Schizophrenia In China Research Articles

Suicide-related behaviours in schizophrenia in China: a comprehensive meta-analysis.

Suicide-related behaviours are common in schizophrenia and are significantly associated with premature death. The objective of this meta-analysis study was to estimate the pooled prevalence of suicide-related behaviours in schizophrenia patients in China. The relevant literature was searched systematically via the relevant electronic databases (PubMed, Embase, PsycINFO, Chinese National Knowledge Infrastructure, Wanfang Databases and Chinese Biological Medical Literature Database) from their inception until 14 September 2016. Only original studies that reported the prevalence of suicide-related behaviours including suicidal ideation (SI), suicide plan, suicide attempt (SA) and completed suicide were selected. Nineteen articles met the inclusion criteria and were analysed. The pooled lifetime prevalence of SI and SA were 25.8% (95% CI 14.7-41.1%) and 14.6% (95% CI 9.1-22.8%), respectively. The 1-month prevalence of SI was 22.0% (95% CI 18.2-26.4%). Subgroup analyses of lifetime SI and SA showed that gender, sample size, survey year, study location and source of patients have no significant mediating effects on the results. Suicide-related behaviours are common in Chinese schizophrenia patients. Due to the high mortality risk, regular screening and effective suicide prevention programmes are warranted.

Quality of Life in Patients With Schizophrenia in China: Relationships Among Demographic Characteristics, Psychosocial Variables, and Symptom Severity.

The aim of the current study was to examine the relationships among demographic characteristics, psychosocial variables, symptom severity, and quality of life (QOL), and the way these variables affect QOL in patients with schizophrenia living in Hubei, China. A convenience sample of 178 individuals with schizophrenia participated. The results suggest that the Schizophrenia Quality of Life Scale was positively and statistically significantly correlated with employment status (r = 0.232, p < 0.01) and monthly household income (r = 0.311, p < 0.01), positively correlated with personal empowerment (r = 0.692; p < 0.001), and negatively correlated with perceived stigma (r = -0.41, p < 0.01) and symptom severity (r = -0.54, p < 0.001). Illness uncertainty was not found to have a relationship with QOL in this sample. Among all variables, personal empowerment (accounting for 22.1% of variance) was the best positive predictor, whereas symptom severity (accounting for 7.6% of variance) was the best negative predictor of QOL in patients with schizophrenia. Implications for future research and practice are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 48-54.].

Electroconvulsive Therapy in Schizophrenia in China: A National Survey.

Little is known about electroconvulsive therapy (ECT) use in the treatment of schizophrenia in China. This study examined the frequency of ECT use, its trend between 2006 and 2012, and its independent demographic and clinical correlates in a nationwide survey in China. A total of 5162 inpatients in 45 Chinese psychiatric hospitals/centers were interviewed (2696 in 2006 and 2466 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Electroconvulsive therapy was used in 6.1% of the whole sample; 4.7% in 2006 and 7.7% in 2012 (P < 0.001) with wide interprovince variations. Multiple logistic regression analyses of the whole sample revealed that patients receiving ECT were more likely to be women, receive second-generation antipsychotics, treated in tertiary referral centers (level III hospitals), had a shorter illness duration, and more positive and depressive symptoms (R = 0.181; P < 0.001). Electroconvulsive therapy for schizophrenia has increased between 2006 and 2012 in China. Its percentage was higher than the figures reported in most other countries. Reasons for the substantial variations in the frequency of ECT across different provinces in China require further investigations.

Season of birth and schizophrenia: Evidence from China

Controversies exist whether season of birth is associated with schizophrenia development later in life, and evidence has mainly come from studies done in developed countries. This study examines the association between season of birth and risk for schizophrenia in China, with special attention to geographical region, urbanity, and gender. Using data from China’s Second National Sampling Survey on Disability, a large-scale, nationally representative sample (N=2,052,694), this study employs discrete-time hazard models to compare the risk for schizophrenia development for people born in different seasons, and conducts subsample analyses by geographical region, urbanity, and gender. People born in the spring have the highest risk when compared to people born in the winter, summer or autumn. Furthermore, the relatively higher risk for people born in the spring is greater in the southern half of the country, in rural areas, and for women. The findings are consistent with results from a robustness check done among people who were conceived and born from 1955 to 1965, periods before, during, and after the 1959–1961 Chinese Famine. This study supports the presence of an association between season of birth and risk for schizophrenia development and of heterogeneity by geographical region, urbanity, and gender.

