Schizophrenia Patients Face High Mental Health Comorbidity, Limited Treatment

A new study showed adults with schizophrenia spectrum disorders have high rates of comorbid mental health conditions and substance use but only a few received minimally adequate psychiatric treatment.¹

According to the Mayo Clinic, untreated schizophrenia can lead to many comorbid conditions, such as suicide ideation, anxiety, OCD, depression, and substance use.² Several treatments and services are available for patients with schizophrenia, including antipsychotic medications, individual placement and support, programs designed to support employment, assertive community treatment, and coordinated specialty care for those receiving their first episode of psychosis.¹

Decades-old surveys collected data on clinical characteristics of adults with a schizophrenia spectrum disorder. However, with the arrival of new treatments, investigators aimed to develop an updated survey.

A team conducted a study to gather current information on the treatment and clinical characteristics of US adults with schizophrenia, schizoaffective, and schizophreniform disorders to inform public health policy and service development. Investigators compared the sociodemographic traits and comorbid behavioral health conditions of 4764 participants with and without a disorder under the schizophrenia spectrum.

Data was leveraged from the US Mental and Substance Use Disorders Prevalence Study, conducted from October 2020 to October 2020. Participants aged 18 – 65 years had a Structured Clinical Interview for the DSM-5 for past-year psychiatric and substance use disorder diagnoses. In total, the sample included 114 adults with a schizophrenia spectrum disorder.

Among adults with schizophrenia, the most common comorbid conditions were major depressive episode (52%; 95% confidence interval [CI], 34% to 69%) and alcohol use (23%; 95% CI, 3% to 43%), cannabis use (20%; 95% CI, 1% to 39%), and posttraumatic stress (17%; 95% CI, 5% to 30%).

Participants with schizophrenia, schizoaffective disorder, or schizophreniform disorder had lower Global Assessment of Functioning scores compared to those without a schizophrenia spectrum disorder (mean ± SE = 44.8 ± 2.0 vs. 77.2 ± 0.5; P < .01). These lower scores suggest that individuals with schizophrenia spectrum disorders experience poorer functioning. The survey revealed most of the individuals with a schizophrenia spectrum disorder were unemployed and had serious functional impairment.

The study revealed 71% of adults with schizophrenia spectrum disorders received some mental health treatment in the past year (95% CI, 55% to 87%), and only 26% were currently taking an antipsychotic (95% CI, 13% to 38%).

“We had hoped that during this period, with the advent of new treatments and services, the circumstances of individuals with schizophrenia spectrum disorders would have improved,” said lead investigator, Natalie Bareis, PhD, from the Columbia University Irving Medical Center and New York State Psychiatric Institute.³ “Instead, persistent high rates of poverty, unemployment, and poor functioning suggest that existing treatment and social welfare approaches are not meeting the needs of many people with schizophrenia spectrum disorders. Policies to improve access to and use of existing evidence-based interventions are essential.”

References

1. ^{Bareis N, Edlund M, Ringeisen H, et al. Characterizing Schizophrenia Spectrum Disorders: Results of the U.S. Mental and Substance Use Disorders Prevalence Study. Psychiatr Serv. Published online September 23, 2024. doi:10.1176/appi.ps.20240138}
2. ^{Schizophrenia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443. Accessed October 2, 2024.}
3. ^{New research identifies critical gaps in mental health care for adults with schizophrenia spectrum disorders. EurekAlert! September 23, 2024. https://www.eurekalert.org/news-releases/1058961. Accessed October 2, 2024.}