Schizophrenia is a severe and draining mental disorder with varying socio-economic impacts based on the age of onset. This study compares socio-demographic characteristics, employment status, financial dependence, marital status, stigmatization, and social functioning between early-onset and late-onset schizophrenia patients. A cross-sectional analysis was conducted on schizophrenia patients, categorized by age of onset (before or after 40). Early-onset schizophrenia was significantly more common in males (75%, p < 0.01), with lower educational attainment (p < 0.05), higher unemployment rates (65% vs. 45%, p = 0.02), and greater financial dependence (80% vs. 55%, p = 0.01) compared to late-onset patients. Early-onset patients also reported significantly higher social isolation (70% vs. 50%, p = 0.03) and fewer marital relationships (30% vs. 50%, p = 0.04). Stigmatization scores were significantly elevated in early-onset patients (mean score 8.2 vs. 5.4, p < 0.001). Treatment costs were also significantly higher (p < 0.01) for early-onset patients, highlighting the increased socio-economic burden associated with an earlier onset of the disorder.
References
[1]
van Os, J. (2009) A Salience Dysregulation Syndrome. British Journal of Psychiatry, 194, 101-103. https://doi.org/10.1192/bjp.bp.108.054254
[2]
Kapur, S. (2003) Psychosis as a State of Aberrant Salience: A Framework Linking Biology, Phenomenology, and Pharmacology in Schizophrenia. American Journal of Psychiatry, 160, 13-23. https://doi.org/10.1176/appi.ajp.160.1.13
[3]
Tandon, R., Keshavan, M.S. and Nasrallah, H.A. (2013) Schizophrenia, “Just the Facts”, Treatment and Prevention. Schizophrenia Research, 147, 1-9. https://doi.org/10.1016/j.schres.2013.04.004
[4]
Keshavan, M.S., Mehta, U.M., Padmanabhan, J.L. and Shah, J.L. (2020) Neurodevelopmental Trajectories in Schizophrenia: Early Insights from Brain Imaging Studies. Schizophrenia Research, 216, 17-25. https://doi.org/10.1016/j.schres.2019.10.045
[5]
Clemmensen, L., Vernal, D.L. and Steinhausen, H. (2012) A Systematic Review of the Long-Term Outcome of Early Onset Schizophrenia. BMC Psychiatry, 12, Article No. 150. https://doi.org/10.1186/1471-244x-12-150
[6]
Howard, R., Rabins, P.V., Seeman, M.V., Jeste, D.V. and Late-Onset, T.I. (2000) Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: An International Consensus. American Journal of Psychiatry, 157, 172-178. https://doi.org/10.1176/appi.ajp.157.2.172
[7]
Jeste, D.V., Harris, M.J., Krull, A., Kuck, J., McAdams, L.A. and Heaton, R. (2003) Clinical and Neuropsychological Characteristics of Patients with Late-Onset Schizophrenia. The American Journal of Geriatric Psychiatry, 11, 33-40. https://doi.org/10.1097/00019442-200301000-00006
[8]
Rabinowitz, J., Levine, S.Z. and Hafner, H. (1998) A Population-Based Elaboration of the Role of Age of Onset on the Course of Schizophrenia. Schizophrenia Research, 61, 95-101. https://doi.org/10.1016/S0920-9964(02)00220-4
[9]
Häfner, H. (2003) Gender Differences in Schizophrenia. Psychoneuroendocrinology, 28, 17-54. https://doi.org/10.1016/s0306-4530(02)00125-7
[10]
Seeman, M.V. (2018) Does Gender Influence Outcome in Schizophrenia? Psychiatric Quarterly, 90, 173-184. https://doi.org/10.1007/s11126-018-9619-y
[11]
Kulkarni, J., Hayes, E. and Gavrilidis, E. (2012) Hormones and Schizophrenia. Current Opinion in Psychiatry, 25, 89-95. https://doi.org/10.1097/yco.0b013e328350360e
[12]
Harvey, P.D. and Rosenthal, J.B. (2012) Cognitive and Functional Deficits in People with Schizophrenia: Evidence for Accelerated or Exaggerated Aging? Schizophrenia Research, 131, 112-117. https://doi.org/10.1016/j.schres.2011.06.037
[13]
Marwaha, S. and Johnson, S. (2004) Schizophrenia and Employment. SocialPsychiatryandPsychiatricEpidemiology, 39, 337-349. https://doi.org/10.1007/s00127-004-0762-4
[14]
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/appi.books.9780890425596
[15]
Davidson, L., Stayner, D.A., Nickou, C., Styron, T.H., Rowe, M. and Chinman, M.J. (2001) Simply to Be Let in: Inclusion as a Basis for Recovery. Psychiatric Rehabilitation Journal, 24, 375-388. https://doi.org/10.1037/h0095076
[16]
Corrigan, P.W. and Watson, A.C. (2002) Understanding the Impact of Stigma on People with Mental Illness. World Psychiatry, 1, 16-20.
