, etc) should be conducted.