Study highlights urgent need for improved care for schizophrenia

New research finds that adults with schizophrenia spectrum disorders have high rates of comorbid mental and substance use disorders and significant social and economic disadvantages, and only 26% received minimally adequate treatment. Meeting the needs of people with schizophrenia spectrum disorders will require innovative interventions and implementation to improve access to and use of evidence-based approaches, the authors argue. The research was published today in Psychiatric Services in Advance.

The researchers, led by Natalie Bareis, Ph.D., with Columbia University Irving Medical Center and New York State Psychiatric Institute, examined national data that were collected from Oct. 2020 to Oct. 2022 on 4,764 adults aged 18 to 65 in the Substance Abuse and Mental Health Services Agency-sponsored U.S. Mental and Substance Use Disorders Prevalence Study (MDPS). Using sampling weights, the authors compared sociodemographic characteristics and comorbid behavioral health conditions of individuals with or without schizophrenia spectrum disorders (schizophrenia, schizoaffective, and schizophreniform disorders).

Among 114 adults with schizophrenia spectrum disorders, the most common comorbid conditions were major depressive episode (52%) and alcohol use (23%), cannabis use (20%), and posttraumatic stress disorders (17%). Both suicidal ideation and suicide attempts in the past year were significantly more likely among individuals with schizophrenia spectrum disorders than among those without them.

While almost everyone with schizophrenia spectrum disorders in this sample had health care coverage, about 70% had any type of mental health treatment in the past year and only about 30% were currently taking an antipsychotic. While many individuals with schizophrenia spectrum disorders may recover, most of the individuals in the survey were unemployed and most had serious functional impairment.

Available, effective treatments and services include antipsychotic medications, individual placement and support, programs to promote employment, assertive community treatment, and coordinated specialty care for first-episode psychosis.

The MDPS is an update to decades old surveys of psychiatric disorders in the U.S. It had a focus on identifying schizophrenia spectrum disorders by administering the Structured Clinical Interview for the DSM-5 to all participants."

Natalie Bareis, Columbia University Irving Medical Center

"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. 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."