Background Poorly defined cohorts and weak study designs have hampered cros
s-cultural comparisons of course and outcome in schizophrenia.
Aims To describe long-term outcome in 18 diverse treated incidence and prev
alence cohorts. To compare mortality, 15- and 25-year illness trajectory an
d the predictive strength of selected baseline and short-term course variab
les.
Method Historic prospective study. Standardised assessments of course and o
utcome.
Results About 75% traced. About 50% of surviving cases had favourable outco
mes, but there was marked heterogeneity across geographic centres. In regre
ssion models, early (2-year) course patterns were the strongest predictor o
f 15-year outcome, but recovery varied by location; 16% of early unremittin
g cases achieved late-phase recovery.
Conclusions A significant proportion of treated incident cases of schizophr
enia achieve favourable long-term outcome. Sociocultural conditions appear
to modify long-term course. Early intervention programmes focused on social
as well as pharmacological treatments may realise longer-term gains.
Declaration of interest Funded by the Laureate Foundation, the World Health
Organization and the participating centres (see Acknowledgements).