Schizophrenia in Chinese and U.S. Online News Media: Exploring Cultural Influence on the Mediated Portrayal of Schizophrenia

ABSTRACTDrawing on the constructionist framing approach, this quantitative content analysis compares online news coverage of schizophrenia in China and the United States in 2015. Incorporating the concept of individualism–collectivism, this study seeks to unveil the effects of culture on the framing of causes, solutions, responsibility attribution, and discourse types. The findings reveal that the link between cultural orientation and the media’s framing of schizophrenia is not simple, as both cross-cultural consistency and differences were observed. In addition, compared to U.S. online media, Chinese online news outlets were more likely to cover schizophrenia episodically, while placing more problem-solving responsibility on society. Moreover, examining stigma and challenge cues, this study also found that schizophrenia was more severely stigmatized in Chinese than in U.S. online news platforms. Theoretical and practical implications are discussed.

Adjunctive antidepressant use in schizophrenia in China: A national survey (2002-2012).

This study examined the pattern of adjunctive antidepressant use in schizophrenia patients and its demographic and clinical correlates in a nationwide survey in China. Fourteen thousand and thirteen patients in 45 Chinese psychiatric hospitals or centers were interviewed (4,486 in 2002, 5,288 in 2006, and 4,239 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Chi-square test, independent-samples t test, Mann-Whitney U test, and multiple logistic regression analysis were used in data analyses. Antidepressant use was found in 5.2% of the study population with 4.6% in 2002, 4.3% in 2006, and 6.9% in 2012, respectively. A significant increase in use from 2006 to 2012 was found (p<.001). Multiple logistic regression analyses in the whole population revealed that patients receiving adjunctive antidepressants were more likely to be outpatients in tertiary referral centers (level-III hospitals) and who had an earlier age of onset, less severe global illness, but more depressive symptoms. They were less likely to receive first-generation antipsychotics but more likely to receive benzodiazepines (R2 =0.255, p<.001). Despite an increasing trend, the frequency of antidepressant use in schizophrenia in China was considerably lower than in Western countries. The benefits and risks associated with concomitant use of antidepressants in schizophrenia need to be studied further.

Prevalence and Factors Associated With Decreased Bone Mineral Density in Young and Middle-Aged Male Schizophrenic Patients

Objective: The prevalence and factors of decreased bone mineral density (BMD) in young and middle-aged schizophrenic male subjects were examined in this study. Methods: The sample included male patients, diagnosed with schizophrenia, between 18 and 45 years old. In the large-sample, cross-sectional study, cluster sampling method was adopted. 200 male inpatients in total, between 18 and 45 years old, diagnosed with schizophrenia, were included and interviewed in Beijing. The clinical assessment instruments included the Positive and Negative Syndrome Scale (PANSS) and a questionnaire with disease-related investigations and general information. The laboratory measurements concluded calcium, phosphorus, total cholesterol, prolactin (PRL), thyroid stimulating hormone, fT3, T3, fT4, T4, testosterone and fasting blood-glucose (FBG). Dual-energy X-ray absorptiometry was used to test BMD. Results: The prevalence of osteopenia or osteoporosis was 33.5% (n=67). The prevalence of fracture in decreased BMD group was 17.9%12/67, significantly higher than that in the normal BMD group 8.3%11/133(p<0.05). Decreased BMD was associated with PANSS-negative scores, PANSS-total scores, body mass index (BMI), smoking and weight. Multiple logistic regression analysis revealed that BMI and PANSS-negative score had statistically significant difference between two groups. Conclusion: Prevalence of decreased bone mineral density was higher in young and middle-aged male subjects with schizophrenia in China. And the prevalence of fracture was more than twice in the decreased BMD group compared with the normal BMD group. PANSS-negative symptom was a risk factor, while BMI was a protective factor.

