Differences in mortality and suicidal behaviour between treated and never-treated people with schizophrenia in rural China.

Background: Many people with schizophrenia remain untreated in the community. Long-term mortality and suicidal behaviour among never-treated individuals with schizophrenia in the community are unknown.
Aims: To explore 10-year mortality and suicidal behaviour among never-treated individuals with schizophrenia.
Method: We used data from a 10-year prospective follow-up study (1994-2004) among people with schizophrenia in Xinjin County, Chengdu, China.
Results: The mortality rate for never-treated individuals with schizophrenia was 2761 per 100 000 person-years during follow-up. There were no significant differences of rates of suicide and all-cause mortality between never-treated and treated individuals. The standardised mortality ratio (SMR) for never-treated people was 10.4 (95% CI 7.2-15.2) and for treated individuals 6.5 (95% CI 5.2-8.5). Compared with treated people, never-treated individuals were more likely to be older, poorer, have a longer duration of illness, marked symptoms and fewer family members.
Conclusions: The never-treated individuals have similar mortality to and a higher proportion of marked symptoms than treated people, which may reflect the poor outcome of the individuals without treatment. The higher rates of mortality, homelessness and never being treated among people with schizophrenia in low- and middle-income nations might challenge presumed wisdom about schizophrenia outcomes in these countries.