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Full-Length Research Report

Do South African Xhosa-Speaking People with Schizophrenia Really Fare Better?

A Longitudinal Mortality Study in Older Patients with Schizophrenia

Published Online:February 26, 2020https://doi.org/10.1024/1662-9647/a000217

Abstract

Abstract.Objectives: Results from multinational WHO studies suggest that schizophrenia patients in developing countries may have more favorable prognoses and morbidity outcomes than those in developed settings. This study serves to establish whether mortality outcomes in South African Xhosa-speaking schizophrenia patients are more favorable than in the general South African population. Methods: We recruited a group of 981 patients from September 1997 to March 2005 as part of a genetic study in the Western, Southern, and Eastern Cape provinces of South Africa. For this substudy, participants were included when they reached the age of 60 years during the study period (8–15 years). We examined factors associated with the probability of dying and computed survival times using national census data as reference. Results: At the time of follow-up, 73 individuals were 60 years or older (21.9% could not be traced); some 40% of the sample had died at the time of the follow-up assessment (mean age at death = 60.12 years, SD = 4.97). Univariate survival analysis, using duration of disorder, revealed that the number of hospitalizations and psychotic episodes impacted survival time. Compared to the age-specific death rates of the general South African population, the death rate in the Xhosa-speaking schizophrenia sample was higher than expected in the 60–69 years category, but lower than expected in the 70+ years category. Conclusion: This study suggests that increased exposure to inpatient mental healthcare (expressed as number of hospitalizations) at baseline, and number of psychotic episodes, improve survival probability in a group of older South African Xhosa-speaking schizophrenia patients.

References

  • Botha, U. A., Koen, L., & Niehaus, D. J. H. (2006). Perceptions of a South African schizophrenia population regarding community attitudes towards their illness. Social Psychiatry & Psychiatric Epidemiology, 41, 619–623. First citation in articleCrossref, Google Scholar

  • Brink, S., Niehaus, D., Oosthuizen, P. P., Muller, J., & Koen, L. (2004). Occupation and schizophrenia in a Xhosa population: A variant of the social drift theory? South African Medical Journal, 94, 42. First citation in articleGoogle Scholar

  • Callaghan, R. C., Boire, M. D., Lazo, R. G., McKenzie, K., & Cohn, T. (2009). Schizophrenia and the incidence of cardiovascular morbidity. Schizophrenia Research, 115, 325–332. First citation in articleCrossref, Google Scholar

  • Chochinov, H. M., Martens, P. J., Prior, H. J., Fransoo, R., Burland, E., & Team, Need. To. Know. (2009). Does a diagnosis of schizophrenia reduce rates of mammography screening? A Manitoba population-based study. Schizophrenia Research, 113, 95–100. First citation in articleCrossref, Google Scholar

  • Chou, F. H., Tsai, K. Y., & Chou, Y. M. (2013). The incidence and all-cause mortality of pneumonia in patients with schizophrenia: A nine-year follow-up study. Journal of Psychiatric Research, 47, 460–466. First citation in articleCrossref, Google Scholar

  • Chou, F. H., Tsai, K. Y., Su, C. Y., & Lee, C. C. (2011). The incidence and relative risk factors for developing cancer among patients with schizophrenia: A nine-year follow-up study. Schizophrenia Research, 129, 97–103. First citation in articleCrossref, Google Scholar

  • Closson, K., McLinden, T., Patterson, T. L., Eyawo, O., Kibel, M., Card, K. G., et al. (2019). HIV, schizophrenia, and all-cause mortality: A population-based cohort study of individuals accessing universal medical care from 1998 to 2012 in British Columbia, Canada. Comparative Outcomes and Service Utilization Trends (COAST) Study. Schizophrenia Research, 209, 198–205. First citation in articleCrossref, Google Scholar

  • Cohen, A., Patel, V., Thara, R., & Gureje, O. (2008). Questioning an axiom: Better prognosis for schizophrenia in the developing world? Schizophrenia Bulletin, 34, 229–244. First citation in articleCrossref, Google Scholar