[17]
Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall.
[18]
Engel, G.L. (1977) The Need for a New Medical Model: A Challenge for Biomedicine. Science, 196, 129-136. https://doi.org/10.1126/science.847460
[19]
Anthony, W.A. (1993) Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s. Psychosocial Rehabilitation Journal, 16, 11-23. https://doi.org/10.1037/h0095655
[20]
Link, B.G., Struening, E.L., Neese-Todd, S., Asmussen, S. and Phelan, J.C. (2001) The Consequences of Stigma for Persons with Mental Illness: Evidence from the Social Sciences. World Psychiatry, 1, 27-35.
[21]
Pernice-Duca, F. (2010) Family Support and Mental Health Recovery. Journal of Marital and Family Therapy, 36, 13-27. https://doi.org/10.1111/j.1752-0606.2009.00186.x
[22]
Drake, R.E., Bond, G.R. and Essock, S.M. (2012) Implementing Evidence-Based Practices for People with Schizophrenia. Schizophrenia Bulletin, 38, 70-80. https://doi.org/10.1093/schbul/sbr014
[23]
Levitas, R., Pantazis, C., Fahmy, E., Gordon, D., Lloyd, E. and Patsios, D. (2007) The Multi-Dimensional Analysis of Social Exclusion. Department for Communities and Local Government.
[24]
Henderson, C., Evans-Lacko, S., Flach, C. and Thornicroft, G. (2014) Responses to Mental Health Stigma Questions: The Importance of Social Desirability and Data Collection Method. Canadian Journal of Psychiatry, 59, 614-620. https://doi.org/10.1177/070674371405901003
[25]
Becker, H.S. (1963) Outsiders: Studies in the Sociology of Deviance. Free Press.
[26]
Cohen, S. and Wills, T.A. (1985) Stress, Social Support, and the Buffering Hypothesis. Psychological Bulletin, 98, 310-357. https://doi.org/10.1037/0033-2909.98.2.310
[27]
Berkman, L.F. and Glass, T. (2000) Social Integration, Social Networks, Social Support, and Health. In: Social Epidemiology, Oxford University Press, 137-173. https://doi.org/10.1093/oso/9780195083316.003.0007
[28]
Elder, G.H. (1994) Time, Human Agency, and Social Change: Perspectives on the Life Course. Social Psychology Quarterly, 57, 4-15. https://doi.org/10.2307/2786971
[29]
Zubin, J. and Spring, B. (1977) Vulnerability: A New View of Schizophrenia. Journal of Abnormal Psychology, 86, 103-126. https://doi.org/10.1037/0021-843x.86.2.103
[30]
Corrigan, P.W., Watson, A.C. and Barr, L. (2006) The Self-Stigma of Mental Illness: Implications for Self-Esteem and Self-Efficacy. Journal of Social and Clinical Psychology, 25, 875-884. https://doi.org/10.1521/jscp.2006.25.8.875
[31]
Abel, K.M., Drake, R. and Goldstein, J.M. (2010) Sex Differences in Schizophrenia. International Review of Psychiatry, 22, 417-428. https://doi.org/10.3109/09540261.2010.515205
[32]
Ochoa, S., Usall, J., Cobo, J., Labad, X. and Kulkarni, J. (2012) Gender Differences in Schizophrenia and First-Episode Psychosis: A Comprehensive Literature Review. Schizophrenia Research and Treatment, 2012, 1-9. https://doi.org/10.1155/2012/916198
[33]
Kirkpatrick, B., Fenton, W.S., Carpenter, W.T. and Marder, S.R. (2008) The NIMH-MATRICS Consensus Statement on Negative Symptoms. Schizophrenia Bulletin, 34, 1021-1030.
