Schizophrenia Bulletin Advance Access originally published online on September 28, 2007
Schizophrenia Bulletin 2008 34(2):229-244; doi:10.1093/schbul/sbm105
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Questioning an Axiom: Better Prognosis for Schizophrenia in the Developing World?
2 Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115
3 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
4 Schizophrenia Research Foundation, Chennai, India
5 Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
1 To whom correspondence should be addressed; tel: 1-617-432-2378, fax: 1-617-432-2565, e-mail: alex_cohen{at}hms.harvard.edu.
Introduction: That schizophrenia has a better course and outcome in developing countries has become an axiom in international psychiatry. This is based primarily on a series of cross-national studies by the World Health Organization (WHO). However, increasing evidence from other research indicates a far more complex picture. Methods: Literature review and tabulation of data from 23 longitudinal studies of schizophrenia outcomes in 11 low- and middle-income countries. Results: We reviewed the evidence about the following domains: clinical outcomes and patterns of course, disability and social outcomes (marital and occupational status, in particular), and untreated samples and duration of untreated psychosis. Outcomes varied across the studies and the evidence suggests a need to reexamine the conclusions of the WHO studies. Additionally, assessments of outcomes should take excess mortality and suicide into account. Conclusions: It is time to reexamine presumed wisdom about schizophrenia outcomes in low- and middle-income countries.
Keywords: longitudinal studies / cross-cultural psychiatry / schizophrenia
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