Wen-Jun Mao

Symptoms of posttraumatic stress disorder and depression among bereaved and non-bereaved survivors following the 2008 Sichuan earthquake

Many studies have suggested that unexpected death of a loved one is an important risk factor of posttraumatic stress disorder (PTSD) and depression among disaster survivors, but few have examined the magnitude of psychiatric morbidities among bereaved survivors. This study examined the prevalence rates of clinically significant PTSD and depressive symptoms and their associated risk factors among Chinese adult survivors following the 2008 Sichuan earthquake. Two hundred and fifty-one bereaved adults were compared with 1474 non-bereaved adult survivors. The estimated rates of PTSD and depressive symptoms were 65.6% and 64.8% for those who lost first-degree family members, 34.1% and 45.5% for those who lost second-degree relatives, and 27.1% and 37.5% for non-bereaved survivors respectively. Loss of a child was a significant predictor of psychopathological symptoms. The results suggested that effective and sustainable mental health services were required, especially for bereaved single-child parents.

Differences in mortality and suicidal behaviour between treated and never-treated people with schizophrenia in rural China

BACKGROUND 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. AIMS To explore 10-year mortality and suicidal behaviour among never-treated individuals with schizophrenia. METHOD We used data from a 10-year prospective follow-up study (1994-2004) among people with schizophrenia in Xinjin County, Chengdu, China. RESULTS 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. CONCLUSIONS 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.

Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China.

BACKGROUND The long-term outcome of never-treated patients with schizophrenia is unclear. AIMS To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. METHOD 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. RESULTS 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. CONCLUSIONS 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.

Criminal behavior among persons with schizophrenia in rural China

OBJECTIVE This study is to explore the prevalence and risk factors for self-reported criminal behavior among persons with schizophrenia in rural China. METHODS We used data from a 14-year prospective follow-up study (1994-2008) of criminal behavior among a cohort (N=510) of persons with schizophrenia in Xinjin County, China. RESULTS The rate of criminal behavior was 10.0% among persons with schizophrenia in a rural community during the follow-up period. Bivariate analyses showed that the risk of criminal behavior was significantly associated with being male, unmarried, previous violent behavior, homelessness, no family caregivers, and high scores on measures of total symptoms of illness. In multivariate logistic regression analyses being male and previous violent behavior were identified as independent predictors of increased criminal behavior in persons with schizophrenia in the follow-up period. CONCLUSIONS Criminal behavior is a common phenomenon among patients with schizophrenia in rural China. The findings of the risk factors for criminal behavior should be considered in planning mental health interventions for high-risk patients and their families.

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.

Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study

BACKGROUND Little is known about gender differences in the long-term outcomes of people with schizophrenia living in the community. AIMS To explore gender differences in the 14-year outcome of people with schizophrenia in rural China. METHOD 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. RESULTS 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 status. CONCLUSIONS 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.

Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study

The influence of marriage on the long-term outcomes of schizophrenia is largely unknown. This study was to examine the impact of marriage on the 14-year outcomes and identify the correlates of marriage among persons with schizophrenia in rural community. All study participants with schizophrenia (n=510) were identified in 1994 in an epidemiological investigation of 123,572 people aged 15years and older and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. The Patients Follow-up Schedule (PFS) was used in 2004 and 2008. The rate of follow-up in 2008 was 95.9%. Unmarried individuals in 1994 had higher rates of homelessness and suicide, and lower rate of survival in 2004 and 2008 than those married. In 14-year follow-up, unmarried individuals were more likely to be male, to have higher level of psychiatric symptoms and lower rate of full remission of illness, and to report lower level of work functioning, as well as with fewer family members and caregiver, and lower family economic status. The predictors of being married in 2008 included being married in 1994, shorter duration of illness, being female, and lower level of education. Being married is predictive of more favorable 14-year outcomes of persons with schizophrenia in the rural community. Given that marriage can be instrumental for enhancing family-based support and caregiving, as well as improving the community tenure of persons with schizophrenia, it is important to develop programs to enhance opportunity for persons with schizophrenia to get and stay married.

Family history of psychosis and outcome of people with schizophrenia in rural China: 14-year follow-up study

OBJECTIVE This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family history of psychosis in a rural community in China. METHODS All participants with schizophrenia (n=510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. RESULTS Individuals with positive family history of schizophrenia had significantly younger age of first onset than those with negative family history of schizophrenia in 1994 and 2004. Compared with individuals with negative family history of schizophrenia, those with positive family history of schizophrenia had significantly higher rate of homelessness and lower rate of death due to other reasons in 10-year (2004) and 14-year follow-up (2008). There were no significantly differences of mean scores on PANSS, SDSS and GAF in 2008 between positive and negative family history groups. CONCLUSIONS The positive family history of schizophrenia is strongly related to younger age of onset, and may predict a poorer long-term outcome (e.g., higher rate of homelessness) in persons with schizophrenia in the rural community. The findings have implications for further studies on specific family-related mechanisms on clinical treatment and rehabilitation, as well as for planning and delivering of community-based mental health services.

Gender Differences of Persons with Schizophrenia in Rural China

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

104 – Never-treated patients with schizophrenia in rural China

XIVth Biennial Winter Workshop on Schizophrenia and Bipolar Disorders, Montreux, Switzerland, 3–7 February 2008. In Schizophrenia Research, 2008, v. 98, Suppl., p. 76, abstract no. 104