  • Cooke, B. K., Magas, L. T., Virgo, K. S., Feinberg, B., Adityanjee, A., & Johnson, F. E. (2007). Appendectomy for appendicitis in patients with schizophrenia. The American Journal of Surgery, 193(1), 41–48. First citation in articleCrossref, Google Scholar

  • Daumit, G. L., Pronovost, P. J., Anthony, C. B., Guallar, E., Steinwachs, D. M., & Ford, D. E. (2006). Adverse events during medical and surgical hospitalizations for persons with schizophrenia. Archives of General Psychiatry, 63, 267–272. First citation in articleCrossref, Google Scholar

  • De Witt, C., Smit, I., Jordaan, E., Koen, L., Niehaus, D. J. H., & Botha, U. (2019). The impact of a psychiatry clinical rotation on the attitude of South African final year medical students towards mental illness. BMC Medical Education, 19, 114. First citation in articleCrossref, Google Scholar

  • Dorrington, R. E., Bradshaw, D., Laubscher, R., & Nannan, N. (2014). Rapid mortality surveillance report 2013. Cape Town: South African Medical Research Council. First citation in articleGoogle Scholar

  • Druss, B. G., Bradford, D., Rosenheck, R. A., Radford, M. J., & Krumholz, H. M. (2001). Quality of medical care and excess mortality in older patients with mental disorders. Archives of General Psychiatry, 58, 565–572. First citation in articleCrossref, Google Scholar

  • Emsley, R. A., Roberts, M. C., Rataemane, S., Pretorius, J., Oosthuizen, P. P., Turner, J., … Stein, D. J. (2002). Ethnicity and treatment response in schizophrenia: A comparison of 3 ethnic groups. Journal of Clinical Psychiatry, 63(1), 9–14. First citation in articleCrossref, Google Scholar

  • Faasen, N., Niehaus, D. J. H., Koen, L., & Jordaan, E. (2014). Undiagnosed metabolic syndrome and other adverse effects among clozapine users of Xhosa descent. South African Journal of Psychiatry, 20(2), 54–57. First citation in articleCrossref, Google Scholar

  • Fan, Z., Wu, Y., Shen, J., & Zhan, R. (2013). Schizophrenia and the risk of cardiovascular diseases: A meta-analysis of thirteen cohort studies. Journal of Psychiatric Research, 47, 1549–1556. First citation in articleCrossref, Google Scholar

  • Goldberg, R. W., Kreyenbuhl, J. A., Medoff, D. R., Dickerson, F. B., Wohlheiter, K., Fang, L. J., … Dixon, L. B. (2007). Quality of diabetes care among adults with serious mental illness. Psychiatric Services, 58, 536–543. First citation in articleCrossref, Google Scholar

  • Green, M. F., Horan, W. P., Lee, J., McCleery, A., Reddy, L. F., & Wynn, J. K. (2018). Social disconnection in schizophrenia and the general community. Schizophrenia Bulletin, 44, 242–249. First citation in articleCrossref, Google Scholar

  • Harrison, G., Hopper, K., Craig, T., Laska, E., Siegel, C., Wanderling, J., … Wiersma, D. (2001). Recovery from psychotic illness: A 15- and 25-year international follow-up study. British Journal of Psychiatry, 178, 506–517. First citation in articleCrossref, Google Scholar

  • Hjorthoj, C., Sturup, A. E., McGrath, J. J., & Nordentoft, M. (2017). Years of potential life lost and life expectancy in schizophrenia: A systematic review and meta-analysis. Lancet Psychiatry, 4, 295–301. First citation in articleCrossref, Google Scholar

  • Holla, B., & Thirthalli, J. (2015). Course and outcome of schizophrenia in Asian countries: Review of research in the past three decades. Asian Journal of Psychiatry, 14, 3–12. First citation in articleCrossref, Google Scholar

  • Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10, 227–237. First citation in articleCrossref, Google Scholar

  • Hugo, C. J., Boshoff, D. E., Traut, A., Zungu-Dirwayi, N., & Stein, D. J. (2003). Community attitudes toward and knowledge of mental illness in South Africa. Social Psychiatry and Psychiatric Epidemiology, 38, 715–719. First citation in articleCrossref, Google Scholar

