Effects of socioeconomic status in cognition of people with schizophrenia:Results from a Latin American collaboration network with 1175 subjects

Background Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls. Methods We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments. Results Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology. Conclusions Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low-and middle-income countries.Fil: Sanguinetti Czepielewski, Letícia. Hospital de Clinicas de Porto Alegre; Brasil. Universidade Federal do Rio Grande do Sul; BrasilFil: Alliende, Luz Maria. Pontificia Universidad Católica de Chile; Chile. Instituto Psiquiátrico Dr. Horwitz Barak; ChileFil: Castañeda, Carmen Paz. Instituto Psiquiátrico Dr. Horwitz Barak; ChileFil: Castro, Mariana Nair. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; ArgentinaFil: Guinjoan, Salvador Martín. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Salud Mental; ArgentinaFil: Massuda, Raffael. Universidade Federal do Paraná; BrasilFil: Berberian, Arthur A.. Universidade Federal de Sao Paulo; BrasilFil: Fonseca, Ana Olivia. Universidade Federal de Sao Paulo; BrasilFil: Gadelha, Ary. Universidade Federal de Sao Paulo; BrasilFil: Bressan, Rodrigo. Universidade Federal de Sao Paulo; BrasilFil: Crivelaro, Marisa. Universidade de Sao Paulo; BrasilFil: Louzã, Mario. Universidade de Sao Paulo; BrasilFil: Undurraga, Juan. Universidad del Desarrollo; Chile. Instituto Psiquiátrico Dr. Horwitz Barak; ChileFil: González Valderrama, Alfonso. Instituto Psiquiátrico Dr. Horwitz Barak; Chile. Universidad Finis Terrae; ChileFil: Nachar, Rubén. Instituto Psiquiátrico Dr. Horwitz Barak; Chile. Universidad Finis Terrae; ChileFil: Nieto, Rodrigo. Universidad de Chile; ChileFil: Montes, Cristian. Universidad de Chile; ChileFil: Silva, Hernan. Universidad de Chile; ChileFil: Langer, Álvaro I.. Millennium Nucleus To Improve The Mental Health Of Adolescents And Youths; Chile. Millennium Institute For Research In Depression And Personality; Chile. Universidad Austral de Chile; ChileFil: Schmidt, Carlos. Universidad de Barcelona; España. Millennium Institute For Research In Depression And Personality; ChileFil: Mayol Troncoso, Rocío. Universidad de Chile. Facultad de Medicina; Chile. Millennium Nucleus To Improve The Mental Health Of Adolescents And Youths; ChileFil: Díaz Zuluaga, Ana M.. Universidad de Antioquia; ColombiaFil: Valencia Echeverry, Johanna. Universidad de Antioquia; ColombiaFil: López Jaramillo, Carlos. Universidad de Antioquia; ColombiaFil: Solís Vivanco, Rodolfo. Instituto Nacional de Neurología y Neurocirugía; MéxicoFil: Reyes Madrigal, Francisco. Instituto Nacional de Neurología y Neurocirugía; MéxicoFil: De La Fuente Sandoval, Camilo. Instituto Nacional de Neurología y Neurocirugía; MéxicoFil: Crossley, Nicolás A.. Universidad Católica de Chile; Chile. Pontificia Universidad Católica de Chile; Chile. King's College London; Reino UnidoFil: Gama, Clarissa S.. Universidade Federal do Rio Grande do Sul; Brasil. Hospital de Clinicas de Porto Alegre; Brasi

Gender, age and geographical representation over the past 50 years of schizophrenia research

Previous studies have suggested that subjects participating in schizophrenia research are not representative of the demographics of the global population of people with schizophrenia, particularly in terms of gender and geographical location. We here explored if this has evolved throughout the decades, examining changes in geographical location, gender and age of participants in studies of schizophrenia published in the last 50 years. We examined this using a meta-analytical approach on an existing database including over 3,000 studies collated for another project. We found that the proportion of studies and participants from low-and-middle income countries has significantly increased over time, with considerable input from studies from China. However, it is still low when compared to the global population they represent. Women have been historically under-represented in studies, and still are in high-income countries. However, a significantly higher proportion of female participants have been included in studies over time. The age of participants included has not changed significantly over time. Overall, there have been improvements in the geographical and gender representation of people with schizophrenia. However, there is still a long way to go so research can be representative of the global population of people with schizophrenia, particularly in geographical terms

The enduring gap in educational attainment in schizophrenia according to the last 50 years of published research: a meta-analysis

Background. Educational attainment is associated with well-being and health. Unfortunately, patients with schizophrenia achieve lower levels of education. Several effective interventions can ameliorate this. However, the magnitude of the education gap in schizophrenia and changes over time are unclear. Methods. We performed a systematic review and meta-analysis including all studies reporting on patients with schizophrenia and describing their years of education, with or without healthy controls. There were no other design constraints on studies. 22 reviewers participated in retrieving data from a search in PubMed and PsycINFO (January 1st, 1970, to November 24th, 2020). We estimated the birth date of participants from their mean age and publication date, and metaanalyzed these data, focusing on educational attainment, the education gap, and changes over time. The protocol was registered in PROSPERO (CRD42020220546). Outcomes. From 32,593 initial references, we included 3,321 studies reporting on 318,632 patients alongside 138,675 healthy controls (170,941 women and 275,821 men from studies describing gender; ethnicity was not collected). Patients educational attainment increased over time mirroring the controls.  However, patients achieved 19 months less than patients, and this remained unchanged throughout the decades. Studies were biased to include more educated patients and controls than their respective larger population, but results were unchanged in studies with groups with similar parental education. Interpretation. Patients with schizophrenia have faced persistent inequality in educational attainment in the last century, despite advances in psychosocial and pharmacological treatment. Reducing this gap should become a priority to improve their functional outcomes