Skip to main content
Log in

The European Schizophrenia Cohort

A naturalistic prognostic and economic study

  • Original Investigation
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Schizophrenia has a variety of clinical profiles, disabilities and outcomes requiring responsive management and the devotion of considerable resources. The primary objective of the European Schizophrenia Cohort (EuroSC) is to relate the types of treatment and methods of care to clinical outcome. Secondary objectives include the assessment of treatment needs in relation to outcome, the calculation of resource consumption associated with different methods of care, and the identification of prognostic factors.

Method

EuroSC is a naturalistic follow-up of a cohort of people aged 18 to 64 years, suffering from schizophrenia and in contact with secondary psychiatric services. The study was done in nine European centres, in France (N=288), Germany (N=618), and Britain (N=302). Participants were interviewed at 6-monthly intervals for a total of 2 years. This initial paper describes the methods used and presents clinical and social baseline data.

Results

The clinical and socio-demographic differences between patients from the different countries were small. However, patients from Britain were considerably more likely than their continental counterparts to have a history of homelessness, rooflessness or imprisonment, even when social and clinical differences between the samples were controlled.

Conclusions

The samples were largely similar in clinical terms. Thus, the social differences between the samples seem likely to be due more to the societal context and may reflect relatively benign situations in the continental locations of our study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Addington D, Addington J, Schissel B (1990) A depression rating scale for schizophrenics. Schizophr Res 3:247–251

    Article  PubMed  Google Scholar 

  2. Addington D, Addington J, Maticka-Tyndale E, Joyce J (1992) Reliability and validity of a depression rating scale for schizophrenia. Schizophr Res 6:201–208

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn, revised. American Psychiatric Association, Washington, DC

    Google Scholar 

  4. Barnes TR (1989) A rating scale for drug-induced akathisia. Br J Psychiatry 154:276–672

    Google Scholar 

  5. Bauer M, Kunze H, von Cranach M, Fritze J, Becker T (2001) Psychiatric reform in Germany. Acta Psychiatr Scand 104(Suppl 401):27–39

    Article  Google Scholar 

  6. Bebbington PE, Marsden L, Brewin CR (1997) The need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey. Psychol Med 27:821–834

    Article  PubMed  Google Scholar 

  7. Bebbington PE, Brugha TS, Hill T, Marsden L, Window S (1999) A validation of the Health of the Nation Outcome Scales (HoNOS). Br J Psychiatry 174:389–394

    PubMed  Google Scholar 

  8. Bebbington P, Brugha T, Jenkins R, Lewis G, Farrell M, Meltzer H (2000) Neurotic disorders and the use of services: a report from the National Survey of Psychiatric Morbidity. Psychol Med 30:1369–1376

    Article  PubMed  Google Scholar 

  9. Bebbington PE, Kuipers L (2003) Schizophrenia and psychosocial stresses. In: Hirsch SR, Weinberger D (eds) Schizophrenia. Blackwell, Oxford, pp 611–634

    Google Scholar 

  10. Beecham J, Knapp M (1992) Costing psychiatric interventions. In: Thornicroft G, Brewin CR, Wing JK (eds) Measuring mental health needs. Gaskell, London

    Google Scholar 

  11. Bell M, Milstein R, Beam-Goulet J, Lysaker P, Cicchetti D (1992) The posItive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. J Nerv Mental Disord 180:723–728

    Google Scholar 

  12. Brazier J, Jones N, Kind P (1993) Testing the validity of the EuroQol and comparing it with the SF-36 health survey questionnaire. Q Life Res 2:169–180

    Article  Google Scholar 

  13. Burns T, Fiander M, Kent A, Ukoumunne OC, Byford S, Fahy T, Kumar KR (2000) Effects of case-load size on the process of care of patients with severe psychotic illness. Report from the UK700 trial. Br J Psychiatry 177:427–433

