Relapse of schizophrenia in US veterans linked to higher rate of adverse social outcomes
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In a cohort of United States military veterans, relapse of schizophrenia symptoms was associated with higher rates of adverse socioeconomic outcomes, according to a study published in the Journal of Clinical Psychiatry.
“The prevalence of schizophrenia, as well as other mental health disorders, is particularly high among U.S. veterans,” Dee Lin, PharmD, MS, of Janssen Scientific Affairs LLC, and colleagues wrote. “Relapse has a detrimental impact on patients, caregivers, society and health care systems.”
Lin and fellow researchers sought to evaluate societal outcomes, including unemployment and homelessness, among a cohort of U.S. veterans diagnosed with schizophrenia who have a recorded history of relapse.
They initiated a retrospective cohort study utilizing U.S. Veterans Health Administration data from Jan. 1, 2013, to Sept. 30, 2019, and included 33,724 eligible individuals. Veterans withtwo or more diagnoses of schizophrenia, schizotypal disorder and/or schizoaffective disorders according to ICD code classifications during the study period on different days were identified. The index date was the earliest observed diagnosis.
Two cohorts were created and propensity scores were matched. One was a relapse cohort of veterans withone or more prior relapses (n = 16,862), defined as hospitalization or an ED visit associated with a schizophrenia diagnosis during the 12-month pre-index period; the second was a non-relapse cohort of veterans (n = 16,862) with no evidence of relapse during the pre-index period. Frequencies of unemployment, divorce, homelessness, incarceration and premature death were compared between cohorts.
In the relapse cohort, 67.4% and 42% of veterans had a history of substance use disorder and non-schizophrenia mental health disorder, respectively, compared with 43.5% and 23.8% in the matched non-relapse cohort.
Researchers also found the relapse cohort had a higher frequency of unemployment (75.4% vs. 71.4%), divorce (35.6% vs. 33.7%), homelessness (38.9% vs. 23.7%), incarceration (0.6% vs. 0.4%), and premature death (23.3% vs. 16.9%) compared with non-relapse counterparts.
“Preventing relapse, managing comorbid mental health and substance use conditions, and providing services to help with employment and housing for this vulnerable population may improve societal and clinical outcomes for patients,” Lin and colleagues wrote.