[34]
Macdonald, E.M., Hayes, R.L. and Baglioni, Jr. (2018) The Quantity and Quality of the Social Networks of Young People with Early Psychosis Compared with Closely Matched Controls. Schizophrenia Research, 204, 380-385.
[35]
Lichter, D.T., Sassler, S. and Turner, R.N. (2022) Marriage and Cohabitation Trends in the 21st Century. Journal of Marriage and Family, 84, 1-19. https://doi.org/10.1111/jomf.12803
[36]
Amato, P.R. (2023) Age and Relationship Quality across the Life Span. Journal of Family Psychology, 37, 129-139. https://doi.org/10.1037/fam0001000
[37]
Jeste, D.V., Wolkowitz, O.M. and Palmer, B.W. (2011) Psychosocial Treatment of Late-Life Schizophrenia. Schizophrenia Research, 133, 1-7. https://doi.org/10.1016/j.schres.2011.09.020
[38]
Heckman, J.J. and Kautz, T. (2021) Education, Social Skills, and Economic Mobility. American Economic Journal: Applied Economics, 13, 200-227.
[39]
McGrath, J., Saha, S., Chant, D. and Welham, J. (2008) Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality. EpidemiologicReviews, 30, 67-76. https://doi.org/10.1093/epirev/mxn001
[40]
Kessler, R.C. (2007) Lifetime Prevalence and Age-of-Onset Distributions of Mental Disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6, 168-176.
[41]
Jobe, T.H. and Harrow, M. (2005) Long-Term Outcome of Patients with Schizophrenia: A Review. The Canadian Journal of Psychiatry, 50, 892-900. https://doi.org/10.1177/070674370505001403
[42]
Bora, E., Yucel, M. and Pantelis, C. (2009) Cognitive Impairment in Schizophrenia and Affective Psychoses: Implications for DSM-V Criteria and Beyond. Schizophrenia Bulletin, 36, 36-42. https://doi.org/10.1093/schbul/sbp094
[43]
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators (2017) Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 328 Diseases and Injuries for 195 Countries, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016. The Lancet, 390, 1211-1259. https://doi.org/10.1016/S0140-6736(17)32154-2
[44]
Brown, E., Smith, J. and Davis, R. (2021) Educational Outcomes in Individuals with Early-Onset Schizophrenia: A Population-Based Study. Journal of Psychiatric Research, 137, 127–134.
[45]
Miller, T. and Adams, M. (2017) Barriers to Employment in Individuals with Chronic Mental Illness. Social Psychiatry and Psychiatric Epidemiology, 52, 813-821.
[46]
Anderson, K. (2020) Employment Outcomes among Individuals with Early and Late-Onset Schizophrenia. Psychiatry Research, 284, Article 112768.
[47]
Garcia, R. (2018) Gender Differences in Occupational Functioning among Schizophrenia Patients: A Cross-Sectional Analysis. BMC Psychiatry, 18, Article No. 324.
[48]
Lund, C., De Silva, M., Plagerson, S., Cooper, S., Chisholm, D., Das, J., et al. (2011) Poverty and Mental Disorders: Breaking the Cycle in Low-Income and Middle-Income Countries. TheLancet, 378, 1502-1514. https://doi.org/10.1016/s0140-6736(11)60754-x
[49]
Macdonald, E. (2000) Social Networks and Social Support among People with Severe Mental Illness. Social Psychiatry and Psychiatric Epidemiology, 35, 500-508.