  • Hulshof, T. A., Zuidema, S. U., Ostelo, R. W., & Luijendijk, H. J. (2015). The mortality risk of conventional antipsychotics in elderly patients: A systematic review and meta-analysis of randomized placebo-controlled trials. Journal of the American Medical Directors Association, 16, 817–824. First citation in articleCrossref, Google Scholar

  • Jablensky, A., & Sartorius, N. (2008). What did the WHO studies really find? Schizophrenia Bulletin, 34, 253–255. First citation in articleCrossref, Google Scholar

  • Jeon, S. W., & Kim, Y. K. (2017). Unresolved issues for utilization of atypical antipsychotics in schizophrenia: Antipsychotic polypharmacy and metabolic syndrome. International Journal Molecular Sciences, 18(10), 601–612. First citation in articleCrossref, Google Scholar

  • Joukamaa, M., Heliovaara, M., Knekt, P., & Aromaa, A. (2001). Mental disorders and cause specific mortality. British Journal of Psychiatry, 179, 498–502. First citation in articleCrossref, Google Scholar

  • Kiseley, S., Smith, M., Lawrence, D., & Maaten, S. (2005). Mortality in individuals who have had psychiatric treatment: Population-based study in Nova Scotia. British Journal of Psychiatry, 187, 552–558. First citation in articleCrossref, Google Scholar

  • Koen, L., Uys, S., Niehaus, D. J. H., & Emsley, R. A. (2007). Negative symptoms and HIV/AIDS risk behaviour knowledge in schizophrenia. Psychosomatics, 48, 128–134. First citation in articleCrossref, Google Scholar

  • Kraepelin, E. (1919). Dementia praecox and paraphrenia. Edinburgh: Livingstone. First citation in articleGoogle Scholar

  • Kurdyak, P., Vigod, S., Calzavara, A., & Wodchis, W. P. (2012). High mortality and low access to care following incident acute myocardial infarction in individuals with schizophrenia. Schizophrenia Research, 142(1–3), 52–57. First citation in articleCrossref, Google Scholar

  • Lee, E. E., Liu, J., Tu, X., Palmer, B. W., Eyler, L. T., & Jeste, D. V. (2018). A widening longevity gap between people with schizophrenia and general population: A literature review and call for action. Schizophrenia Research, 196, 9–13. First citation in articleCrossref, Google Scholar

  • Luckhoff, M., Koen, L., Jordaan, E., & Niehaus, D. (2014). Attempted suicide in a Xhosa schizophrenia and schizoaffective disorder population. Suicide and Life-Threatening Behaviour, 44, 167–174. First citation in articleCrossref, Google Scholar

  • Manu, P., Dima, L., & Shulman, M. (2015). Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management. Acta Psychiatrica Scandinavica, 132, 97–108. First citation in articleCrossref, Google Scholar

  • Martens, P. J., Chochinov, H. M., Prior, H. J., Fransoo, R., Burland, E. & Need To Know Team. (2009). Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study. Schizophrenia Research, 113, 101–106. First citation in articleCrossref, Google Scholar

  • Mbanga, N. I., Niehaus, D. J., Mzamo, N. C., Wessels, C. J., Allen, A., Emsley, R. A., & Stein, D. (2002). Attitudes towards and beliefs about schizophrenia in Xhosa families with affected probands. Curiatonis, 25(1), 69–73. First citation in articleGoogle Scholar

  • Murray, C. J. L. & GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the global burden of disease study 2013. Lancet, 385, 117–171. First citation in articleCrossref, Google Scholar

  • Nasrallah, H. A., Meyer, J. M., Goff, D. C., McEvoy, J. P., Davis, S. M., Stroup, T. S., & Lieberman, J. A. (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research, 86, 15–22. First citation in articleCrossref, Google Scholar

  • Newman, S. C., & Bland, R. C. (1991). Mortality in a cohort of patients with schizophrenia: A record linkage study. Canadian Journal of Psychiatry, 36, 239–245. First citation in articleCrossref, Google Scholar

