🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 129 (from laksa058)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa129.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.nimh.nih.gov/health/statistics/schizophrenia\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.nimh.nih.gov/health/statistics/schizophrenia\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia","crawl_time":1775034641,"first_indexed_time":1619882301,"http_code":200,"src_unparsed":"gov,nih!nimh,www,\/health\/statistics\/schizophrenia s443","src_root_hash":"7295144728021232729","history_drop_reason":null,"meta_title":"Schizophrenia - National Institute of Mental Health (NIMH)","meta_descriptions":["An overview of statistics for schizophrenia. Schizophrenia is a serious and potentially disabling mental disorder that affects how a person thinks, feels, and behaves."],"attrs_boilerpipe_text":"Definition\nSchizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling.\nSymptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated. \nAdditional information can be found on the\nNIMH Health Topics page on Schizophrenia\n.\nAge-Of-Onset for Schizophrenia\nSchizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).\n1,2\nMore subtle changes in cognition and social relationships may precede the actual diagnosis, often by years.\nPrevalence of Schizophrenia\nPrecise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here.\nAcross studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.\n3,4,5\nEstimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.\n6,7\nBurden of Schizophrenia\nDespite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns.\nSchizophrenia is one of the top 15 leading causes of disability worldwide.\n8\nIndividuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population).\n9,10,11,12\nThe estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.\n10\nCo-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia.\n10\nPossible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.\n13\nAn estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness.\n9\nApproximately half of individuals with schizophrenia have co-occurring mental and\/or behavioral health disorders.\n14\nFinancial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care.\n5\nData Sources\nMcGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality.\nEpidemiol Rev.\n2008;30:67-76.\nPMID: 18480098 \nHollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.).\nSchizophrenia\n(3rd ed., pp. 24-46). London: Blackwell.\nKessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R).\nBiol Psychiatry.\n2005 Oct 15;58(8):668-76.\nPMID: 16023620 \nWu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach.\nPsychol Med.\n2006 Nov;36(11):1535-40.\nPMID: 16907994 \nDesai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194.\ndoi\/10.1111\/jphs.12027\/epdf \nSaha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia.\nPLoS Med.\n2005 May;2(5):e141.\nPMID: 15916472 \nMoreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses.\nPLoS One.\n2018;13(4):e0195687.\nPMID: 29649252 \nGlobal, 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.\nLancet.\n2017 Sep 16;390(10100):1211-1259.\nPMID: 28919117 \nPalmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination.\nArch Gen Psychiatry.\n2005 Mar;62(3):247-53.\nPMID: 15753237 \nOlfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States.\nJAMA Psychiatry.\n2015 Dec;72(12):1172-81.\nPMID: 26509694 \nSchoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States.\nSchizophr Bull.\n2017 Oct 21;43(6):1262-1272.\nPMID: 28398566 \nSimon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults.\nJAMA Psychiatry.\n2018 Mar 1;75(3):254-260.\nPMID: 29387876 \nLaursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia.\nAnnu Rev Clin Psychol.\n2014;10:425-48.\nPMID: 24313570 \nTsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis.\nPsychiatry Res.\n2013 Nov 30;210(1):16-20.\nPMID: 23726869 \nStatistical Methods and Measurement Caveats\nThe prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies.\n3,4,5\nIndividuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and\/or may receive little or no health care.\nInformation on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.\n3,5\nNational Comorbidity Survey Replication (NCS-R)\nThe NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents.\n3\nThe Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University.\nSurvey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%).\nFor more information, see\nPMID: 15297905 \n.\nMedical Expenditure Panel Survey (MEPS)\nThe MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses.\nPatients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.\n5\nMEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis.\nFor more information, see\ndoi\/10.1111\/jphs.12027\/epdf \nand the\nMEPS Survey Background Page \n.","attrs_markdown":"[Skip to main content](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#main-content)\n\n![](https:\/\/www.nimh.nih.gov\/themes\/nimhtheme\/uswds\/images\/us_flag_small.png)\n\nAn official website of the United States government\n\nHere’s how you know\n\nHere’s how you know\n\n![](https:\/\/www.nimh.nih.gov\/themes\/nimhtheme\/uswds\/images\/icon-dot-gov.svg)\n\n**Official websites use .gov**  \nA **.gov** website belongs to an official government organization in the United States.