71 per 1000 (59/8799) versus a rural prevalence of 4.13 per 1000 (43/10 424) (chi squared =6.02, P<0.025). There

are several possible explanations for these differences. These results could be seen as a within -country confirmation of the International Pilot Project on Schizophrenia7 findings that persons from less-developed countries are more likely to have a full recovery from a schizophrenic illness than persons Inhibitors,research,lifescience,medical from developed countries. Overall, the rural areas in China are much less developed than the urban areas, so a higher rate of full recovery in less-developed areas would lead to lower overall prevalence in the rural population (assuming similar urban versus rural incidence). The tighter social networks and lower occupational demands Inhibitors,research,lifescience,medical in rural areas could result in a lower incidence of schizophrenia because fewer acute psychotic episodes progress to a chronic illness. Given that most rural patients do not receive treatment and most urban patients do receive treatment, higher urban prevalence

could occur Inhibitors,research,lifescience,medical because involvement with the treatment system increases stigma, discrimination, and chronic social dysfunction. There may be a higher rate of death among schizophrenic patients in rural areas than in urban areas. There may be some degree of “social drift” of patients to urban areas, but the two studies did not Bortezomib mw sample temporary rural residents living in urban areas (the “floating population”) and almost all persons continue to live with their families after developing a serious mental illness, so it is unlikely Inhibitors,research,lifescience,medical that social drift is a major factor

in the reported differences. The differences may also be due Inhibitors,research,lifescience,medical to methodological problems in the studies. For example, the screening method (using key informants) and the examination method (using a translated version of the PSE-9) may be less sensitive in rural areas where the level of illiteracy is much higher than in urban areas. Unlike the GBD estimates, both the 1982 and 1993 studies found that the point prevalence for schizophrenia was much higher in women. In 1982, the point prevalence for women 15 years of age or older was 5.91 per 1000 (112/18 964) versus a male prevalence of 3.60 per 1000 (69/19 172) (chi squared = 10.74, F<0.005) Rolziracetam and in 1993 the point prevalence for women was 6.65 per 1000 (64/9619) versus a male prevalence of 3.96 per 1000 (38/9604) (chi squared = 6.62, P<0.025). It is certainly possible that these surprising gender-based differences in rates are due to methodological problems. For example, key informants may have been less likely to label men’s behavior as “unusual” and men who were interviewed may have been less willing than women to acknowledge symptoms.