  • Niehaus, D. J., Laurent, C., Jordaan, E., Koen, L., Oosthuizen, P., Keyter, N., … Emsley, R. A. (2004). Suicide attempts in an African schizophrenia population: An assessment of demographic risk factors. Suicide and Life-Threatening Behaviour, 34, 320–327. First citation in articleCrossref, Google Scholar

  • Niehaus, D. J. H., Koen, L., Laurent, C., Muller, J., DeLeuze, J. F., Mallet, J., … Emsley, R. A. (2005). Positive and negative symptoms in affected sibling pairs with schizophrenia: Implications for genetic studies in an African Xhosa sample. Schizophrenia Research, 15(79), 239–249. First citation in articleCrossref, Google Scholar

  • Nielsen, R. E., Uggerby, A. S., Jensen, S. O., & McGrath, J. J. (2013). Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades: A Danish nationwide study from 1980 to 2010. Schizophrenia Research, 146(1–3), 22–27. First citation in articleCrossref, Google Scholar

  • Osby, U., Correia, N., Brandt, L., Ekbom, A., & Sparen, P. (2000). Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophrenia Research, 29(45), 21–28. First citation in articleCrossref, Google Scholar

  • Patel, V., Cohen, A., Thara, R., & Gureje, O. (2006). Is the outcome of schizophrenia really better in developing countries? Brazilian Journal of Psychiatry, 28, 149–152. First citation in articleCrossref, Google Scholar

  • Piotrowski, P., Gondek, T. M., Królicka-Deręgowska, A., Misiak, B., Adamowksi, T., & Kiejna, A. (2017). Causes of mortality in schizophrenia: An updated review of European studies. Psychiatria Danubina, 29, 108–120. First citation in articleCrossref, Google Scholar

  • Ringen, P. A., Engh, J. A., Birkenaes, A. B., Dieset, I., & Andreassen, O. A. (2014). Increased mortality in schizophrenia because of cardiovascular disease: A non-systematic review of epidemiology, possible causes, and interventions. Frontiers of Psychiatry, 5, 137. First citation in articleCrossref, Google Scholar

  • Sbarra, D. A. (2015). Divorce and health: Current trends and future directions. Psychosomatic Medicine, 77, 227–236. First citation in articleCrossref, Google Scholar

  • Shibre, T., Medhin, G., Alem, A., Kebede, D., Teferra, S., Jacobson, L., … Fekadu, A. (2015). Long-term clinical course and outcome of schizophrenia in rural Ethiopia: A 10-year follow-up of a population-based cohort. Schizophrenia Research, 161, 414–420. First citation in articleCrossref, Google Scholar

  • Shor, E., Roelfs, D. J., Curreli, M., Clemow, L., Burg, M. M., & Schwartz, J. E. (2012). Widowhood and mortality: A meta-analysis and meta-regression. Demography, 49, 575–606. First citation in articleCrossref, Google Scholar

  • Statistics South Africa (Stats SA). (2014). Mortality and causes of death in South Africa, 2011: Findings from death notification. Pretoria: Stats SA. Retrieved from http://www.statssa.gov.za/publications/P03093/P030932011.pdf First citation in articleGoogle Scholar

  • Vermeulen, J., van Rooijen, G., Doedens, P., Numminen, E., van Tricht, M., & de Haan, L. (2017). Antipsychotic medication and long-term mortality risk in patients with schizophrenia: A systematic review and meta-analysis. Psychological Medicine, 47, 2217–2228. First citation in articleCrossref, Google Scholar

  • Wagner, L. C., Torres-González, F., Runte Geidel, A., & King, M. B. (2011). Existential questions in schizophrenia: Perceptions of patients and caregivers. Revista Saúde Pública, 45, 401–408. First citation in articleCrossref, Google Scholar

  • Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, 72, 334–341. First citation in articleCrossref, Google Scholar

  • Zhuo, C., Tao, R., Jiang, R., Lin, X., & Shao, M. (2017). Cancer mortality in patients with schizophrenia: Systematic review and meta-analysis. British Journal of Psychiatry, 211(1), 7–13. First citation in articleCrossref, Google Scholar