Effect of living with patients on caregiver burden of individual with schizophrenia in China.

Caregiver burden may be especially high in China. However, there has been no empirical study comparing burden experienced by caregivers who live with their patient kin and caregivers live separately from their kin. This study compared caregiver burden in cohabiting and non-cohabiting families and examined characteristics that may account for observed differences ion experienced burden. Patients were evaluated on symptoms, insight, attitudes toward medication before discharge and their prime caregivers were evaluated on family burden shortly after admission. Bivariate analysis of covariance and multiple regression analyses were used to compare burden between these two groups and to identify factors that might account for observed differences between them. Of 243 schizophrenic patients, 4.9% lived with their primary caregivers. Caregiver burden was greater among caregivers living with patient kin on three factors, caregiver distress, disrupted routines and assistance provided by caregivers, but not on caregiver perceptions of behavioral problems or suicidality. Multiple regression analysis showed that living with caregiver explained 6.7%, 8.3% and 6.7% of the variance in distress, disrupted routines and helpfulness. Living with a patient was by far the strongest correlate of increased burden experienced by schizophrenia caregivers in this study and these caregivers should be offered community-based support.

An exploratory cross-sectional study on the impact of education on perception of stigma by Chinese patients with schizophrenia.

BackgroundStigma is a major issue across various society and cultures, and few studies focus on the perception of stigma by Chinese patients with schizophrenia. In the current cross-sectional study, we sought to assess the extent of internalized stigma among outpatients with schizophrenia in China and to investigate whether education level correlated with the experience of stigma.MethodsOutpatients with schizophrenia were evaluated using the brief psychosis rating scale (BPRS), the positive and negative syndrome scale (PANSS), the clinical global impression-severity of illness (CGI-SI) scale and the Stigma Scale for Mental Illness (SSMI 2C). Patients were categorized into the high education and low education group according to their educational levels.ResultsOne hundred thirty-three subjects were included in the study. Their mean course of illness was 4.32 ± 6.14 years (range, 1 month to 15 years). Their mean BPRS score was 19.87 ± 5.46, their mean PANSS score was 44.11 ± 13.1, and their mean CGI-SI score was 2.22 ± 0.81. In addition, the mean SSMI 2C score of the high education group (7.15 ± 0.98) was markedly higher than that of the low education group (5.75 ± 0.79, P < 0.05). The mean domain I score of the high education group (2.30 ± 0.76) was comparable to that of the low education group (2.07 ± 0.78, P > 0.05). The mean domain II score of the high education group (2.42 ± 0.96) was markedly higher than that of the low education group (2.01 ± 0.79, P < 0.05). Moreover, the mean domain III score of the high education group (2.43 ± 0.79) was significantly higher than that of the low education group (1.67 ± 0.77, P < 0.05).ConclusionsEducation level impacts on the perception of stigma by patients with schizophrenia and more psycho-education should be done to improve patients’ knowledge about schizophrenia.

Smoking in male patients with schizophrenia in China: A meta-analysis

BackgroundThe aim of this study was to examine the prevalence of current smoking in male patients with schizophrenia in China. MethodA systematic literature search was conducted from database inception until June 20, 2015 without language restrictions in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and WanFang Database. Studies fulfilling the following criteria were included: (a) data available in male schizophrenia patients and (b) data available on current smoking status. Statistical analyses were performed with the Comprehensive Meta-Analysis program. ResultsA total of 23 studies met eligibility criteria for the meta-analysis. The pooled prevalence of current smoking was 59.1% (95% Confidence interval [CI]: 53.3–64.7%). Current smoking was significantly more frequent in inpatients than in outpatients (61.3% vs. 48.2%, Q=7.5, P=0.006), and higher in chronic compared to first-episode patients (74.5% vs. 45.1%, Q=32.3, P=0.0001). Furthermore, using a median split, patients aged 38.2 years or older smoked more often than those aged below 38.2 years (65.8% vs. 52.3%, Q=6.4, P=0.01). There were no significant associations between prevalence of current smoking and definitions of smoking, study publication year, sample size and illness duration. ConclusionsThe pooled prevalence of current smoking of male patients with schizophrenia in China is lower compared to Western and other Asian countries. Possible relationships between lower prevalence of current smoking and psychopathology in patients with schizophrenia require further investigation.

