Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 34 (2), 229-44

Questioning an Axiom: Better Prognosis for Schizophrenia in the Developing World?


Questioning an Axiom: Better Prognosis for Schizophrenia in the Developing World?

Alex Cohen et al. Schizophr Bull.


Introduction: That schizophrenia has a better course and outcome in developing countries has become an axiom in international psychiatry. This is based primarily on a series of cross-national studies by the World Health Organization (WHO). However, increasing evidence from other research indicates a far more complex picture.

Methods: Literature review and tabulation of data from 23 longitudinal studies of schizophrenia outcomes in 11 low- and middle-income countries.

Results: We reviewed the evidence about the following domains: clinical outcomes and patterns of course, disability and social outcomes (marital and occupational status, in particular), and untreated samples and duration of untreated psychosis. Outcomes varied across the studies and the evidence suggests a need to reexamine the conclusions of the WHO studies. Additionally, assessments of outcomes should take excess mortality and suicide into account.

Conclusions: It is time to reexamine presumed wisdom about schizophrenia outcomes in low- and middle-income countries.

Comment in

Similar articles

See all similar articles

Cited by 56 PubMed Central articles

See all "Cited by" articles


    1. Patel V, Cohen A, Thara R, Gureje O. Is the outcome of schizophrenia really better in developing countries? Rev Bras Psiquiatr. 2006;28:149–152. - PubMed
    1. Bhugra D. Severe mental illness across cultures. Acta Psychiatr Scand Suppl. 2006;34(2):229–244.
    1. Isaac M, Chand P, Murthy P. Schizophrenia outcome measures in the wider international community. Br J Psychiatry. 2007;191(suppl 50):s71–s77. - PubMed
    1. Kulhara P, Chakrabarti S. Culture and schizophrenia and other psychotic disorders. Psychiatr Clin North Am. 2001;24:449–464. - PubMed
    1. Mueser KT, McGurk SR. Schizophrenia. Lancet. 2004;363:2063–2072. - PubMed