Long-term outcome of early-onset compared to adult-onset schizophrenia: A nationwide Danish register study

Ditte Lammers Vernal; Søren Kjærgaard Boldsen; Marlene Briciet Lauritsen; Christoph U Correll; René Ernst Nielsen

doi:10.1016/j.schres.2020.03.045

Long-term outcome of early-onset compared to adult-onset schizophrenia: A nationwide Danish register study

Schizophr Res. 2020 Jun:220:123-129. doi: 10.1016/j.schres.2020.03.045. Epub 2020 Apr 13.

Authors

Ditte Lammers Vernal¹, Søren Kjærgaard Boldsen², Marlene Briciet Lauritsen³, Christoph U Correll⁴, René Ernst Nielsen⁵

Affiliations

¹ Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark. Electronic address: dhl@rn.dk.
² Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark. Electronic address: sobo@teknologisk.dk.
³ Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: marlene.lauritsen@rn.dk.
⁴ The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, NY 11004, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany. Electronic address: ccorrell@northwell.edu.
⁵ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Department of Psychiatry, Unit for Psychiatric Research, Aalborg, Denmark. Electronic address: ren@rn.dk.

PMID: 32299717
DOI: 10.1016/j.schres.2020.03.045

Abstract

Objective: Early-onset schizophrenia (EOS) may have worse outcomes than adult-onset schizophrenia (AOS), but data are scarce. We compared outcomes of EOS vs. AOS.

Methods: Longitudinal, register-based study of patients diagnosed with schizophrenia in Denmark between 1996 and 2012, with follow-up until 12/2014. Co-primary outcomes were psychiatric inpatient days during the initial two years after schizophrenia diagnosis and mean number of annual inpatient days for the remaining follow-up.

Results: Altogether, 16,337 patients with schizophrenia were included (EOS = 1223, AOS = 15,114, mean follow-up = 9.5 ± 5.0 years). EOS were hospitalized longer during the first two years than AOS (180.9 ± 171.0 vs 163.4 ± 183.1 days, p < 0.005; IRR = 1.27, 95% CI = 1.19-1.35, p < 0.001), but duration and annual rates thereafter did not differ (EOS = 26.8 ± 57.1 days, AOS = 26.6 ± 56.2 days, p = 0.95; IRR = 1.07, 95% CI = 0.94-1.23, p = 0.30). Fewer EOS patients were never psychiatrically hospitalized (EOS = 17.2%, AOS = 20.1%, p < 0.001), but with no difference in re-admissions in patients diagnosed during hospitalization (EOS = 77.1% vs AOS = 78.1%, p = 0.56). More EOS patients were admitted involuntarily (41% vs. 36%, p < 0.02). AOS patients had more often comorbid substance use disorders during follow-up than EOS (EOS = 21.7%, AOS = 34.2%, p < 0.001). Substance use disorders and out-of-home placement were significantly associated with more inpatient days during both short- and long-term follow-up.

Conclusion: Although EOS was associated with more inpatient days in the first two years after diagnosis, results do not seem to support a generally poorer long-term outcome of EOS compared to AOS. Longer initial hospitalization may be driven by different treatment patterns in child and adolescent vs. adult psychiatry. These data suggest that patient characteristics other than age of onset significantly affect outcomes.

Keywords: Child- and adolescent psychiatry; Early-onset schizophrenia; Registries; Schizophrenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Denmark / epidemiology
Hospitalization
Humans
Schizophrenia* / epidemiology