Unmedicated patients with schizophrenia in economically underdeveloped areas of China

Highlights

• Untreated schizophrenia has a poor prognosis, but its pattern in economically underdeveloped areas of China was not clear.

• The proportion of unmedicated schizophrenia patients was 32.3% in rural and 15.8% in urban patients.

• Effective policies and measures should be implemented urgently to improve the treatment rate in this population.

Abstract

Objectives

Untreated schizophrenia commonly leads to poor prognosis. The medication treatment rate of schizophrenia patients in economically underdeveloped areas of China has not been well-studied. This study aimed to examine the pattern of unmedicated schizophrenia patients in economically underdeveloped rural and urban areas of China.

Method

A total of 4240 schizophrenia patients in Lanzhou (1720 rural and 2520 urban patients) registered in the community mental-health service system in Lanzhou, Gansu province were included. Their socio-demographic and clinical characteristics including medication treatment status were collected and analyzed.

Results

The proportion of unmedicated schizophrenia patients was 22.5% (n = 953) in the whole sample, with 32.3% (556/1720) in rural and 15.8% (397/2520) in urban patients (X²=161.1, P < 0.001). Multiple logistic regression analyses revealed that unmedicated schizophrenia patients in rural area were more likely to be older (OR=1.02, 95%CI: 1.01–1.03), male (OR=1.35, 95%CI: 1.07–1.71), unmarried (OR=0.71, 95%CI: 0.55-0.91), and have lower educational level (OR=0.39, 95%CI: 0.24-0.65), longer illness duration (OR=1.01, 95%CI: 1.00–1.02) and less frequent admissions (OR=0.46, 95%CI: 0.38-0.54). In contrast, unmedicated patients in urban area were more likely to be older (OR=1.01, 95%CI: 1.00–1.02), unmarried (OR=0.77, 95%CI: 0.61-0.98), employed (OR=2.38, 95%CI: 1.87–3.04), and have lower educational level (OR=0.49, 95%CI: 0.37-0.65), better financial status (OR=0.60, 95%CI: 0.48-0.76) and less frequent admissions (OR=0.81, 95%CI: 0.75-0.87).

Conclusions

The rate of unmedicated schizophrenia patients is high in economically underdeveloped areas of China, particularly in rural areas. Effective policies and measures should be implemented urgently to improve the treatment rate in this population.

Introduction

Early intervention with appropriate medications can improve the prognosis of schizophrenia (Cohen et al., 2008; Higuchi et al., 2019). Compared to schizophrenia patients treated with psychotropic medications, unmedicated schizophrenia patients usually have poor long-term outcomes, such as higher suicide risk, more severe psychotic symptoms, worse social functioning (Kurihara et al., 2005; Li et al., 2018; Padmavathi et al., 1998; Ran et al., 2001, 2007) and poorer physical condition (De Hert et al., 2011; Wasnik et al., 2019). Longer duration of untreated psychosis is also associated with worse prognosis (Marshall et al., 2005; Penttilä et al., 2014; Perkins et al., 2005).

In developing countries, such as in China, the treatment rate of schizophrenia patients remains relatively low (Padmavathi et al., 1998; Phillips et al., 2009; Ran et al., 2001; Srinivasan et al., 2001). For instance, one study (Phillips et al., 2009) found that 27.6% of Chinese patients with schizophrenia or related disorders never sought help from mental health professionals, while 12% had received treatment in non-psychiatric services, such as provided by general physicians and Chinese medicine practitioners. A longitudinal study in China found that the proportion of treatment-naïve patients with schizophrenia gradually decreased from 30.6% in 1994 to 20.4% in 2008 (Ran et al., 2015a). Several demographic and clinical factors are associated with the use of medication in schizophrenia patients, such as higher education level, greater access to mental health professionals, higher financial status, less economic burden of treatment and better social support system (Wang et al., 2000; World Health Organization, 2005). However, most studies had a small sample size and were conducted in economically developed areas of China, and therefore, their findings may not be applicable to economically underdeveloped areas (Yang, 2019).

In China, most patients with schizophrenia and other severe mental illness usually live in the community, partly supported by the recently developed community-based psychiatric service system. Due to limited health resources, however, schizophrenia patients in economically underdeveloped areas usually have little or no access to mental health services (Xiang et al., 2018). Understanding the pattern of unmedicated schizophrenia patients can help develop appropriate policies and treatment strategies for this vulnerable group. To date, there are no large-scale studies that specifically examined the medication treatment rate of schizophrenia patients in economically underdeveloped areas of China.

Therefore, we investigated the pattern of unmedicated schizophrenia patients who were living in economically underdeveloped areas of China, and also explored its demographic and clinical correlates. Due to the differences in financial level, social support and health resources, patients living in both rural and urban areas were studied. We hypothesized that the proportion of unmedicated schizophrenia patients in rural areas would be higher than in urban areas.