\n\n![](https:\/\/www.nimh.nih.gov\/themes\/nimhtheme\/uswds\/images\/icon-https.svg)\n\n**Secure .gov websites use HTTPS**  \nA **lock** ( Locked padlock icon) or **https:\/\/** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.\n\nDue to current HHS and NIH restructuring, some content on nimh.nih.gov is not being updated regularly. Please refer to [clinicaltrials.gov](https:\/\/clinicaltrials.gov\/) and [nih.gov](https:\/\/www.nih.gov\/about-nih\/nih-director\/statements\/nih-launches-initiative-modernize-strengthen-biosafety-oversight) for up-to-date information on NIH research.\n\n[![NIMH Logo](https:\/\/www.nimh.nih.gov\/themes\/nimhtheme\/nimh-logo.svg)](https:\/\/www.nimh.nih.gov\/ \"NIMH Home\")\n\n[In Crisis? Call or Text 988](https:\/\/988lifeline.org\/)\n\nTransforming the understanding   \n and treatment of mental illnesses.\n\n[Home](https:\/\/www.nimh.nih.gov\/) \\| [Help for Mental Illnesses](https:\/\/www.nimh.nih.gov\/health\/find-help)\n\n[Información en español](https:\/\/www.nimh.nih.gov\/health\/topics\/espanol)\n\n- [Mental Health Information](https:\/\/www.nimh.nih.gov\/health)\n- [Get Involved](https:\/\/www.nimh.nih.gov\/get-involved)\n- [Research](https:\/\/www.nimh.nih.gov\/research)\n- [Funding](https:\/\/www.nimh.nih.gov\/funding)\n- [News & Events](https:\/\/www.nimh.nih.gov\/news)\n- [About Us](https:\/\/www.nimh.nih.gov\/about)\n\n[Health Topics NIMH offers expert-reviewed information on mental disorders and a range of topics.](https:\/\/www.nimh.nih.gov\/health\/topics)\n\n[Statistics NIMH statistics pages include statistics on the prevalence, treatment, and costs of mental illness for the population of the United States.](https:\/\/www.nimh.nih.gov\/health\/statistics)\n\n[Brochures and Fact Sheets Download, read, and order free NIMH brochures and fact sheets about mental disorders and related topics.](https:\/\/www.nimh.nih.gov\/health\/publications)\n\n[Help for Mental Illnesses If you or someone you know has a mental illness, there are ways to get help. 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Learn more about research conducted at NIMH.](https:\/\/www.nimh.nih.gov\/research\/research-conducted-at-nimh)\n\n[Priority Research Areas Learn about NIMH priority areas for research and funding that have the potential to improve mental health care over the short, medium, and long term.](https:\/\/www.nimh.nih.gov\/research\/priority-research-areas)\n\n[Resources for Researchers Information about resources such as data, tissue, model organisms and imaging resources to support the NIMH research community.](https:\/\/www.nimh.nih.gov\/research\/research-funded-by-nimh\/research-resources)\n\n[Opportunities & Announcements Find all NIMH and cross-NIH funding opportunities.](https:\/\/www.nimh.nih.gov\/funding\/opportunities-announcements)\n\n[Funding Strategy for Grants Read more about the NIMH Strategic Plan for Research, Strategic Research Priorities, the anatomy of NIMH funding, and our yearly funding strategy for research grants.](https:\/\/www.nimh.nih.gov\/funding\/funding-strategy-for-research-grants)\n\n[Application Process Explore the NIMH grant application process, including how to write your grant, how to submit your grant, and how the review process works.](https:\/\/www.nimh.nih.gov\/funding\/grant-writing-and-application-process)\n\n[Managing Grants Learn about how NIMH manages research grants, including policies and reporting requirements.](https:\/\/www.nimh.nih.gov\/funding\/managing-your-grant)\n\n[Clinical Research Find the latest NIH and NIMH policies, guidance, and resources for clinical research.](https:\/\/www.nimh.nih.gov\/funding\/clinical-research)\n\n[Training Explore NIMH research training and career development opportunities.](https:\/\/www.nimh.nih.gov\/funding\/training)\n\n[Small Business Research Learn about funding opportunities for small businesses.](https:\/\/www.nimh.nih.gov\/funding\/sbir)\n\n### Quick Links\n[Funding & Grant News](https:\/\/www.nimh.nih.gov\/funding\/opportunities-announcements\/funding-grant-news)\n\n[Support for Clinical Trials at NIMH](https:\/\/www.nimh.nih.gov\/funding\/opportunities-announcements\/clinical-trials-foas)\n\n[Science Updates List of NIMH science updates including press releases, research highlights, and institute announcements.](https:\/\/www.nimh.nih.gov\/news\/science-updates)\n\n[Meetings and Events Details about upcoming events—including meetings, conferences, workshops, lectures, webinars, and chats—sponsored by NIMH.](https:\/\/www.nimh.nih.gov\/news\/events)\n\n[Multimedia NIMH videos and podcasts featuring science news, lecture series, meetings, seminars, and special events.](https:\/\/www.nimh.nih.gov\/news\/media)\n\n[Innovation Speaker Series An annual lecture series dedicated to innovation, invention, and scientific discovery.](https:\/\/www.nimh.nih.gov\/news\/innovation-speaker-series)\n\n[About the Acting NIMH Director Learn more about the Acting Director of the NIMH, Shelli Avenevoli, Ph.D.](https:\/\/www.nimh.nih.gov\/about\/director)\n\n[Advisory Boards and Groups Read about the boards and groups that advise and provide guidance to the Institute.](https:\/\/www.nimh.nih.gov\/about\/advisory-boards-and-groups)\n\n[Strategic