Targeted Literature Review of the Clinical, Social, and Economic Burdens of Schizophrenia in Japan

OBJECTIVES: Schizophrenia is a serious mental disorder which has its social impact with clinical, economic and humanistic burdens. This targeted literature review aims to better elucidate the disease burden in patients with schizophrenia and caregivers in Japan.

METHODS: The targeted literature review was comprised of systematic literature review for PubMed, Ichushi, CiNii, J-STAGE (2013-2023), and handsearching for conference proceedings and other data sources including medical associations, government and patient associations (2018-2023) to identify the epidemiology, clinical management, society and welfare, humanistic and economic burdens of schizophrenia patients and caregivers.

RESULTS: Totally 157 publications, 73 conference proceedings and 37 other data sources were included. Patients with schizophrenia were found to suffer from several comorbidities or complications, such as obesity, hypertension, depression, congestive heart failure, and type 2 diabetes mellitus. Three publications about cognitive impairment were identified and some reported assessment of cognitive function by BACS, and a calculation method by combination with WAIS-III and JART. Z-score of BACS was reported as -2.1 and the latter study reported that significantly lower cognitive impairment score was observed in patients with schizophrenia than healthy individuals. Concerning hospitalization, isolation from community life during hospitalization with dissatisfying inpatient care and lack of abilities to coordinate lifestyle following discharge were reported. It was also reported that five factors of promoting cognitive functioning and self-care, identifying reasons for readmission, cooperative systems within the community, sharing goals about community life and creating restful spaces were related to reduction in early readmission. Caregivers’ productivity loss assessed by WPAI was reported that they tended to more experience presenteeism than absenteeism, with annual productivity loss of JPY 2.36 million.

CONCLUSIONS: This targeted literature review revealed complex and multifaceted burdens among patients, caregivers and healthcare systems, and reinforced the need for integrated and collaborative approaches among stakeholders with holistic and evidence-based strategies.