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Division of Psychiatry, University of Bristol, UK
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, NY, USA
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
Indian Council of Medical Research, Ansari Nagar, New Delhi, and WHO Centre for Research and Training in Mental Health, Agra, India
WHO Collaborating Centre, Sofia, Bulgaria
Department of Social Psychiatry, University Hospital Groningen, The Netherlands
Schizophrenia Research Unit, Central Institute of Mental Health, Mannheim, Germany
University of Rochester, Rochester, NY, USA
Division of Mental Health, World Health Organization, Geneva, Switzerland
Department of Psychiatry, University of Hong Kong, Hong Kong
Department of Psychiatry, Universidad del Valle, Cali, Colombia
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Psychology, University of Hawaii, Honolulu, HI, USA
Department of Neuropsychiatry, Nagasaki University School of Medicine, Nagasaki, Japan
Division of Mental Health, World Health Organization, Geneva, Switzerland
Institute of Mental Health, Beijing Medical University, Beijing, China
Psychiatric Demography Unit, Prague Psychiatric Centre, Prague, Czech Republic
Schizophrenia Research Foundation, Madras, India
Research Centre for Mental Health, Russian Academy of Medical Sciences, Moscow, Russia
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
St Loman's Hospital and the Health Research Board, Dublin, Ireland
Department of Psychiatry, Graduate School of Behavioural and Cognitive Neurosciences, Groningen, The Netherlands
Correspondence: Professor G. Harrison, Division of Psychiatry, University of Bristol, 41 St Michael's Hill, Bristol BS2 8DZ, UK. Tel: 0117 928 7768; Fax: 0117 925 9709; e-mail: G.Harrison{at}bristol.ac.uk
Declaration of interest Funded by the Laureate Foundation, the World Health Organization and the participating centres (see Acknowledgements).
Background Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.
Aims To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.
Method Historic prospective study. Standardised assessments of course and outcome.
Results About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.
Conclusions A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
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