Plan Learn more about NIMH's roadmap for the Institute’s research priorities over the next five years.](https:\/\/www.nimh.nih.gov\/about\/strategic-planning-reports)\n\n[Offices and Divisions Learn more about the functions of each NIMH office and division.](https:\/\/www.nimh.nih.gov\/about\/organization)\n\n[Budget Read the annual NIMH Congressional Justifications.](https:\/\/www.nimh.nih.gov\/about\/budget)\n\n[Careers at NIMH Search for jobs, including scientific, administrative and executive careers at NIMH.](https:\/\/www.nimh.nih.gov\/about\/careers)\n\n[Staff Directories Find the names, telephone numbers, email addresses, and office locations of NIMH staff.](https:\/\/www.nimh.nih.gov\/about\/staff-directories)\n\n[History Explore key milestones, discoveries, and the impact of NIMH-funded studies on mental health.](https:\/\/www.nimh.nih.gov\/about\/nimh-history)\n\n[Getting to NIMH Find directions, maps, parking information, and other visitor information for NIMH.](https:\/\/www.nimh.nih.gov\/about\/connect-with-nimh)\n\n### Quick Links\n**[Contribute to Mental Health Research](https:\/\/www.nimh.nih.gov\/about\/connect-with-nimh\/donate-to-mental-health-research \"Donate to Mental Health Research\")**\n\n- [Mental Health Information](https:\/\/www.nimh.nih.gov\/health)\n  - 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[Staff Directories](https:\/\/www.nimh.nih.gov\/about\/staff-directories)\n  - [History](https:\/\/www.nimh.nih.gov\/about\/nimh-history)\n  - [Getting to NIMH](https:\/\/www.nimh.nih.gov\/about\/connect-with-nimh)\n\n- [Health Topics](https:\/\/www.nimh.nih.gov\/health\/topics)\n- [Statistics](https:\/\/www.nimh.nih.gov\/health\/statistics)\n- [Brochures and Fact Sheets](https:\/\/www.nimh.nih.gov\/health\/publications)\n- [Help for Mental Illnesses](https:\/\/www.nimh.nih.gov\/health\/find-help)\n- [Clinical Trials](https:\/\/www.nimh.nih.gov\/health\/trials)\n\n[Home](https:\/\/www.nimh.nih.gov\/) \\> [Mental Health Information](https:\/\/www.nimh.nih.gov\/health) \\> [Statistics](https:\/\/www.nimh.nih.gov\/health\/statistics) \\> Schizophrenia\n\n###### Share Page\nMenu\n\n- [Definition](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#part_2589)\n- [Age-Of-Onset for Schizophrenia](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#part_2715)\n- [Prevalence of Schizophrenia](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#part_2543)\n- [Burden of Schizophrenia](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#part_2544)\n- [Data Sources](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#part_2546)\n\n# Schizophrenia\n## Definition\nSchizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling.\n\nSymptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated.\n\nAdditional information can be found on the [NIMH Health Topics page on Schizophrenia](https:\/\/www.nimh.nih.gov\/health\/topics\/schizophrenia).\n\n## Age-Of-Onset for Schizophrenia\nSchizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).1,2 More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years.\n\n## Prevalence of Schizophrenia\nPrecise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here.\n\n- Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.3,4,5\n- Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.6,7\n\n## Burden of Schizophrenia\nDespite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns.\n\n- Schizophrenia is one of the top 15 leading causes of disability worldwide.8\n- Individuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population).9,10,11,12\n  - The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.10\n  - Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia.10 Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.13\n  - An estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness.9\n- Approximately half of individuals with schizophrenia have co-occurring mental and\/or behavioral health disorders.14\n- Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care.5\n\n## Data Sources\n1. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. *Epidemiol Rev.* 2008;30:67-76. [PMID: 18480098](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18480098\/)\n2. Hollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.). *Schizophrenia* (3rd ed., pp. 24-46). London: Blackwell.\n3. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). *Biol Psychiatry.* 2005 Oct 15;58(8):668-76. [PMID: 16023620](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16023620\/)\n4. Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. *Psychol Med.* 2006 Nov;36(11):1535-40. [PMID: 16907994](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16907994\/)\n5. Desai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194. [doi\/10.1111\/jphs.12027\/epdf](http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jphs.12027\/epdf)\n6. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. *PLoS Med.* 2005 May;2(5):e141. [PMID: 15916472](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15916472\/)\n7. Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. *PLoS One.* 2018;13(4):e0195687. [PMID: 29649252](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29649252\/)\n8. 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. *Lancet.