Is the course and outcome of schizophrenia better in the ‘developing’ world?

Abstract 

Historically, poor outcome has often been considered to be an integral part of the concept of schizophrenia, though in recent times this has been challenged by many cross-cultural studies. In this article, we review various studies pertaining to course and outcome of schizophrenia to have an understanding about variations in course and outcome of schizophrenia across cultures and nations. For better appraisal, the research studies have been divided into studies prior to cross-cultural World Health Organization (WHO) sponsored studies (Pre-WHO studies), WHO sponsored cross-cultural studies, and studies on course and outcome of schizophrenia not sponsored by WHO. We believe that the evidence arising from various studies across the globe largely supports the ‘favorable outcome hypothesis in developing countries’, i.e. developing countries have a larger proportion of patients with a good outcome and lesser percentage with a worst outcome as compared to developed countries, albeit amidst the controversies discussed by us. We suggest that in course and outcome studies, culture should not be used as a synonym for unexplained variance and research designs focusing at other potential factors impacting course and outcome of schizophrenia are much needed.