    PubMed  Google Scholar 

  14. Chisholm D, Knapp M (2002) The economics of schizophrenia care in Europe: the EPSILON study. Epidemiol Psychiatr Soc 11:12–17

    Google Scholar 

  15. Cooper JE, Kendell RE, Gurland BJ, Sharpe L, Copeland JRM, Simon R (1972) Psychiatric diagnosis in New York and London. Maudsley Monograph No. 20. Oxford University Press, London

    Google Scholar 

  16. Dausch BM, Miklowitz DJ, Richards JA (1996) Global Assessment of Relational Functioning Scale (GARF): II. Reliability and validity in a sample of families of bipolar patients. Fam Proc 35:175–189

    Article  Google Scholar 

  17. Draine J, Salzer MS, Culhane DP, Hadley TR (2002) Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatr Serv 53:565–573

    Article  PubMed  Google Scholar 

  18. Gaite L, Vazquez-Barquero JL, Borra C, Ballesteros J, Schene A, Welcher B, Thornicroft G, Becker T, Ruggeri M, Herran A, Koeter M, Meijer K, Monden M, Sijsenaar M, Van-Wijngaarden B, Knudsen HC, Larsen A, Martiny K, Schou C, Beecham J, Brooks L, Chisholm D, Griffiths G, Grove J, Knapp M, Leese M, McCrone P, Padfield S, White IR, Arrizabalaga AA, Castanedo SH, Retuerto MP, Bourgon EV, Amaddeo F, Bisoffi G, Cristofalo D, Dall'Agnola R, Lasalvia A, Tansella M (2002) Quality of life in patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 105:283–292

    Article  PubMed  Google Scholar 

  19. Garratt AM, Ruta DA, Abdalla ME, Buckingham JK, Russell IT (1993) The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? Br Med J 306:1440–1444

    Google Scholar 

  20. Goldman HH, Skodol AE, Lave TR (1992) Revising AXIS V for DSM-IV: a review of measures of social functioning. Am J Psychiatr 149:1148–1156

    PubMed  Google Scholar 

  21. Group for the Advancement of Psychiatry Committee on the Family (1996) Global Assessment of Relational Functioning Scale (GARF): I. Background and rationale. Group for the Advancement of Psychiatry Committee on the Family. Fam Proc 35:155–172

    Google Scholar 

  22. Guy W (1976) ECDEV Assessment manual for psychopharmacology. Revised DHEW Pub (AOM). National Institute for Mental Health, Rockville MD

    Google Scholar 

  23. Harding CM, Hall GM (1997) Long-term outcome studies of schizophrenia: do females continue to display better outcome as expected. Int Rev Psychiatry 9:409–418

    Article  Google Scholar 

  24. Hurst NP, Jobanputra P, Hunter M, Lambert M, Lochhead A, Brown H (1994) Validity of EuroQol—a generic health status instrument—in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol 33:655–662

    PubMed  Google Scholar 

  25. Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. Br Med J 306:1437–1440

    Google Scholar 

  26. Johnson S, Kuhlmann R, EPCAT Group (2000) The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiatr Scand 102(Suppl 405):14–23

    Article  Google Scholar 

  27. Johnson S, Zinkler M, Priebe S (2001) Mental health service provision in England. Acta Psychiatr Scand 104(Suppl 410):47–55

    Article  Google Scholar 

  28. Kay SR, Opler LA, Lindenmayer JP (1987) The Positive and Negative Syndromes Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  Google Scholar 

  29. Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br J Psychiatry 155:59–65

    Google Scholar 

  30. Kay SR (1991) Positive and negative syndromes in schizophrenia. Brunner/Mazel, New York

    Google Scholar 

  31. Knapp M (1997) Costs of schizophrenia (review). Br J Psychiatry 171:509–518

    PubMed  Google Scholar 

  32. Knapp M, Chisholm D, Leese M, Amaddeo F, Tansella M, Schene A, Thornicroft G, Vazquez-Barquero JL, Knudsen HC, Becker T (2002) EPSILON. European psychiatric services: inputs linked to outcome domains and needs: comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European psychiatric services: inputs linked to outcome domains and needs. Acta Psychiatr Scand 105:42–54

