The Social Determinants of Schizophrenia: An African Journey in Social Epidemiology

The epidemiology of schizophrenia in developing countries, and especially in Africa, is controversial. One of the major findings of the World Health Organization multisite studies of schizophrenia conducted during the 1970s-1990s was that outcome of schizophrenia was better in developing countries. More recent research suggests this may not be the case in contemporary Africa. Rapid urbanization, industrialization, migration, conflict and ongoing poverty and deprivation characterize most of sub-Saharan Africa in recent decades; and it is likely that these potent risk factors for psychosis have contributed to shifts in the social epidemiology of psychosis and schizophrenia in that continent. In studying the epidemiology of schizophrenia, it is also necessary to examine evidence on first-episode psychosis (FEP) since it is often difficult to confirm a diagnosis of schizophrenia at onset. The author reviews nearly 50 years of epidemiological research on psychosis and schizophrenia in Africa; and argues that novel and flexible methods are required in contemporary efforts to study schizophrenia in the region. Specific contexts require specific approaches that are relevant and sensitive to local political, socio-economic and cultural conditions and dynamics. The future role of social epidemiology in helping clarify the burden, risk factors and natural history of schizophrenia within Africa depends largely on its success in integrating classic approaches with novel methods that are relevant to the specific socio-economic, political and cultural transformations taking place on that continent.