The burden of schizophrenia includes direct costs, indirect costs, and intangible costs. Direct costs are estimated by the amount of services used and the price of treatment. Indirect costs are estimated by the average reduced future earnings of both patients and caregivers. Intangible costs are those that may be associated with the illness, such as trauma and depression. For the cost of specific treatments, please see the psychosocial and pharmaceutical treatment costs topics.

What is the evidence for the burden of schizophrenia?

Moderate quality evidence finds the overall annual cost of schizophrenia varies worldwide, ranging from US$94 million in Puerto Rico to US$102 billion in the USA (2013; 0.02-1.65% of GDP). Indirect costs associated with productivity loss due to absenteeism, unemployment, or premature mortality contributed 50 to 85% of the overall costs. Hospitalisation accounts for the greatest proportion of direct illness costs.

Relapse costs between US$6,033 and US$32,753 per relapse in the USA, and between US$8,665 and US$18,676 per relapse in Europe and Australia. Re-hospitalisation costs between US$6,383 and US$28,767 in the USA, between US$1,615 and US$39,088 in Europe, Japan and New Zealand, and between US$2,217 and $14,923 in other countries.

Moderate to low quality evidence finds psychosocial burden associated with schizophrenia includes: stigma, marginalisation, discrimination, social withdrawal, disengagement, loneliness, fear, despair, helplessness, problems with relationships and interpersonal skills, frustrations with mental health services, problems with self-esteem and over protection, unmet needs for social reciprocity, constancy, hope and understanding, problems with finding and keeping work, and having a place to live. Facilitating factors to overcome these difficulties are: providing empathetic living spaces, work spaces and routine environments, meaningful occupations and supported employment, exercise for socialisation as well as for health reasons, trust, knowledge in advance of what is happening, training for health workers to listen more and work in partnership and family support.

April 2022

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Positive symptoms of schizophrenia, including hallucinations and delusions, have been described throughout ancient Egyptian, Hindu, Chinese, Greek, and Roman writings. Emil Kraepelin, a German physician, was one of the first to classify schizophrenia using the term “dementia praecox”, meaning premature dementia. The term “schizophrenia” was coined by Eugen Bleuler around 1910, and roughly translates to “splitting of the mind”, a term not meant to suggest a split personality, but to describe a separation of psychological functions: cognition, percept and affect. Since then, the definition of schizophrenia has continued to change.

What is the evidence regarding the history of schizophrenia?

Low quality evidence suggests that the general public in ancient Greece and Rome may have had an awareness of psychotic disorders, but no reference is made to a condition that would meet modern diagnostic criteria for schizophrenia. The magnitude of any changes in incidence rates over time is unclear.

April 2022

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

April 2022

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

April 2022

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Incidence refers to how many new cases of schizophrenia there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there are at a particular point in time, or over a lifetime. Incidence is usually reported as the number of new cases per 100,000 people per year, but this can vary. Differences in the incidence of a disorder can provide clues to its possible causes. For example, a population register with information gained from consensus data helps to identify all adults in a defined area who were born within a certain time period (a cohort). Cross linking this information with a mental health register for the cohort can be used to identify people who received treatment for schizophrenia over particular times. This information provides the incidence of schizophrenia for various age groups within that cohort.

What is the evidence for variation in incidence according to ethnicity?

Moderate to high quality evidence suggests the incidence of psychotic disorders in ethnic minority groups in the UK and the Netherlands is higher than in the majority population in those areas (large effect). This effect is largest in areas with low ethnic density compared to areas with high ethnic density.

April 2022

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

April 2022

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

April 2022

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

April 2022

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Incidence refers to how many new cases of schizophrenia there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there are at a particular point in time, or over a lifetime. Incidence is usually reported as the number of new cases per 100,000 people per year, but this can vary. Differences in the incidence of a disorder can provide clues to its possible causes. For example, a population register with information gained from consensus data helps to identify all adults in a defined area who were born within a certain time period (a cohort). Cross linking this information with a mental health register for the cohort can be used to identify people who received treatment for schizophrenia over particular times. This information provides the incidence of schizophrenia for various age groups within that cohort.

What is the evidence for differences in incidence rates according to sex?

Overall, moderate to high quality evidence finds the incidence of schizophrenia is higher in males than in females. However, this is only apparent in males up until around 40 years of age, then incidence is similar between males and females until about 50 years, then it is higher in females than males over 50 years of age. This is proposed to be due to decreasing oestrogen levels in females over time, as oestrogen is a proposed protective factor for schizophrenia.

April 2022

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Incidence refers to how many new cases of schizophrenia there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there are at a particular point in time, or over a lifetime. Incidence is usually reported as the number of new cases per 100,000 people per year, but this can vary. Differences in the incidence of a disorder can provide clues to its possible causes. For example, a population register with information gained from consensus data helps to identify all adults in a defined area who were born within a certain time period (a cohort). Cross linking this information with a mental health register for the cohort can be used to identify people who received treatment for schizophrenia over particular times. This information provides the incidence of schizophrenia for various age groups within that cohort.

The term “migrant” usually refers to first generation migrants – people with a foreign birth place, however some studies also include locally born offspring, or second generation migrants in their analyses. Any association observed between migrant status and increased incidence of schizophrenia has stimulated a great deal of research and explanatory hypotheses, including additional stress relating to migration and settling into a new country, and possible issues with discrimination. Other explanations include a tendency for at-risk individuals to migrate, and underlying genetic variances across cultures.

What is the evidence on incidence of schizophrenia in migrant populations?

Moderate to high quality evidence finds the incidence rate of schizophrenia is higher in migrants than in native-born populations. This is found in both first and second generation migrants, and particularly in migrants with black skin and in those living in the UK, The Netherlands, and Scandinavian countries.

Please also see the topic on incidence of schizophrenia in refugees.

April 2022

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