[50]
Gayer-Anderson, C. and Morgan, C. (2012) Social Networks, Support and Early Psychosis: A Systematic Review. EpidemiologyandPsychiatricSciences, 22, 131-146. https://doi.org/10.1017/s2045796012000406
[51]
Johnson, J. (2019) Romantic Relationships in Early-Onset Schizophrenia: Developmental Considerations. Schizophrenia Bulletin, 45, 237-245.
[52]
Smith, R. and Wang, L. (2018) Late-Onset Schizophrenia: Marital and Social Functioning in Older Patients. Journal of Nervous and Mental Disease, 206, 97-103.
[53]
Larsen, T.K. (2020) The Impact of Early-Onset Schizophrenia on Relationships: A Longitudinal Analysis. Schizophrenia Research, 218, 222-229.
[54]
Mehta, S. and Farina, A. (1997) Is Being “Sick” Really Better? Effect of the Disease View of Mental Disorder on Stigma. JournalofSocialandClinicalPsychology, 16, 405-419. https://doi.org/10.1521/jscp.1997.16.4.405
[55]
Henderson, C. (2014) Time to Change: Anti-Stigma Campaign Impact on Attitudes to Mental Illness. The British Journal of Psychiatry, 204, 333-337.
[56]
Thornicroft, G. (2007) Stigma and Discrimination in Mental Illness. The Lancet, 370, 810-821.
[57]
Corrigan, P.W. (2005) Three Strategies for Changing Attributions about Severe Mental Illness. Schizophrenia Bulletin, 31, 143-155.
[58]
Perry, B.L. and Medina, V. (2021) Stigma and Social Exclusion in Schizophrenia: A Developmental and Life-Course Perspective. Social Science & Medicine, 284, Article 114228.
[59]
Gabbard, G.O. and Lanza, H. (2020) Social Support Networks and Late-Onset Schizophrenia: Implications for Care. Journal of Geriatric Psychiatry, 33, 15-24.
[60]
Muench, J. and Angermeyer, M.C. (2015) Strategies to Reduce Stigma and Discrimination in Schizophrenia: A Review of Interventions. Current Opinion in Psychiatry, 28, 231-238.
[61]
Sachs, N.A. and Strauss, G.P. (2020) Social Functioning in Schizophrenia across the Lifespan: Trends, Challenges, and Opportunities. Schizophrenia Research: Cognition, 22, Article 100189.
[62]
Aleman, A., Kahn, R.S. and Selten, J. (2003) Sex Differences in the Risk of Schizophrenia. ArchivesofGeneralPsychiatry, 60, 565-271. https://doi.org/10.1001/archpsyc.60.6.565
[63]
Seeman, M.V. (2009) Does Gender Influence Outcome in Schizophrenia? Gender Medicine, 6, 60-74.
[64]
Rosenheck, R. (2006) Employment Outcomes of Schizophrenia Patients in Vocational Programs: Impact of Gender and Onset. Psychiatric Services, 57, 510-516.
[65]
Knapp, M., Mangalore, R. and Simon, J. (2004) The Global Costs of Schizophrenia. SchizophreniaBulletin, 30, 279-293. https://doi.org/10.1093/oxfordjournals.schbul.a007078
[66]
Marwaha, S. (2007). Employment Outcomes in People with Schizophrenia: A Meta-Analysis of Observational Studies. Acta Psychiatrica Scandinavica, 116, 280-289.
[67]
Goldstein, J.M. (2002). Sex Differences in the Neurobiology of Schizophrenia: A Review. Schizophrenia Research, 56, 75-88.
[68]
Morgan, C. (2008) Clinical and Social Outcomes of Psychosis: A 10-Year Follow-Up of the ÆSOP First-Episode Cohort. The British Journal of Psychiatry, 192, 97-105.