* 2017 Sep 16;390(10100):1211-1259. [PMID: 28919117](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28919117\/)\n9. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. *Arch Gen Psychiatry.* 2005 Mar;62(3):247-53. [PMID: 15753237](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15753237\/)\n10. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. *JAMA Psychiatry.* 2015 Dec;72(12):1172-81. [PMID: 26509694](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26509694\/)\n11. Schoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States. *Schizophr Bull.* 2017 Oct 21;43(6):1262-1272. [PMID: 28398566](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28398566\/)\n12. Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. *JAMA Psychiatry.* 2018 Mar 1;75(3):254-260. [PMID: 29387876](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29387876\/)\n13. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. *Annu Rev Clin Psychol.* 2014;10:425-48. [PMID: 24313570](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24313570\/)\n14. Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. *Psychiatry Res.* 2013 Nov 30;210(1):16-20. [PMID: 23726869](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23726869\/)\n### Statistical Methods and Measurement Caveats\nThe prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies.3,4,5\n\nIndividuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and\/or may receive little or no health care.\n\nInformation on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.3,5\n\nNational Comorbidity Survey Replication (NCS-R)\n\n- The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents.3 The Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University.\n\n- Survey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%).\n\n- For more information, see [PMID: 15297905](https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15297905) .\n### Medical Expenditure Panel Survey (MEPS)\n- The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses.\n- Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis.\n- For more information, see [doi\/10.1111\/jphs.12027\/epdf](http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jphs.12027\/epdf)  and the [MEPS Survey Background Page](https:\/\/meps.ahrq.gov\/mepsweb\/about_meps\/survey_back.jsp) .\n\n## Disclaimer\nWe link to external websites for informational purposes only, but we do not endorse or guarantee their accuracy. Once you leave our site, you will be subject to the new website’s privacy policy. Read NIMH’s [full external linking policy](https:\/\/www.nimh.nih.gov\/site-info\/policies#part_2717) for more information.\n\n##### NIMH Resources\n[Health Topics](https:\/\/www.nimh.nih.gov\/health\/topics)   \n[Brochures and Fact Sheets](https:\/\/www.nimh.nih.gov\/health\/publications)   \n[Contact Us](https:\/\/www.nimh.nih.gov\/site-info\/contact-nimh)   \n[Información en español](https:\/\/www.nimh.nih.gov\/health\/topics\/espanol)\n\n##### Policies and Notices\n[Privacy Policy](https:\/\/www.nimh.nih.gov\/site-info\/privacy-policy)   \n[Website Policies](https:\/\/www.nimh.nih.gov\/site-info\/policies)   \n[FOIA](http:\/\/www.nih.gov\/icd\/od\/foia\/index.htm)    \n[Accessibility](https:\/\/www.nimh.nih.gov\/site-info\/accessibility)   \n[HHS Vulnerability Disclosure](https:\/\/www.hhs.gov\/vulnerability-disclosure-policy\/index.html)\n\n##### Federal Resources\n[National Institutes of Health (NIH)](http:\/\/www.nih.gov\/)    \n[NIH Virtual Tour](https:\/\/www.nih.gov\/virtual-tour\/)    \n[U.S. Department of Health and Human Services](https:\/\/www.hhs.gov\/)    \n[USA.gov](http:\/\/www.usa.gov\/)\n\nThe National Institute of Mental Health (NIMH) is part of NIH, a component of the U.S. Department of Health and Human Services.\n\n[Top](https:\/\/www.nimh.nih.gov\/health\/statistics\/schizophrenia#skipnav)","attrs_readable_markdown":"## Definition\nSchizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling.\n\nSymptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated.\n\nAdditional information can be found on the [NIMH Health Topics page on Schizophrenia](https:\/\/www.nimh.nih.gov\/health\/topics\/schizophrenia).\n\n## Age-Of-Onset for Schizophrenia\nSchizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).1,2 More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years.\n\n## Prevalence of Schizophrenia\nPrecise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here.\n\n- Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.3,4,5\n- Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.6,7\n\n## Burden of Schizophrenia\nDespite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns.\n\n- Schizophrenia is one of the top 15 leading causes of disability worldwide.8\n- Individuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population).9,10,11,12\n  - The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.10\n  - Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia.10 Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.13\n  - An estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness.9\n- Approximately half of individuals with schizophrenia have co-occurring mental and\/or behavioral health disorders.14\n- Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care.5\n\n## Data Sources\n1. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. *Epidemiol Rev.