    Article  PubMed  Google Scholar 

  33. Kovess V, Boisguerin B, Antoine D, Reynauld M (1995) Has the sectorization of psychiatric services in France really been effective? Soc Psychiatry Psychiatr Epidemiol 30:132–138

    Article  PubMed  Google Scholar 

  34. Lane RD, Glazer WM, Hansen TE, Berman WH, Kramer SI (1985) Assessment of tardive dyskinesia using the abnormal involuntary movement scale. J Nerv Ment Dis 173:353–357

    PubMed  Google Scholar 

  35. Lang FH, Forbes JF, Murray GD, Johnstone EC (1997) Service provision for people with schizophrenia. I. Clinical and economic perspective. Br J Psychiatry 171:159–164

    PubMed  Google Scholar 

  36. Lehman AF (1983) The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Eval Program Plann 6:143–151

    Article  PubMed  Google Scholar 

  37. Marwaha S, Johnson S (2004) Schizophrenia and employment. A review. Soc Psychiatry Psychiatr Epidemiol 39:337–349

    Article  PubMed  Google Scholar 

  38. Marwaha S, Johnson S, Bebbington P, Angermeyer M, Brugha T, Azorin J-M, Killian R, Hansen K, Toumi M (2005) Characteristics and correlates of employment in people with schizophrenia. Findings from the international EuroSC study. Br J Psychiatry (in press)

  39. Mason P, Harrison G, Glazebrook C, Medley I, Croudace T (1996) The course of schizophrenia over 13 years. A report from the International Study on Schizophrenia (ISoS) coordinated by the World Health Organization. Br J Psychiatry 169:580–586

    PubMed  Google Scholar 

  40. McCrone P, Leese M, Thornicroft G, Schene A, Knudsen HC, Vazquez-Barquero JL, Tansella M, Becker T, Chisholm D (2001) A comparison of needs of patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 103:370–379

    Article  PubMed  Google Scholar 

  41. Norman RMG, Malla AK, Cortese L, Diaz F (1996) A study of the interrelationship between and comparative interrater reliability of the SAPS, SANS and PANSS. Schizophr Res 19:73–85

    Article  PubMed  Google Scholar 

  42. Overall JE, Gorham DR (1962) Brief Psychiatric Rating Scale. Psychol Rep 10:799–812

    Google Scholar 

  43. Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P (1995) The Camberwell Assessment of Need (CAN). The validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595

    PubMed  Google Scholar 

  44. Psychopharmacology Research Branch NIMH (1976) Abnormal Involuntary Movement Scale (AIMS). In: Guy W (ed) Assessment manual for psychopharmacology (revised). NIMH, Rockville, MD, pp 534–537

    Google Scholar 

  45. Ruggeri M, Lasalvia A, Bisoffi G, Thornicroft G, Gazquez-Barquero JL, Becker T, Knapp M, Knudsen HC, Schene A, Tansella M (2003) Satisfaction with mental health services among people with schizophrenia in five European sites: results from the EPSILON study. Schizophr Bull 29:229–245

    PubMed  Google Scholar 

  46. Salvador-Carulla L, Haro JM, Cabases J, Madoz V, Sacristan JA, Vazquez-Barquero JL (1999) Service utilization and costs of first-onset schizophrenia in two widely differing health service areas in North-East Spain. PSICOST Group. Acta Psychiatr Scand 100:335–343

    PubMed  Google Scholar 

  47. Sartorius N, Kuyken W (1994) Translation of health status instruments. In: Orley J, Kuyken W (eds) Quality of life assessment: international perspectives. Springer, Berlin Heidelberg New York, pp 2–18

