Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
Mol Psychiatry. 2023 Dec;28(12):5319-5327. doi: 10.1038/s41380-023-02138-4. Epub 2023 Jul 27.
Schizophrenia substantially contributes to the burden of mental disorders. Schizophrenia's burden and epidemiological estimates in some countries have been published, but updated estimates of prevalence, incidence, and schizophrenia-related disability at the global level are lacking. Here, we present the data from and critically discuss the Global Burden of Diseases, Injuries, and Risk Factors Study data, focusing on temporal changes in schizophrenia's prevalence, incidence, and disability-adjusted life years (DALYs) globally. From 1990 to 2019, schizophrenia raw prevalence (14.2 to 23.6 million), incidence (941,000 to 1.3 million), and DALYs (9.1 to 15.1 million) increased by over 65%, 37%, and 65% respectively, while age-standardized estimates remained stable globally. In countries with high socio-demographic index (SDI), both prevalence and DALYs increased, while in those with low SDI, the age-standardized incidence decreased and DALYs remained stable. The male/female ratio of burden of schizophrenia has remained stable in the overall population over the past 30 years (i.e., M/F = 1.1), yet decreasing from younger to older age groups (raw prevalence in females higher than males after age 65, with males having earlier age of onset, and females longer life expectancy). Results of this work suggest that schizophrenia's raw prevalence, incidence, and burden have been increasing since 1990. Age-adjusted estimates did not reduce. Schizophrenia detection in low SDI countries is suboptimal, and its prevention/treatment in high SDI countries should be improved, considering its increasing prevalence. Schizophrenia sex ratio inverts throughout the lifespan, suggesting different age of onset and survival by sex. However, prevalence and burden estimates for schizophrenia are probably underestimated. GBD does not account for mortality from schizophrenia (and other mental disorders, apart from anorexia nervosa).
精神分裂症在精神障碍负担中占很大比重。一些国家已经公布了精神分裂症的负担和流行病学估计，但全球范围内缺乏最新的患病率、发病率和与精神分裂症相关的残疾估计。在这里，我们展示了来自全球疾病、伤害和危险因素研究的数据，并对其进行了批判性讨论，重点关注精神分裂症在全球范围内的患病率、发病率和残疾调整生命年（DALYs）的时间变化。1990 年至 2019 年，精神分裂症的原始患病率（1420 万至 2360 万）、发病率（94.1 万至 130 万）和 DALYs（910 万至 1510 万）分别增加了 65%、37%和 65%，而全球年龄标准化估计值保持稳定。在社会人口指数（SDI）较高的国家，患病率和 DALYs 都有所增加，而在 SDI 较低的国家，年龄标准化发病率下降，DALYs 保持稳定。在过去 30 年中，精神分裂症负担的男女比例在总人口中保持稳定（即 M/F=1.1），但从年轻到老年群体呈下降趋势（65 岁以后女性的原始患病率高于男性，男性发病年龄更早，女性预期寿命更长）。这项工作的结果表明，自 1990 年以来，精神分裂症的原始患病率、发病率和负担一直在增加。年龄调整后的估计值并没有减少。在 SDI 较低的国家，精神分裂症的检测情况并不理想，而在 SDI 较高的国家，应该改善其预防/治疗措施，因为精神分裂症的患病率在不断增加。精神分裂症的性别比例在整个生命周期中发生逆转，表明男女发病年龄和生存时间不同。然而，精神分裂症的患病率和负担估计值可能被低估了。GBD 没有考虑到精神分裂症（以及除神经性厌食症以外的其他精神障碍）的死亡率。