* 2008;30:67-76. [PMID: 18480098](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18480098\/)\n2. Hollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.). *Schizophrenia* (3rd ed., pp. 24-46). London: Blackwell.\n3. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). *Biol Psychiatry.* 2005 Oct 15;58(8):668-76. [PMID: 16023620](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16023620\/)\n4. Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. *Psychol Med.* 2006 Nov;36(11):1535-40. [PMID: 16907994](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16907994\/)\n5. Desai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194. [doi\/10.1111\/jphs.12027\/epdf](http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jphs.12027\/epdf)\n6. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. *PLoS Med.* 2005 May;2(5):e141. [PMID: 15916472](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15916472\/)\n7. Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. *PLoS One.* 2018;13(4):e0195687. [PMID: 29649252](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29649252\/)\n8. 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. *Lancet.* 2017 Sep 16;390(10100):1211-1259. [PMID: 28919117](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28919117\/)\n9. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. *Arch Gen Psychiatry.* 2005 Mar;62(3):247-53. [PMID: 15753237](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15753237\/)\n10. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. *JAMA Psychiatry.* 2015 Dec;72(12):1172-81. [PMID: 26509694](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26509694\/)\n11. Schoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States. *Schizophr Bull.* 2017 Oct 21;43(6):1262-1272. [PMID: 28398566](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28398566\/)\n12. Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. *JAMA Psychiatry.* 2018 Mar 1;75(3):254-260. [PMID: 29387876](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29387876\/)\n13. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. *Annu Rev Clin Psychol.* 2014;10:425-48. [PMID: 24313570](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24313570\/)\n14. Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. *Psychiatry Res.* 2013 Nov 30;210(1):16-20. [PMID: 23726869](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23726869\/)\n### Statistical Methods and Measurement Caveats\nThe prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies.3,4,5\n\nIndividuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and\/or may receive little or no health care.\n\nInformation on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.3,5\n\nNational Comorbidity Survey Replication (NCS-R)\n\n- The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents.3 The Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University.\n\n- Survey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%).\n\n- For more information, see [PMID: 15297905](https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15297905) .\n### Medical Expenditure Panel Survey (MEPS)\n- The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses.\n- Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis.\n- For more information, see [doi\/10.1111\/jphs.12027\/epdf](http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jphs.12027\/epdf)  and the [MEPS Survey Background Page](https:\/\/meps.ahrq.gov\/mepsweb\/about_meps\/survey_back.jsp) .","meta_canonical":null}

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Boilerpipe Text	Definition Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling. Symptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated. Additional information can be found on the NIMH Health Topics page on Schizophrenia . Age-Of-Onset for Schizophrenia Schizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). 1,2 More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years. Prevalence of Schizophrenia Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here. Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%. 3,4,5 Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%. 6,7 Burden of Schizophrenia Despite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns. Schizophrenia is one of the top 15 leading causes of disability worldwide. 8 Individuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population). 9,10,11,12 The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years. 10 Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia. 10 Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them. 13 An estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness. 9 Approximately half of individuals with schizophrenia have co-occurring mental and/or behavioral health disorders. 14 Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care. 5 Data Sources McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67-76. PMID: 18480098 Hollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.). Schizophrenia (3rd ed., pp. 24-46). London: Blackwell. