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Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia.
To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China.
This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted.
Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide.
Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development.
This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China.
Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses.
The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015.
This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.
Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.
To explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI.
Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China.
Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status.
Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.
The long-term outcome of never-treated patients with schizophrenia is
To compare the 14-year outcomes of never-treated and treated patients
with schizophrenia and to establish predictors for never being
All participants with schizophrenia (n = 510) in Xinjin,
Chengdu, China were identified in an epidemiological investigation of 123
572 people and followed up from 1994 to 2008.
The results showed that there were 30.6%, 25.0% and 20.4% of patients who
received no antipsychotic medication in 1994, 2004 and 2008 respectively.
Compared with treated patients, those who were never treated in 2008 were
significantly older, had significantly fewer family members, had higher
rates of homelessness, death from other causes, being unmarried, living
alone, being without a caregiver and poor family attitudes. Partial and
complete remission in treated patients (57.3%) was significantly higher
than that in the never-treated group (29.8%). Predictors of being in the
never-treated group in 2008 encompassed baseline never-treated status,
being without a caregiver and poor mental health status in 1994.
Many patients with schizophrenia still do not receive antipsychotic
medication in rural areas of China. The 14-year follow-up showed that
outcomes for the untreated group were worse. Community-based mental
healthcare, health insurance and family intervention are crucial for
earlier diagnosis, treatment and rehabilitation in the community.
Little is known about gender differences in the long-term outcomes of
people with schizophrenia living in the community.
To explore gender differences in the 14-year outcome of people with
schizophrenia in rural China.
A 14-year follow-up study among a 1994 cohort (n = 510)
of participants with schizophrenia was conducted in Xinjin County,
Chengdu, China. All participants and their informants were followed up in
2004 and 2008 using the Patients Follow-up Schedule.
Compared with female participants, male participants were significantly
younger, had significantly higher rates of mortality, suicide and
homelessness, and poorer family and social support. There was no
significant gender difference in Positive and Negative Syndrome Scale
scores, previous suicide attempts, those never treated, previous hospital
admission or inability to work. Longer duration of illness was associated
with functional decline and comparatively poorer family economic
The long-term outcomes of men with schizophrenia is worse than those of
women with the disorder in rural China. Higher mortality, suicide and
homelessness rates in men may contribute partly to the higher prevalence
of schizophrenia in women in China. Policies on social and family support
and gender-specific intervention strategies for improving long-term
outcomes should be developed for people with this disorder.
Many people with schizophrenia remain untreated in the community.
Long-term mortality and suicidal behaviour among never-treated
individuals with schizophrenia in the community are unknown.
To explore 10-year mortality and suicidal behaviour among never-treated
individuals with schizophrenia.
We used data from a 10-year prospective follow-up study (1994–2004) among
people with schizophrenia in Xinjin County, Chengdu, China.
The mortality rate for never-treated individuals with schizophrenia was
2761 per 100 000 person-years during follow-up. There were no significant
differences of rates of suicide and all-cause mortality between
never-treated and treated individuals. The standardised mortality ratio
(SMR) for never-treated people was 10.4 (95% CI 7.2–15.2) and for treated
individuals 6.5 (95% CI 5.2–8.5). Compared with treated people,
never-treated individuals were more likely to be older, poorer, have a
longer duration of illness, marked symptoms and fewer family members.
The never-treated individuals have similar mortality to and a higher
proportion of marked symptoms than treated people, which may reflect the
poor outcome of the individuals without treatment. The higher rates of
mortality, homelessness and never being treated among people with
schizophrenia in low- and middle-income nations might challenge presumed
wisdom about schizophrenia outcomes in these countries.
Long-term mortality and the risk factors for premature death among
patients with schizophrenia living in rural communities are unknown.
To explore the 10-year mortality and its risk factors among patients with
We used data from a 10-year prospective follow-up study (1994–2004) of
mortality among people with schizophrenia, and death registration data
for Xinjin County, Chengdu, China.
The mortality rate was 2228 per 100 000 person-years during follow-up.
Both all-cause mortality and suicide rates were significantly greater in
male than in female patients. Age at illness onset (>45 years),
duration of illness (⩾10 years), age greater than 50 years, physical
illness, inability to work, male gender, and never having received
treatment were identified as independent predictors of increased
Higher mortality rates in male patients may contribute to the higher
prevalence of schizophrenia in women compared with men in China. The
findings of risk factors for mortality should be taken into account when
developing interventions to improve outcomes among people with
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