Never-treated patients with schizophrenia in the developing country of Bali

Background: A considerable number of individuals with schizophrenia go undiagnosed and untreated in developing countries. In the current study, we investigated the prevalence of schizophrenia, the treatment status of individuals with schizophrenia, and factors associated with never-treated status in a Balinese rural community. Method: A door-to-door survey was conducted on 8546 people from the general population to detect individuals with schizophrenia using standardized screening instruments in Bali. Results: Thirty-nine individuals with schizophrenia were identified, giving a point prevalence of 4.2 per 1000 population. Never-treated group subjects (n = 20: 51.3%) had a significantly higher total score on the Positive and Negative Syndrome Scale (p < 0.05) and were less likely to have a history of violent behavior (p < 0.01) than Treated group subjects (n = 19: 48.7%). All 9 subjects who had never shown violent behavior remained untreated. Conclusion: The clinical condition of the never-treated individuals with schizophrenia was poor. Individuals with schizophrenia without violent behavior had no opportunity to undergo medical treatment in this developing country setting.