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 2005 Oct 15;58(8):668-76. PMID: 16023620 Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. Psychol Med. 2006 Nov;36(11):1535-40. PMID: 16907994 Desai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194. doi/10.1111/jphs.12027/epdf Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May;2(5):e141. PMID: 15916472 Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One. 2018;13(4):e0195687. PMID: 29649252 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. Lancet. 2017 Sep 16;390(10100):1211-1259. PMID: 28919117 Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005 Mar;62(3):247-53. PMID: 15753237 Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015 Dec;72(12):1172-81. PMID: 26509694 Schoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States. Schizophr Bull. 2017 Oct 21;43(6):1262-1272. PMID: 28398566 Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. JAMA Psychiatry. 2018 Mar 1;75(3):254-260. PMID: 29387876 Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10:425-48. PMID: 24313570 Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. Psychiatry Res. 2013 Nov 30;210(1):16-20. PMID: 23726869 Statistical Methods and Measurement Caveats The prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies. 3,4,5 Individuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and/or may receive little or no health care. Information on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page. 3,5 National Comorbidity Survey Replication (NCS-R) The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents. 3 The Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University. Survey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%). For more information, see PMID: 15297905 . Medical Expenditure Panel Survey (MEPS) The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses. Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study. 5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis. For more information, see doi/10.1111/jphs.12027/epdf and the MEPS Survey Background Page .
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[Health Topics](https://www.nimh.nih.gov/health/topics) - [Statistics](https://www.nimh.nih.gov/health/statistics) - [Brochures and Fact Sheets](https://www.nimh.nih.gov/health/publications) - [Help for Mental Illnesses](https://www.nimh.nih.gov/health/find-help) - [Clinical Trials](https://www.nimh.nih.gov/health/trials) [Home](https://www.nimh.nih.gov/) \> [Mental Health Information](https://www.nimh.nih.gov/health) \> [Statistics](https://www.nimh.nih.gov/health/statistics) \> Schizophrenia ###### Share Page Menu - [Definition](https://www.nimh.nih.gov/health/statistics/schizophrenia#part_2589) - [Age-Of-Onset for Schizophrenia](https://www.nimh.nih.gov/health/statistics/schizophrenia#part_2715) - [Prevalence of Schizophrenia](https://www.nimh.nih.gov/health/statistics/schizophrenia#part_2543) - [Burden of Schizophrenia](https://www.nimh.nih.gov/health/statistics/schizophrenia#part_2544) - [Data Sources](https://www.nimh.nih.gov/health/statistics/schizophrenia#part_2546) # Schizophrenia ## Definition Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling. Symptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated. Additional information can be found on the [NIMH Health Topics page on Schizophrenia](https://www.nimh.nih.gov/health/topics/schizophrenia). ## Age-Of-Onset for Schizophrenia Schizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).1,2 More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years. ## Prevalence of Schizophrenia Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here. - Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.3,4,5 - Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.6,7 ## Burden of Schizophrenia Despite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns. - Schizophrenia is one of the top 15 leading causes of disability worldwide.8 - Individuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population).9,10,11,12 - The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.10 - Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia.10 Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.13 - An estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness.9 - Approximately half of individuals with schizophrenia have co-occurring mental and/or behavioral health disorders.14 - Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care.5 ## Data Sources 1. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67-76. [PMID: 18480098](http://www.ncbi.nlm.nih.gov/pubmed/18480098/) 2. Hollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.). Schizophrenia (3rd ed., pp. 24-46). London: Blackwell. 3. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 2005 Oct 15;58(8):668-76. [PMID: 16023620](http://www.ncbi.nlm.nih.gov/pubmed/16023620/) 4. Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. Psychol Med. 2006 Nov;36(11):1535-40. [PMID: 16907994](http://www.ncbi.nlm.nih.gov/pubmed/16907994/) 5. Desai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194. [doi/10.1111/jphs.12027/epdf](http://onlinelibrary.wiley.com/doi/10.1111/jphs.12027/epdf) 6. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May;2(5):e141. [PMID: 15916472](http://www.ncbi.nlm.nih.gov/pubmed/15916472/) 7. Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One. 2018;13(4):e0195687. [PMID: 29649252](http://www.ncbi.nlm.nih.gov/pubmed/29649252/) 8. 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. Lancet. 