Work functioning of schizophrenia patients in a rural south Indian community: status at 4-year follow-up.

PURPOSE: This report describes the work functioning of schizophrenia patients receiving antipsychotic treatment in a rural south Indian community and examines the factors associated with it. METHODS: We assessed work functioning of 201 patients who have completed a minimum of 3 years of follow-up as part of a cohort study of schizophrenia patients receiving community-based treatment. 'Work' section of the Indian disability evaluation and assessment scale (IDEAS) was used to evaluate work-related disability at the time of recruitment and after a mean (SD) 47.0 (9.6) months of follow-up. Patients with moderate to profound work-related disability were compared with those with no or mild disability across socio-demographic and clinical variables. RESULTS: 75 (37.3 %) were agriculturists; 58 (28.9 %) were pursuing household jobs; 28 (13.9 %) were daily wage labourers; 7 (3.5 %) were skilled labourers; 7 (3.5 %) were involved in other jobs. 26 (12.9 %) were not doing any sort of work. The proportion of patients with moderate or profound disability reduced from 137/201 (68.2 %) at baseline to 82/201 (40.8 %) at follow-up (p < 0.001). Work-related disability reduced significantly [mean (SD) work score on IDEAS was 2.2 (1.6) at baseline and 1.1 (1.2) at follow-up; t = -9.1; p < 0.001]. Logistic regression analysis showed that work-related disability was significantly associated with male gender, longer duration of illness, higher psychopathology and poor treatment adherence. CONCLUSION: Nearly two-thirds of schizophrenia patients living in this rural south Indian community had satisfactory work functioning, a rate, which is substantially higher than rates reported from high-income countries. Agrarian work atmosphere and rural sociocultural milieu may have contributed to this in our sample. However, substantial proportion of patients remains considerably disabled. This highlights the need for concerted, community-level efforts to improve their functioning.

Prevalence & correlates of areca use among rural south Indian schizophrenia patients: A comparative study with general population.

Aims of this study were to compare the prevalence of areca use among schizophrenia patients and general population of a south Indian rural community and to study the correlates of areca use among patients. A cohort of 300 schizophrenia patients, who are being followed up as a part of a community intervention program, formed the study group. The control group (n=382) was selected randomly from the general population of this region. Both were interviewed regarding the sociodemographic details, use of areca nut, alcohol and tobacco. Among patients, Positive and Negative Syndrome Scale (PANSS), Simpson's Angus Scale (SAS) and Indian Disability Evaluation and Assessment Scale (IDEAS) were applied. Use of antipsychotic and anticholinergic medications was also noted. These clinical correlates were compared between users and non-users. The prevalence of areca use among schizophrenia patients was significantly higher when compared to the general population (39.0% vs 14.4%, p<0.001). There was no significant difference in positive symptoms, negative symptoms, extrapyramidal symptoms, antipsychotic and anticholinergic drug dosage between areca chewers and non-chewers. Areca use is significantly higher among schizophrenia patients of this rural area when compared to that among the general population. Considering the health hazards that areca abuse may lead to, this issue needs attention.