    Google Scholar 

  48. Schene AH (1990) Objective and subjective dimensions of family burden. Towards an integrative framework for research. Soc Psychiatry Psychiatr Epidemiol 25:289–297

    Article  PubMed  Google Scholar 

  49. Schene AH, Wijngaarden B (1992) The involvement evaluation questionnaire. Department of Psychiatry, University of Amsterdam, Amsterdam

    Google Scholar 

  50. Schwarz D, Lellouch J (1967) Explanatory and prognostic attitudes in therapeutic trials. J Chronic Dis 20:637–648

    Article  PubMed  Google Scholar 

  51. Simpson S, Angus R (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl. 212:11–19

    PubMed  Google Scholar 

  52. Slade M, Phelan M, Thornicroft G (1998) A comparison of needs assessed by staff and an epidemiologically representative sample of patients with psychosis. Psychol Med 28:543–550

    Article  PubMed  Google Scholar 

  53. Slade M, Loftus L, Phelan M, Thornicroft G, Wykes T (1999) The Camberwell assessment of need. Gaskell, London

    Google Scholar 

  54. Spitzer RL, Williams JB, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: rationale, and description. Arch Gen Psychiatry 49:624–629

    PubMed  Google Scholar 

  55. Thornicroft G, Tansella M, Becker T, Knapp M, Leese M, Schene A, Vazquez-Barquero JL (2004) The personal impact of schizophrenia in Europe. Schizophr Res 69:125–132

    Article  PubMed  Google Scholar 

  56. Tracy K, Adler LA, Rotrosen J, Edson R, Lavori P (1997). Interrater reliability issues in multicentre trials. Part I: theoretical concepts and operational procedures used in Department of Veterans Affairs Cooperative Study #394. Psychopharmacol Bull 33:53–57

    PubMed  Google Scholar 

  57. van Agt HM, Essink-Bot ML, Krabbe PF, Bonsel GJ (1994) Test–retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med 39:1437–1444

    Google Scholar 

  58. Van-Wijngaarden B, Schene A, Koeter M, Becker T, Knapp M, Knudsen HC, Tansella M, Thornicroft G, Vazquez-Barquero JL, Lasalvia A, Leese M (2003) People with schizophrenia in five countries: conceptual similarities and intercultural differences in family caregiving. Schizophr Bull 39:573–586

    Google Scholar 

  59. Walsh E, Buchanan A (2003) Criminal and violent behaviour in schizophrenia. In: Murray R, Jones P, Susser E, van Os J, Cannon M (eds) The epidemiology of schizophrenia. CUP, Cambridge

    Google Scholar 

  60. Weiden P, Rapkin B, Mott T, Zygmunt A, Goldman D, Horvitz-Lennon M, Frances A (1994) Rating of Medication Influences (ROMI) scale in schizophrenia. Schizophr Bull 20:297–310

    PubMed  Google Scholar 

  61. Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablensky A, Regier R, Sartorius N (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry 47:589–593

    PubMed  Google Scholar 

  62. World Health Organization (1973) The international pilot study of schizophrenia. WHO, Geneva

    Google Scholar 

  63. World Health Organization (1992). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. WHO, Geneva

    Google Scholar 

Download references

Acknowledgements

This study was funded by an unrestricted research grant from Lundbeck A/S and a grant from the German Federal Ministry of Education and Research in the framework of the Research Association Public Health Saxony (grant no. 01EG9732/7). The first six authors of the paper received indirect support (in honoraria and travel funds) from Lundbeck A/S to participate in project management meetings. We are particularly grateful to the participants who gave of their time over the course of the study, and to the clinical teams who supported the project.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Paul E. Bebbington.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bebbington, P.E., Angermeyer, M., Azorin, JM. et al. The European Schizophrenia Cohort. Soc Psychiat Epidemiol 40, 707–717 (2005). https://doi.org/10.1007/s00127-005-0955-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-005-0955-5

Keywords

Navigation