2017 Sep 16;390(10100):1211-1259. [PMID: 28919117](http://www.ncbi.nlm.nih.gov/pubmed/28919117/) 9. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005 Mar;62(3):247-53. [PMID: 15753237](http://www.ncbi.nlm.nih.gov/pubmed/15753237/) 10. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015 Dec;72(12):1172-81. [PMID: 26509694](http://www.ncbi.nlm.nih.gov/pubmed/26509694/) 11. Schoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States. Schizophr Bull. 2017 Oct 21;43(6):1262-1272. [PMID: 28398566](http://www.ncbi.nlm.nih.gov/pubmed/28398566/) 12. Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. JAMA Psychiatry. 2018 Mar 1;75(3):254-260. [PMID: 29387876](http://www.ncbi.nlm.nih.gov/pubmed/29387876/) 13. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10:425-48. [PMID: 24313570](http://www.ncbi.nlm.nih.gov/pubmed/24313570/) 14. Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. Psychiatry Res. 2013 Nov 30;210(1):16-20. [PMID: 23726869](http://www.ncbi.nlm.nih.gov/pubmed/23726869/) ### Statistical Methods and Measurement Caveats The prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies.3,4,5 Individuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and/or may receive little or no health care. Information on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.3,5 National Comorbidity Survey Replication (NCS-R) - The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents.3 The Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University. - Survey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%). - For more information, see [PMID: 15297905](https://www.ncbi.nlm.nih.gov/pubmed/15297905) . ### Medical Expenditure Panel Survey (MEPS) - The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses. - Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis. - For more information, see [doi/10.1111/jphs.12027/epdf](http://onlinelibrary.wiley.com/doi/10.1111/jphs.12027/epdf) and the [MEPS Survey Background Page](https://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp) . ## Disclaimer We link to external websites for informational purposes only, but we do not endorse or guarantee their accuracy. Once you leave our site, you will be subject to the new website’s privacy policy. 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Readable Markdown	## Definition Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling. Symptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated. Additional information can be found on the [NIMH Health Topics page on Schizophrenia](https://www.nimh.nih.gov/health/topics/schizophrenia). ## Age-Of-Onset for Schizophrenia Schizophrenia is typically diagnosed in the late teens years to early thirties, and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties).1,2 More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years. ## Prevalence of Schizophrenia Precise prevalence estimates of schizophrenia are difficult to obtain due to clinical and methodological factors such as the complexity of schizophrenia diagnosis, its overlap with other disorders, and varying methods for determining diagnoses. Given these complexities, schizophrenia and other psychotic disorders are often combined in prevalence estimation studies. A summary of currently available data is presented here. - Across studies that use household-based survey samples, clinical diagnostic interviews, and medical records, estimates of the prevalence of schizophrenia and related psychotic disorders in the U.S. range between 0.25% and 0.64%.3,4,5 - Estimates of the international prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75%.6,7 ## Burden of Schizophrenia Despite its relatively low prevalence, schizophrenia is associated with significant health, social, and economic concerns. - Schizophrenia is one of the top 15 leading causes of disability worldwide.8 - Individuals with schizophrenia have an increased risk of premature mortality (death at a younger age than the general population).9,10,11,12 - The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.10 - Co-occurring medical conditions, such as heart disease, liver disease, and diabetes, contribute to the higher premature mortality rate among individuals with schizophrenia.10 Possible reasons for this excess early mortality are increased rates of these medical conditions and under-detection and under-treatment of them.13 - An estimated 4.9% of people with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness.9 - Approximately half of individuals with schizophrenia have co-occurring mental and/or behavioral health disorders.14 - Financial costs associated with schizophrenia are disproportionately high relative to other chronic mental and physical health conditions, reflecting both “direct” costs of health care as well as “indirect” costs of lost productivity, criminal justice involvement, social service needs, and other factors beyond health care.5 ## Data Sources 1. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67-76. [PMID: 18480098](http://www.ncbi.nlm.nih.gov/pubmed/18480098/) 2. Hollis C, Rapoport J (2008). Child and Adolescent Schizophrenia. In D Weinberger, P Harrison (Eds.). Schizophrenia (3rd ed., pp. 24-46). London: Blackwell. 3. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 2005 Oct 15;58(8):668-76. [PMID: 16023620](http://www.ncbi.nlm.nih.gov/pubmed/16023620/) 4. Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. Psychol Med. 2006 Nov;36(11):1535-40. [PMID: 16907994](http://www.ncbi.nlm.nih.gov/pubmed/16907994/) 5. Desai, PR, Lawson, KA, Barner, JC, Rascati, KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. Journal of Pharmaceutical Health Services Research, 2013 Jul;4(4):187-194. [doi/10.1111/jphs.12027/epdf](http://onlinelibrary.wiley.com/doi/10.1111/jphs.12027/epdf) 6. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May;2(5):e141. [PMID: 15916472](http://www.ncbi.nlm.nih.gov/pubmed/15916472/) 7. Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One. 2018;13(4):e0195687. [PMID: 29649252](http://www.ncbi.nlm.nih.gov/pubmed/29649252/) 8. 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. Lancet. 2017 Sep 16;390(10100):1211-1259. [PMID: 28919117](http://www.ncbi.nlm.nih.gov/pubmed/28919117/) 9. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005 Mar;62(3):247-53. [PMID: 15753237](http://www.ncbi.nlm.nih.gov/pubmed/15753237/) 10. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015 Dec;72(12):1172-81. [PMID: 26509694](http://www.ncbi.nlm.nih.gov/pubmed/26509694/) 11. Schoenbaum M, Sutherland JM, Chappel A, Azrin S, Goldstein AB, Rupp A, Heinssen RK. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States. Schizophr Bull. 2017 Oct 21;43(6):1262-1272. [PMID: 28398566](http://www.ncbi.nlm.nih.gov/pubmed/28398566/) 12. Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. JAMA Psychiatry. 2018 Mar 1;75(3):254-260. [PMID: 29387876](http://www.ncbi.nlm.nih.gov/pubmed/29387876/) 13. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10:425-48. [PMID: 24313570](http://www.ncbi.nlm.nih.gov/pubmed/24313570/) 14. Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. Psychiatry Res. 2013 Nov 30;210(1):16-20. [PMID: 23726869](http://www.ncbi.nlm.nih.gov/pubmed/23726869/) ### Statistical Methods and Measurement Caveats The prevalence rate of schizophrenia and related psychotic disorders is difficult to estimate using typical household survey methods alone. Accurate assessment of schizophrenia is best achieved using clinicians trained in the diagnosis of mental illnesses. The U.S. prevalence studies cited here were selected based on their use of U.S. population samples and use of methods that involved clinical diagnosis, either via clinical reappraisal (validation) studies or clinical record studies.3,4,5 Individuals with schizophrenia and other psychotic disorders may be under-counted in prevalence estimation studies. These individuals may be under-represented in household surveys because they may reside in prisons, other institutions, or may lack a permanent address. Similarly, some people with schizophrenia and other psychotic disorders may not be fully reflected in medical records data because they may not have a documented diagnosis, and/or may receive little or no health care. Information on statistical methods and measurement caveats can be found in the papers cited on this page and listed in the reference section. Below we provide additional background information for large datasets used in two studies cited on this page.3,5 National Comorbidity Survey Replication (NCS-R) - The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Non-affective psychosis was assessed in a subsample of 2,322 respondents.3 The Sheehan Disability Scales (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on 0-10 scales. The NCS-R was led by Harvard University. - Survey non-response: In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents. Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant – too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and, household units that were never contacted (2.0%). - For more information, see [PMID: 15297905](https://www.ncbi.nlm.nih.gov/pubmed/15297905) . ### Medical Expenditure Panel Survey (MEPS) - The MEPS collect data from community-dwelling people in the U.S. It does not include patients living in group homes, supported living arrangements, prisons, and institutions. In addition, homeless people and undocumented immigrants are excluded. These groups may have a higher prevalence of schizophrenia. MEPS survey responses were obtained from a single respondent for all the members of the family, therefore some recall bias may be associated with the responses. - Patients for the schizophrenia study were selected based on ICD-9 codes only. Due to the stigma associated with the condition, physicians are known to give patients an interim non-schizophrenia diagnosis when uncertain about schizophrenia until it can be confirmed. To capture patients who may be given an interim non-schizophrenia diagnosis, researchers used the ICD-9 code for non-organic psychoses in addition to that for schizophrenic disorder in their study.5 MEPS collects information about conditions through patient interviews and some miscoding may occur as the household participants describe their conditions during the interviews and the coders record the ICD-9 codes for the diagnosis. - For more information, see [doi/10.1111/jphs.12027/epdf](http://onlinelibrary.wiley.com/doi/10.1111/jphs.12027/epdf) and the [MEPS Survey Background Page](https://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp) .
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