Research identifies critical gaps in mental health care for adults with schizophrenia spectrum disorders

New research shows that adults with schizophrenia spectrum disorders are more likely to have comorbid mental health and substance abuse disorders, and are at significant socioeconomic disadvantage, with only 26% receiving minimally adequate treatment.

To meet the needs of people with schizophrenia spectrum disorders, innovative interventions and implementations are needed to improve access to and use of evidence-based approaches, the authors argue. research was published today in Psychiatric services.

The researchers, led by Natalie Bareis, Ph.D., of Columbia University Irving Medical Center and the New York State Psychiatric Institute, examined national data collected from October 2020 to October 2022 among 4,764 adults ages 18 to 65 in the U.S. Mental and Substance Use Disorders Prevalence Study (MDPS) sponsored by the Substance Abuse and Mental Health Services Agency.

Using sampling weights, the authors compared sociodemographic characteristics and comorbid behavioral health disorders of individuals with or without schizophrenia spectrum disorders (schizophrenia, schizoaffective, and schizophreniform disorders).

Among 114 adults with schizophrenia spectrum disorders, the most common comorbidities were major depressive episode (52%) and alcohol use (23%), cannabis use (20%), and posttraumatic stress disorder (17%). Both suicidal ideation and suicide attempts in the past year were significantly more likely among individuals with schizophrenia spectrum disorders than among those without.

Although nearly all with schizophrenia spectrum disorders in this sample had health insurance, about 70% had some form of mental health care in the past year, and only about 30% were currently taking an antipsychotic medication. Although many individuals with schizophrenia spectrum disorders can recover, most individuals in the survey were unemployed, and most had severe functional limitations.

Available, effective treatments and services include antipsychotic medications, individual placement and support, employment promotion programs, assertive community treatment, and coordinated specialist care for a first episode of psychosis.

“The MDPS is an update of decades-old surveys of psychiatric disorders in the U.S. It focused on identifying schizophrenia spectrum disorders by administering the Structured Clinical Interview for the DSM-5 to all participants,” Bareis noted. “We had hoped that during this time, with the advent of new treatments and services, the circumstances of individuals with schizophrenia spectrum disorders would have improved.

“Instead, persistently high rates of poverty, unemployment, and poor functioning suggest that existing treatment and social welfare approaches are not meeting the needs of many people with schizophrenia spectrum disorders. Policies to improve access to and use of existing evidence-based interventions are essential.”