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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Mental health laws in many countries limit involuntary hospital admissions to patients who meet an obligatory dangerousness criterion for risk to themselves or others. This policy approach is in use throughout Australia, the USA, and some areas of Canada and Europe. Alternative criteria implemented in the UK and other parts of Canada and Europe allow involuntary treatment in the absence of dangerousness, on the grounds of an assessed need for treatment if the patient is deemed unable to give consent.

What is the evidence regarding policies and laws relevant to schizophrenia?

Moderate to high quality evidence indicates that a requirement for patients to satisfy an obligatory ‘dangerousness’ criterion to allow compulsory treatment may be associated with a longer duration of untreated psychosis.

April 2022

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