Title: Systematic Review of the Incidence & Prevalence of Schizophrenia and Other Psychoses in England, 1950-2009
Funder: Department of Health (Ref: 0230145)
Principal Investigators (Cambridge): Dr Dan Jackson (Institute of Public Health)
Principal Investigators (Institute of Psychiatry): Professor Robin Murray, Dr Craig Morgan, Professor Paul McCrone, Dr Jane Boydell.
The Department of Health commissioned us to conduct a systematic review of the literature pertaining to incidence and prevalence of psychotic disorders in England, published between 1950 and 2009. Here, you will find further details of the systematic review, including the final, peer-reviewed report accepted by the Department of Health, as well as supplemental data and files.
Executive Summary: Available here
Full report (version 1.05): Available here
Supplemental Online Data: Available here
Lay Synopsis: Care for people with schizophrenia and similar (psychotic) illnesses is increasingly designed around the needs and wishes of service users and carers. Planning for new teams such as early intervention services (EIS) means the NHS needs a detailed understanding of the occurrence of illness in the population (epidemiology) including numbers of new cases (incidence) and people suffering at any one time (prevalence). Without this knowledge service commissioning doesn’t match needs.
We systematically reviewed all the relevant research on the epidemiology of schizophrenia and other psychoses in England over the past from 1950 to 2009. We initially identified 5291 studies. Of these, 147 citations met our inclusion criteria based on quality and the information we needed.
We showed that schizophrenia is more common in men than women, especially in young adults and is far more common in some black and minority ethnic (BME) groups than in other communities. Some of this is due to the illness being more common in dense, city populations and in deprived areas, but there must also be other reasons. Virtually all studies gave the same messages; they were least clear for depressive psychosis and bipolar disorder.
The review defined very precise estimates of incidence, prevalence and costs, information that commissioners need when designing services for their populations. Rough estimates of need are not good enough and we can now provide quite accurate figures for small areas.
We recommend that this is taken further in order to develop useful tools for commissioners and by using NHS information for research and evaluation. The review did not find evidence that the overall incidence of psychotic illness has increased over the decades, although we need to keep this under review because such increases would suggest new causes might be operating. Resources for helping people with psychotic illness in EI and other services can now be better targeted.
This project was funded by the Department of Health Policy Research Programme. The work reflects the views of the research team, and not necessarily those of the Department of Health. The team forms part of the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough and received library and search support from the East of England Evidence Adoption Centre.
The authors of this review were helped by many people. We are grateful to Professor John McGrath for his wise guidance during the planning and conduct of this review. His expertise allowed us to improve the final quality of this work. The CLAHRC and Evidence Adoption Centre played a pivotal role in providing us with expert librarians and other resources when designing and conducting the systematic search strategy; we are indebted to them. We thank Anna Capasso for making this possible, and Katerina Lagoudaki for help in drafting the report summary. Without the diligent, patient help and expertise of the librarians involved in this project, we would have been unable to develop such a comprehensive and systematic strategy to search the research literature. We therefore pass on our heartfelt thanks to Karen Rigby, Kerry Herbert and Margaret Bevan at the Education Library, Hinchingbrooke Health Care NHS Trust, as well as to Barbara Norrey from the Mid Essex PCT for her expert guidance on the grey literature. We are grateful to Ian White, MRC Biostatistics Unit, for providing access to expertise to conduct the analyses contained within this review. We would also like to thank the following researchers for providing timely clarifications or additional data for some studies and citations included in this report: Prof. Brian Cooper, Prof. Tom Burns, Prof. Francis Creed, Prof. Thomas Barnes, Prof Peter Congdon, Prof. Philippa Garety, Prof. Joe Kai, Dr Andrew Thompson, Dr Emma Mitford, Dr Martin Frisher, Prof. Ilana Crome and Kate Beaven and Ellie Smith from the Office for National Statistics. Finally, we are grateful to Alan Roach and the PRP team for patiently guiding this review towards completion. In addition we detail below acknowledgements specific to various authors of this report.