Do South African Xhosa-Speaking People with Schizophrenia Really Fare Better? A Longitudinal Mortality Study in Older Patients with Schizophrenia

Objectives: Results from multinational WHO studies suggest that schizophrenia patients in developing countries may have more favorable prognoses and morbidity outcomes than those in developed settings. This study serves to establish whether mortality outcomes in South African Xhosa-speaking schizophrenia patients are more favorable than in the general South African population. Methods: We recruited a group of 981 patients from September 1997 to March 2005 as part of a genetic study in the Western, Southern, and Eastern Cape provinces of South Africa. For this substudy, participants were included when they reached the age of 60 years during the study period (8-15 years). We examined factors associated with the probability of dying and computed survival times using national census data as reference. Results: At the time of follow-up, 73 individuals were 60 years or older (21.9% could not be traced): some 40% of the sample had died at the time of the follow-up assessment (mean age at death = 60.12 years, SD = 4.97). Univariate survival analysis, using duration of disorder, revealed that the number of hospitalizations and psychotic episodes impacted survival time. Compared to the age-specific death rates of the general South African population, the death rate in the Xhosa-speaking schizophrenia sample was higher than expected in the 60-69 years category, but tower than expected in the 70+ years category. Conclusion: This study suggests that increased exposure to inpatient mental healthcare (expressed as number of hospitalizations) at baseline, and number of psychotic episodes, improve survival probability in a group of older South African Xhosa-speaking schizophrenia patients.