Current cigarette smoking in Chinese female patients with schizophrenia: A meta-analysis

The study objective was to perform a meta-analysis of the prevalence of current smoking in Chinese female patients with schizophrenia. A systematic literature search was conducted and studies fulfilling the following criteria were included: female schizophrenia patients; reporting current smoking rate computed from samples. Eight studies were included. The pooled current smoking prevalence was 4.3% (95% Confidence interval [CI]: 3.2–5.6%). The finding showed that smoking rate of female patients with schizophrenia in China was lower compared to their Western and other Asian counterparts.

Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis.

Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China. Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis. The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies). Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.

Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care.

Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China. A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection. The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics. Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.

Comparisons of family environment between homeless and non-homeless individuals with schizophrenia in Xiangtan, Hunan.

BackgroundHomelessness is an increasingly important problem for individuals with serious mental illness in China.AimIdentify the characteristics of families that are associated with homelessness among individuals with schizophrenia.MethodsParticipants were 1856 homeless individuals with schizophrenia (defined as those who had no place of residence or involved caregivers for 7 consecutive days) and 1728 non-homeless individuals with schizophrenia from Xiangtan, Hunan. The self-completion Family Environment Scale-Chinese Version (FES-CV) was administered to these participants after their acute psychotic symptoms resolved.ResultsCompared to individuals in the non-homeless group, those in the homeless group were older and more likely to be non-locals (i.e., from outside of Xiangtan), be residents of rural (versus urban) communities, have temporary (versus permanent) jobs, be married, and have a low level of education. After controlling for demographic differences using multivariate logistic regression models, homelessness was independently associated higher scores in the FES-CV intellectual-cultural orientation, organization, achievement orientation, and control subscales and with lower scores in the FES-CV cohesion, moralreligious emphasis, independence, and active-recreational orientation subscales.ConclusionAfter controlling for sociodemographic factors, certain aspects of the family environment areassociated with being homeless among patients with schizophrenia in China. Further work is needed to identify interventions that can reduce the risk of homelessness in high-risk individuals.

Prevalence of schizophrenia in China between 1990 and 2010.

BackgroundDramatic development and changes in lifestyle in many low and middle–income countries (LMIC) over the past three decades may have affected mental health of their populations. Being the largest country and having the most striking record of development, industrialization and urbanization, China provides an important opportunity for studying the nature and magnitude of possible effects.MethodsWe reviewed CNKI, WanFang and PubMed databases for epidemiological studies of schizophrenia in mainland China published between 1990 and 2010. We identified 42 studies that reported schizophrenia prevalence using internationally recognized diagnostic criteria, with breakdown by rural and urban residency. The analysis involved a total of 2 284 957 persons, with 10 506 diagnosed with schizophrenia. Bayesian methods were used to estimate the probability of case of schizophrenia (“prevalence”) by type of residency in different years.FindingsIn urban China, lifetime prevalence was 0.39% (0.37–0.41%) in 1990, 0.57% (0.55–0.59%) in 2000 and 0.83% (0.75–0.91%) in 2010. In rural areas, the corresponding rates were 0.37% (0.34–0.40%), 0.43% (0.42–0.44%) and 0.50% (0.47–0.53%). In 1990 there were 3.09 (2.87–3.32) million people in China affected with schizophrenia during their lifetime. The number of cases rose to 7.16 (6.57–7.75) million in 2010, a 132% increase, while the total population increased by 18%. The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010.ConclusionsThe prevalence of schizophrenia in China has more than doubled between 1990 and 2010, with rates being particularly high in the most developed areas of modern China. This has broad implications, as the ongoing development in LMIC countries may be increasing the global prevalence of schizophrenia.

Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China.

Meta-analyses support the efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in western cultures. This study aimed to compare the efficacy of CBT and supportive therapy (ST) for patients with schizophrenia in China. A multicentre randomized controlled, single-blinded, parallel-group trial enrolled a sample of 192 patients with schizophrenia. All patients were offered 15 sessions of either CBT or ST over 24 weeks and followed up for an additional 60 weeks. All measures used were standardized instruments with good reliability and validity. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptoms of schizophrenia. The Schedule for Assessing Insight (SAI) was used to assess patients' insight and the Personal and Social Performance Scale (PSP) was used to assess their social functioning. Effect-size analysis showed that patients made rapid improvements in all symptoms, insight and social functioning as measured by the PANSS, SAI and PSP at 12 and 24 weeks and maintained these improvements over the course of the study to 84 weeks. Patients in the CBT group showed significantly greater and more durable improvement in PANSS total score (p=0.045, between-group d=0.48), positive symptoms (p=0.018, between-group d=0.42) and social functioning (p=0.037, between-group d=0.64), with significant differences emerging after completion of therapy. Both CBT and ST combined with medication had benefits on psychopathology, insight and social functioning of patients with schizophrenia. CBT was significantly more effective than ST on overall, positive symptoms and social functioning of patients with schizophrenia in the long term.

Economic Burden of Schizophrenia in China: Based on Medical Insurance Database from Guangzhou City

Economic Burden of Schizophrenia in China: Based on Medical Insurance Database from Guangzhou City

Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: a field survey.

In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers’ social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score (“1 = never” and “5 = very often”). Approximately 65% of caregivers reported that they tried to conceal their family members’ illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = −0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = −0.18, p<0.001). Urban residence (standard β = −0.12, p<0.01) and patients did not complete primary school education (standard β = −0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient’s educational level and regional differences. More interventions and supports should been given to caregivers who are lack of social support, who live in rural area and who are the patients’ parents, spouses or siblings.

Socioeconomic factors influencing antipsychotic prescription for schizophrenia inpatients in China

Medication is critical in schizophrenia therapy, and prescription patterns have changed considerably over the past 20 years in China. This study attempts to evaluate the prescription patterns of antipsychotics for inpatients with schizophrenia in China and to identify factors influencing these patterns. Claims data of inpatients diagnosed with schizophrenia in 2010 were derived from the reimbursement database of Wuhan and Wuxi. A total of 5251 inpatients received antipsychotic medications, of whom 29.0% received second-generation antipsychotics apart from clozapine (SGAs#), 13.7% received clozapine (CLO), 13.5% received first-generation antipsychotics (FGAs), 43.8% received at least both drug classes, and 5.1% used FGAs, CLO as well as SGAs#. Multinomial logistic regression for 2904 identified inpatients showed that factors of drug reimbursement policy, duration of hospitalization, age group, and municipality were statistically significant in antipsychotic medication. Drug list B and the 25-45 age group presented a significant relationship with SGAs# prescription (FGAs vs. SGAs#). Furthermore, the 12-30-day duration of hospitalization and the 25-45 age group showed a significant relationship with SGAs# prescription (CLO vs. SGAs#). Socioeconomic factors such as health insurance policies, especially reimbursement policy of drugs and payment system, as well as mental health resource distribution are important in antipsychotic prescription in China.

Advances in neuroimaging research of schizophrenia in China.

SummarySince Hounsfield’s first report about X-ray computed tomography (CT) in 1972, there has been substantial progress in the application of neuroimaging techniques to study the structure, function, and biochemistry of the brain. This review provides a summary of recent research in structural and functional neuroimaging of schizophrenia in China and four tables describing all of the relevant studies from mainland China. The first research report using neuroimaging techniques in China dates back to 1983, a study that reported encephalatrophy in 30% of individuals with schizophrenia. Functional neuroimaging research in China emerged in the 1990s and has undergone rapid development since. Recently, structural and functional brain networks has become a hot topic among China’s neuroimaging researchers.