The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta analysis

Schizophr Res. 2009 Apr;109(1-3):15-23. doi: 10.1016/j.schres.2009.01.008. Epub 2009 Feb 23.


Background: The duration of untreated psychosis (DUP) is defined as the period between the onset of symptoms of psychosis and the start of antipsychotic treatment. Delay in the initiation of treatment, resulting in a long DUP, is associated with a poor prognosis in high-income (HI) countries. It is not known if longer DUP is associated with poor outcomes in Low and Middle Income (LAMI) countries, where schizophrenia might have a more benign course.

Methods: A systematic review and meta-analysis of studies from LAMI countries that reported an association between DUP and response to treatment, measures of disability and mortality. The association between DUP, symptoms and cognitive function at presentation were also examined.

Findings: Meta analysis of five studies that reported the association between DUP and the reduction in total symptoms scores after treatment found a significant negative correlation between DUP and improvement in symptoms after treatment (r=-0.290, 95% CI=-0.483 to -0.069, z=-2.559, p<0.011). Prolonged DUP was also associated with increased levels of disability. One study reported that longer DUP was associated with a higher mortality in the following decade.

Conclusions: Delay in the initial initiation of treatment for psychosis is associated with a poorer response to treatment and increased levels of disability in LAMI countries.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use*
  • Cognition Disorders
  • Cross-Cultural Comparison
  • Developing Countries / economics*
  • Female
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Poverty / statistics & numerical data*
  • Prognosis
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / drug therapy
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenic Psychology
  • Time Factors
  • Treatment Outcome


  • Antipsychotic Agents