Schizophrenia is a highly prevalent condition. There is evidence suggesting that a large proportion of individuals with schizophrenia are not diagnosed, or do not get any/evidence-based treatment, get appropriate diagnosis/treatment with delays or do not adhere to treatment

Höschl, Cyril

Kanavos, Panos

Knapp, Martin

Pompili, Maurizio

Tinelli, Michela

Winkler, Petr

LSE Research Online

Abstract Title: The impact of non-treatment of schizophrenia in OECD countries: a literature review Authors: Tinelli, Michela1; Kanavos, Panos1; Winkler, Petr2; Knapp, Martin1; Höschl, Cyril2; Pompili, Maurizio3 1 LSE Health and Social Care, the London School of Economics, Houghton Street, London WC2A 2AE, United Kingdom Michela Tinelli, health economics: m.tinelli@lse.ac.uk; Panos Kanavos, international health policy: p.g.kanavos@lse.ac.uk; Martin Knapp, health and social care policy and practice: m.kanpp@lse.ac.uk 2 Department of Social Psychiatry, Prague Psychiatric Center / National Institute of Mental Health, Ustavni 91, 181 03 Prague, Czech Republic.  Cyril Höschl, psychiatry: Cyril.Hoschl@nudz.cz Winkler Petr, psychiatry Petr.Winkler@nudz.cz  3 Dept. of Neurosciences, Mental Health and Sensory Organs. Sant'Andrea Hospital, Sapienza University of Rome, Italy Maurizio Pompili, psychiatry maurizio.pompili@uniroma1.it   Introduction Schizophrenia is a highly prevalent condition. There is evidence suggesting that a large proportion of individuals with schizophrenia are not diagnosed, or do not get any/evidence-based treatment, get appropriate diagnosis/treatment with delays or do not adhere to treatment.   Objectives To review the literature on the impact of non-treatment of schizophrenia  Aims: to examine the state of knowledge regarding the impact of unmet needs associated with non-treatment of schizophrenia.  Methods: A series of databases (MEDLINE, PsycINFO, ISI-Web-of-Science, International-Bibliography-of-the-Social-Sciences, and Social-Care-Online) and grey literature sources (OECD-library, Open-Grey-Library, Greylit-library, and Advanced-Google-search) were searched for outputs published in English (2004-2014). Geography included OECD countries. Participants were individuals with schizophrenia (or other psychosis). Types of studies screened were: literature reviews; empirical studies of interventions irrespective of design; and observational studies. Outcome measures included: use of health and social care resources; comorbidities; use of criminal justice resources; employment; education; violence and premature death; and homelessness. Non-treatment was defined as: missed (or delayed) diagnosis; lack of (or delays in) treatment; inappropriate treatment; and non-adherence/non-compliance. Experts checked the methodology and provided additional publications. Results 927 citations were extrapolated from searches and feedback of experts. Of these, 41 studies were relevant, whose quality ranged from poor to excellent. Evidence referred to current/usual care, in the USA (n=11), UK (8), Sweden (5) Australia (4), and additional 14 countries (1-3 papers each). The majority of the studies investigated impact on use of healthcare resources (20) or violence (20), followed by employment issues (13). A few studies examined impact on education (4), use of criminal justice resources (3), homelessness (3) or comorbidities (2). International literature of mixed quality suggests that the effect of non-treatment of schizophrenia can: lead to increased use of health care services as well as productivity losses for the individual and society, violent acts and premature deaths. Additional evidence reports on the social impact of schizophrenia due to above-average rates of imprisonment, poor education, and homelessness.   Conclusions This literature review suggests that non-treatment of schizophrenia is devastating and can have significant impact on the individual, their family, and the society overall.  

The impact of non-treatment of schizophrenia in OECD countries: a literature review

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