Outcome of first contact schizophrenia in Jamaica.

Several previous studies have identified high incidence rates, high relapse rates and poor short-term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62%) were treated at home, and 120 (38%) were admitted to hospital for treatment. Two hundred and sixty-four (83%) were still being seen after one year. The relapse rate was 13% (41 patients), higher for admissions (24, 20%) than for those treated at home (17, 9%; p < 0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p < 0.005). One hundred and thirty-five (43%) were in gainful employment within the 12-month period of follow-up, contrasted with the 40% unemployment rate for the 2.4 million population of the island (chi square = 39.322, p < 0.001). There was a self-reported use of medication in 213 (67%) patients, with 142 (45%) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first service contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short-term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK.