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. 2025 Jun 10;87(7):4336–4343. doi: 10.1097/MS9.0000000000003449

Trends in schizophrenia-related mortality from 1999 to 2020: year, gender, and regional variations

Hurmat Fatima Bhatti a, Maham Tahir a, Muhammad Shaheer Bin Faheem b, Momina Khabir c, Ali Tahir a, Muhammad Abdullah Aftab Qureshi a, Danish Ali Ashraf a, Muhammad Saad Iqbal a, Sumaya Samadi d,*
PMCID: PMC12369731  PMID: 40851973

Abstract

Background:

Schizophrenia affects about 1% of the global population, with 1.5 million Americans diagnosed annually. Despite higher mortality rates in this group, trends by year, gender, and region remain insufficiently explored. This study evaluated global trends in schizophrenia (F20) mortality from 1999 to 2020, analyzing variations by year, gender, and region. Additionally, we examined age-adjusted mortality rates (AAMRs) by place of death and year to provide a comprehensive understanding of these trends.

Methods:

The CDC WONDER database was used to analyze schizophrenia-related mortality from 1999 to 2020, calculating mortality rates and 95% confidence intervals (CIs) to assess national trends.

Results:

Throughout the study, males had higher AAMRs for schizophrenia (1.3%, 95% CI: 1.3–1.3) than females (0.9%, 95% Cl: 0.9–1.4). In metropolitan areas, the AAMR was 96.6, declining from 1999 to 2015 (APC: −1.07%) before rising (APC: 6.41%). Non-metropolitan areas had an AAMR of 58.9, decreasing from 1999 to 2017 (APC: −0.86%) before increasing by 2020 (APC: 8.95%). Overall, schizophrenia-related AAMRs rose from 1.2 in 1999 to 1.4 in 2020, with fluctuations.

Conclusion:

Schizophrenia-related mortality declined from 1999 to 2015 but rose afterward. Males consistently had higher AAMRs, while urban areas showed greater mortality, reflecting social and environmental risks. Early declines may be linked to improved psychiatric care, whereas the recent rise correlates with the opioid epidemic and COVID-19. These findings highlight the need for better investment in mental health care, early intervention, access in underserved areas, and better management of comorbidities.

Keywords: age-adjusted mortality rates, CDC WONDER, chronic psychiatric disorder, mortality trends, schizophrenia

HIGHLIGHTS

  • Schizophrenia-related deaths fell until 2015 and then rose through 2020.

  • Males had higher mortality rates than females throughout the study.

  • Urban areas showed higher mortality than rural counterparts.

  • Recent mortality rise may be linked to the impacts of opioids and COVID-19.

Introduction

Schizophrenia is a severe, chronic psychiatric disorder that profoundly disrupts cognition, emotions, and behavior, often leading to significant functional impairment and a diminished quality of life. While it affects approximately 1% of the global population, its impact far exceeds its prevalence, placing a heavy burden on individuals, families, and healthcare systems. In the USA alone, an estimated 1.5 million people are newly diagnosed with schizophrenia each year[1]. However, prevalence estimates vary based on diagnostic criteria, with studies placing the U.S. rate between 0.25% and 0.64%[2–4] and international estimates ranging from 0.33% to 0.75% among non-institutionalized populations[5,6]. Despite advances in research, schizophrenia remains one of the most complex and challenging psychiatric disorders to manage, making it a critical public health concern.

The etiology of schizophrenia is multifaceted, arising from a complex interplay of genetic, environmental, and neurobiological factors. Individuals with a first-degree relative diagnosed with schizophrenia face a significantly elevated risk, with heritability estimates reaching approximately 80% [7]. However, genetic predisposition alone does not determine disease onset; environmental influences such as prenatal exposure to infections, malnutrition, and early-life psychosocial stressors further contribute to susceptibility[8]. These factors shape not only the onset and progression of the disorder but also its clinical presentation, which is categorized into three domains. Positive symptoms, including hallucinations, delusions, and disorganized thinking, reflect distortions in perception and thought. Negative symptoms, such as diminished emotional expression, social withdrawal, and avolition, result in a loss of motivation and engagement with daily life. Cognitive symptoms, including deficits in memory, attention, and executive functioning, further impair an individual’s ability to navigate personal relationships, occupational responsibilities, and social interactions[9]. These disruptions often lead to significant functional impairment, compounding the stigma and isolation experienced by many individuals with schizophrenia.

Demographic factors significantly shape the epidemiology and outcomes of schizophrenia, which typically emerges in late adolescence or early adulthood and is diagnosed between the late teens and early thirties, with males experiencing an earlier onset (late adolescence to early twenties) than females (early twenties to early thirties)[4,10]. Although schizophrenia affects all racial and ethnic groups, diagnostic disparities persist, with African Americans disproportionately diagnosed, possibly due to biases in clinical assessments[11,12]. Socioeconomic and geographic factors further impact access to care, contributing to stark differences in outcomes. Individuals with schizophrenia face a drastically reduced life expectancy, with studies estimating an average of 28.5 years of potential life lost[13]. This disparity is largely driven by high rates of comorbid conditions such as heart disease, liver disease, and diabetes, which are often underdiagnosed and undertreated[14]. Suicide further compounds this issue, with 4.9% of individuals with schizophrenia dying by suicide, particularly in the early stages of illness[15]. Despite advancements in healthcare, individuals with schizophrenia have not experienced the same improvements in life expectancy as the general population, underscoring persistent inequities in mental health services and long-term support.

Despite the obvious impact of schizophrenia, access to appropriate mental health services remains alarmingly inadequate. Currently, the majority of individuals with schizophrenia worldwide do not receive the care they need, with only 31.3% of people with psychosis accessing specialized mental health services[16]. Mental hospitals continue to house nearly half of all individuals diagnosed with schizophrenia, yet they often fail to provide effective treatment and, in many cases, violate basic human rights[17]. Many mental health systems remain underfunded and inefficient, with resources disproportionately allocated to institutionalized care rather than community-based support. Expanding and improving community-based mental health services is critical for addressing these gaps. Such initiatives should integrate mental health care into primary healthcare settings, general hospitals, and dedicated community mental health centers while providing supported housing and outreach programs for home-based care. Early intervention is also crucial, as symptoms – such as social withdrawal and disrupted sleep patterns – are frequently misinterpreted as typical adolescent behavior, delaying diagnosis and treatment[18]. Without substantial reforms in mental health infrastructure and service delivery, individuals with schizophrenia will continue to face profound barriers to care, exacerbating health disparities and worsening long-term outcomes.

By examining trends in schizophrenia-related mortality from 1999 to 2020, this study aims to highlight the impact of these disparities, particularly in relation to gender, age, and geographic location. Identifying these variations will provide valuable insight into the evolving challenges of schizophrenia management and inform public health strategies aimed at improving healthcare accessibility, reducing premature mortality, and enhancing the overall well-being of affected individuals.

Methods

Study setting and population

In this descriptive study, the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database was utilized to retrieve death certificate data. The analysis spanned the years 1999–2020, focusing on mortality related to schizophrenia, using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code F20.

This dataset comprises cause-of-death information from death certificates for all 50 states. To identify deaths attributable to schizophrenia, the Multiple Cause-of-Death Public Use record death certificates were examined, defining schizophrenia-related deaths as those where schizophrenia was listed as either a contributing or underlying cause of death on the certificates.

In accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, this study exclusively utilized de-identified, publicly available data. Consequently, institutional review board (IRB) approval was not required.

Data abstraction

For this study, demographic data were extracted, including gender, urbanization status, overall mortality trends over time, and place of death. Age and sex distributions were analyzed to provide a comprehensive demographic profile. The place of death was categorized as home, hospice facility, nursing home/long-term care, medical facility (inpatient, outpatient, emergency room, dead on arrival, or status unclear), and other. Urbanization data, available for 2013, were classified into six categories: large central metro, large fringe metro, medium metro, small metro, micropolitan (non-metro), and non-core (non-metro). These classifications, derived from death certificate records, have been widely utilized in previous epidemiological studies using the WONDER database.

Statistical analysis

Taking into account variables like age, year, sex, state, and level of urbanization, we computed the crude and age-adjusted mortality rates (AAMRs) per 100,000 population for schizophrenia from 1990 to 2020 and provided 95% confidence intervals (CIs) to assess national trends in schizophrenia-related mortality. By dividing the total number of deaths from schizophrenia by the total population of the USA for each year, crude mortality rates were calculated. The Join Point Regression Program (Join Point V 5.2.0.0, National Cancer Institute) was utilized to evaluate the annual percent change (APC) in AAMR. This program fits log-linear regression models to discover significant temporal fluctuations in AAMR. APCs were classified as rising or falling based on whether the mortality trend’s slope deviated substantially from zero. A P-value of less than 0.05 and a two-tailed t-test were used to determine statistical significance.

Results

Schizophrenia-related AAMR stratified by gender

From 1990 to 2020, the overall number of deaths due to schizophrenia was 25,287 (Supplementary Table 1 http://links.lww.com/MS9/A852). Throughout the study period, the AAMR for males and females was found to be 7.7 and 5.0 (Supplementary Table 2 http://links.lww.com/MS9/A852). Males consistently had a higher schizophrenia-related AAMR than females. Overall, the AAMR was 1.3% (95% Cl: 1.3–1.3) for males, compared to 0.9% (95% Cl: 0.9–0.9) for females. In 1999, the AAMR for males was 1.3% (95% Cl: 1.3–1.4), showing a slight decline to 1.2% in 2015 (APC: −0.42; 95% Cl: −1.1 to 0.12), before rising significantly to 1.7% in 2020 (APC: 6.50; 95% Cl: 3.9–11.8). A similar pattern was observed in females, with an AAMR of 1.1% (95% Cl: 1.1–1.2) in 1999, decreasing to 0.8% in 2015 (APC: −2.02; 95% Cl: −3.2 to −1.3), followed by an increase to 1.2% in 2020 (APC: 6.5; 95% Cl: 2.4–18.5). These trends highlight a general decline in AAMR until 2025, after which there was a notable rise in mortality rates, particularly among males in the later years (Fig. 1).

Figure 1.

Figure 1.

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Trends in schizophrenia-related age-adjusted mortality rate stratified by gender, 1999–2020.

Schizophrenia-related AAMR stratified by urbanization

From 1990 to 2020, the deaths in metro areas were 21,479 and in non-metro areas were 3265. The AAMR in metro areas was 30.8 and non-metro areas was 13.7 (Supplementary Table 4 http://links.lww.com/MS9/A852). Schizophrenia-related AAMRs declined in both metropolitan and non-metropolitan areas before experiencing a sharp increase leading up to 2020. In metropolitan areas, the overall AAMR was 96.6, with a significant decline from 1999 to 2015 (APC: −1.07; 95% CI: −1.70 to −0.56), followed by a marked increase until 2020 (APC: 6.41; 95% CI: 3.87–12.15). Similarly, non-metropolitan areas had an overall AAMR of 58.9, showing a steady decline from 1999 to 2017 (APC: −0.86%; 95% CI: −2.15 to −0.29), before rising sharply through 2020 (APC: 8.95%; 95% CI: 1.36–18.58) (Fig. 2). This resurgence in mortality rates may be attributed to factors such as reduced access to mental healthcare, socioeconomic disparities, and the impact of global health crises, including the COVID-19 pandemic, which disproportionately affected vulnerable populations [19].

Figure 2.

Figure 2.

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Trends in schizophrenia-related age-adjusted mortality rate stratified by urbanization, 1999–2020.

Schizophrenia-related AAMR stratified by year

Various peaks have been observed in the trends of death throughout the years. Overall, the deaths have been decreased from 1990 to 2020 (Supplementary Table 3 http://links.lww.com/MS9/A852). Between 1999 and 2020, the schizophrenia-related AAMR increased from 1.2 to 1.4, although trends varied throughout this period. While certain years showed periods of decline, the overall trajectory reflected a gradual rise in mortality rates over time (Fig. 3).

Figure 3.

Figure 3.

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Trends in schizophrenia-related age-adjusted mortality rate stratified by year, 1999–2020.

Schizophrenia-related AAMR stratified by place of death

The majority of schizophrenia-related deaths occurred in nursing homes or long-term care facilities (38.8%), followed by hospital inpatients (26.3%) and individuals who passed away at home (19%). Hospice facilities accounted for the smallest share of deaths (2.2%), while 0.3% occurred in unknown locations. These patterns suggest that many individuals with schizophrenia require long-term institutional care, likely due to the severity of their condition, coexisting health issues, and challenges with independent living. The relatively low number of deaths in hospice settings may reflect the underuse of palliative care services, possibly due to barriers in access, stigma, or a lack of coordination between psychiatric and end-of-life care (Fig. 4).

Figure 4.

Figure 4.

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Trends in schizophrenia-related age-adjusted mortality rate stratified by place of death, 1999–2020.

Discussion

Our study revealed significant trends in schizophrenia-related AAMR over the 20-year period from 1999 to 2020, with notable variations by gender, urbanization, and place of death. One of the key findings was the initial decline in AAMR until 2015, followed by a sharp resurgence leading up to 2020. This pattern was largely consistent among both men and women, suggesting that improvements in psychiatric care, medication availability, and public health initiatives contributed to earlier declines, whereas external factors, such as healthcare system challenges, socioeconomic stressors, and global crises, may have driven the later increase.

Males consistently exhibited higher AAMRs than females, which aligns with existing literature on schizophrenia mortality disparities. Biological factors such as X-linked genetic influences and the protective role of estrogen may contribute to the observed gender differences, as estrogen has been suggested to have neuroprotective effects in schizophrenia[20]. Additionally, men tend to experience earlier disease onset, more severe symptoms, and higher rates of substance abuse, which significantly increase the risk of mortality[21]. Psychosocial factors, including lower healthcare-seeking behavior, higher rates of homelessness, and reduced social support, may further explain the disparity.

The initial decline in AAMR for both genders before 2015 may be attributed to specific advancements in schizophrenia treatment and management. The widespread adoption of second-generation antipsychotics, including risperidone, olanzapine, and aripiprazole, provided better symptom control with fewer extrapyramidal side effects, improving medication adherence and reducing mortality[22]. At the same time, Assertive Community Treatment (ACT) programs, which were expanded in the early 2000s, proved effective in preventing hospitalizations and stabilizing high-risk patients with severe mental illness. Studies showed that ACT reduced psychiatric hospitalizations compared to standard care[23,24], improved patient satisfaction, and promoted independent living[23]. Additionally, growing awareness of cardiovascular risks in schizophrenia patients led to better screening and management of metabolic disorders, reducing deaths from preventable conditions. However, the decline in mortality did not persist beyond 2015[14].

The sharp increase in AAMR after this period, particularly in males, suggests a convergence of multiple systemic failures. Between 2016 and 2019, the National Institute of Mental Health (NIMH) reduced its funding for schizophrenia research by approximately 17.5%. By 2021, the number of NIMH-funded grants for schizophrenia had decreased by 22% compared to 2016, comprising only 10.1% of the NIMH budget[25]. This shift reflects a broader trend in which NIMH has increasingly prioritized basic brain research, particularly in genetics and neural circuits, over clinical trials focused on treatments for serious psychiatric disorders. For example, funding for homelessness-related research at NIMH declined from 10 grants in 2016 to just four by 2019, despite long-standing evidence that at least one-third of homeless individuals suffer from serious mental illness. The NIMH Strategic Plan for 2020–2024 highlights this trend, emphasizing basic research on brain function while mentioning serious mental illnesses – such as schizophrenia – only in passing[26].

ACT programs are effective but not equally available across the USA due to differences in mental health funding and infrastructure. States like New York and Wisconsin have well-developed ACT programs for schizophrenia, while states such as Alabama, Louisiana, and many rural areas have limited access. This uneven distribution leads to differences in patient outcomes. The opioid crisis, which peaked between 2015 and 2020, had a severe impact on people with schizophrenia, who are more likely to struggle with substance use disorders. This contributed to higher death rates, with studies estimating that 47%–70% of individuals with schizophrenia have a substance use disorder, and over 80% if tobacco use is included[27]. Additionally, the COVID-19 pandemic had a catastrophic impact on this population, with studies showing that individuals with schizophrenia were nearly three times more likely to die from COVID-19 than the general population, likely due to higher rates of cardiovascular disease, diabetes, and difficulties accessing medical care during lockdowns[28].

Urbanization patterns also played a significant role in shaping schizophrenia-related mortality trends. Both metropolitan and non-metropolitan areas initially experienced a decline in AAMR, followed by a steep increase leading up to 2020. In metropolitan areas, the availability of mental health resources may have contributed to early declines, but worsening social determinants of health – such as rising economic pressures, increased homelessness, and higher levels of social isolation – could explain the later increase[29]. Non-metropolitan areas experienced a more prolonged decline in AAMR until 2017; however, the sharp rise in AAMR after 2017 suggests growing disparities in healthcare infrastructure, which have left many individuals with schizophrenia without adequate support. The significant increase in AAMR in both urban and rural areas in recent years highlights the urgent need for equitable mental health services that address both the unique challenges of urban environments and the lack of specialized care in rural settings.

Patterns in place of death further emphasize the severe burden of schizophrenia and the gaps in healthcare services for this population. The highest proportion of schizophrenia-related deaths occurred in long-term care facilities (38.8%), followed by medical facility inpatients (26.3%), suggesting that many individuals with schizophrenia require institutionalized care due to the chronic and debilitating nature of the disease. This also reflects systemic issues, such as a shortage of community-based mental health services and inadequate social support, leaving patients with fewer options for care. The relatively high percentage of deaths occurring at home (19%) raises concerns about inadequate medical supervision, potentially due to financial constraints, social isolation, or a lack of family support. Financial barriers may prevent families from accessing necessary medical services, while social isolation – often exacerbated by stigma – further compounds the issue. The notably low percentage of deaths in hospice facilities (2.2%) points to a significant underutilization of palliative care services for individuals with schizophrenia. This could be due to multiple barriers, including stigma, a lack of integration between psychiatric and palliative care services, and limited awareness among healthcare providers about the end-of-life needs of schizophrenia patients[30].

Additionally, the underrepresentation of individuals with schizophrenia in hospice care highlights the marginalization of this population in the context of end-of-life care. The absence of effective communication between psychiatric care providers and palliative care teams prevents the delivery of holistic, patient-centered care. The underutilization of hospice services calls for increased education and awareness among healthcare providers about the unique end-of-life care needs of individuals with schizophrenia[31]. There is also an urgent need for better end-of-life planning and improved coordination between psychiatric and general medical services to ensure that these patients receive compassionate, comprehensive care.

Schizophrenia is unique in its comparison to other chronic diseases. Unlike conditions such as diabetes, cardiovascular disease, and cancer, schizophrenia receives significantly less research funding and pharmaceutical innovation despite its high burden on individuals and society[26]. This disparity is particularly concerning given the strong correlations between schizophrenia and various physical health conditions, including metabolic syndrome, cardiovascular disease, and diabetes[14]. Notably, schizophrenia has been linked to higher rates of breast cancer, while rates of prostate cancer appear lower in this population[32]. These findings suggest a need for greater integration between psychiatric and general medical care to ensure that individuals with schizophrenia receive comprehensive health monitoring and early intervention for comorbid conditions.

This condition profoundly impacts not just mental health but also overall well-being, with early signs appearing as motor and cognitive impairments in childhood[33]. In the USA, there are early intervention programs such as RAISE (Recovery After Initial Schizophrenia Episode) and NAVIGATE, designed to help individuals who have recently been diagnosed with schizophrenia. However, access to these programs remains inconsistent, and many individuals still receive Usual Community Care, which typically includes less intensive and less coordinated treatment, making it less effective in addressing the needs of those with first-episode psychosis[34]. A study done in 2015 highlights that Coordinated Specialty Care (CSC), a more comprehensive treatment approach, leads to better functional (ability to manage daily tasks) and symptomatic (reduction of psychotic symptoms) outcomes[34]. CSC is a team-based treatment that involves specialists such as psychiatrists, therapists, and case managers working together to provide individualized care. Unfortunately, delays in diagnosis and treatment often prevent patients from receiving timely access to CSC. Additionally, many CSC programs are time-limited, focusing on the first few years after diagnosis, which might not be enough to ensure long-term recovery. Expanding these programs to ensure they are available beyond the initial years of diagnosis and in under-resourced and rural areas could improve long-term recovery for individuals with schizophrenia[34].

In the USA, there is no national mandate for early intervention in schizophrenia, meaning that there is no nationwide requirement to provide early treatment for individuals diagnosed with schizophrenia. As a result, access to Early Intervention in Psychosis (EIP) services, which include CSC programs, is not guaranteed and varies significantly between states. This inconsistency leads to disparities in care, with rural and under-resourced communities often facing greater difficulties in accessing quality mental health services. Implementing EIP services in these areas is particularly challenging due to geographic isolation, limited mental health resources (lack of enough trained professionals or facilities), and inadequate staffing. Furthermore, the lack of centralized funding and the variability in financial support at the state level make it difficult to maintain or expand these programs. These barriers prevent many individuals with schizophrenia from receiving timely and comprehensive care. Expanding EIP services nationwide, particularly in rural areas and underserved communities, could help bridge these gaps and improve long-term outcomes for individuals experiencing first-episode psychosis[35].

Another major limitation of U.S. early intervention programs is that they typically last only 2–5 years, despite schizophrenia being a lifelong condition. Many individuals struggle after transitioning out of these services, often facing a decline in care and worsening symptoms. Research suggests that extending the duration of early intervention – similar to what has been proposed in Europe and Australia, where some programs extend up to 5–7 years – could significantly improve long-term patient outcomes[36]. By developing longer-term, continuous care models, the USA can provide ongoing psychiatric support, social services, and rehabilitation beyond the critical early years.

Schizophrenia patients often have comorbid conditions like cardiovascular disease, diabetes, and metabolic syndrome, but mental and physical health care in the USA is typically managed separately. To improve overall health outcomes, mental health providers should oversee physical health monitoring, typically done by primary care, to ensure early detection of serious risks. Recommendations include regular monitoring of BMI, glucose, lipid profiles, prolactin, and sexual dysfunction to guide antipsychotic choices[37].

Finally, research funding for schizophrenia lags behind that for other chronic diseases. Schizophrenia treatment has not seen promising advances, like observed in cancer and cardiovascular disease, despite its substantial impact on individuals and society. The UK and EU have invested in biomarker-based risk assessment tools to detect schizophrenia earlier, as well as precision medicine approaches to develop more personalized treatments. In the USA, increased funding could accelerate epigenetic research – such as the development of histone deacetylase inhibitors, which show promise in improving cognitive function in schizophrenia patients. Expanding research in this area could lead to more effective, targeted treatments for schizophrenia in the future[38].

Limitations

Several limitations must be acknowledged when interpreting these findings. First, the accuracy of death certificate data may be a potential concern, as misclassification or incomplete reporting could lead to either an underestimation or overestimation of schizophrenia-related mortality rates. Additionally, this study does not account for individual clinical factors, such as disease severity, treatment regimens, or comorbidities, which limits our ability to fully comprehend the factors driving mortality trends. Changes in diagnostic criteria, coding practices, and healthcare policies over time may also introduce inconsistencies in the data. Moreover, the urbanization data used were last updated in 2013, meaning shifts in population distribution and access to healthcare since then may not be captured in our analysis. Variations in healthcare infrastructure, reporting standards, and mental health policies across states may further contribute to discrepancies in reported mortality rates. Lastly, the reliance on aggregate data from the CDC WONDER database limits the ability to conduct individual-level analyses, potentially overlooking critical risk factors or protective interventions that could influence schizophrenia-related mortality.

Conclusion

From 1999 to 2020, schizophrenia-related mortality rates followed a noticeable pattern – initially declining with advancements in treatment, better psychiatric care, and community support programs, only to rise sharply after 2015. This increase may be linked to cuts in research funding, healthcare inequalities, the opioid crisis, and the effects of the COVID-19 pandemic. The study also found that men had consistently higher mortality rates than women, likely due to earlier onset, more severe symptoms, and higher rates of substance abuse.

These findings highlight the need for a better approach to schizophrenia care, one that fully integrates mental and physical health treatment. Many patients also struggle with conditions like heart disease, diabetes, and metabolic syndrome, making it even more important to bridge the gap between psychiatric and general healthcare. Limited access to palliative care and inconsistent early intervention programs – especially in rural and underserved areas – suggest that many patients are not getting the support they need. On top of that, schizophrenia research continues to receive far less funding than other chronic illnesses, creating a major gap in treatment advancements and long-term care strategies.

To improve outcomes, we need real action – stronger policies, better healthcare access, and more investment in schizophrenia research. Expanding early intervention programs and ensuring mental and physical healthcare work hand in hand are crucial steps in reducing mortality rates and improving the quality of life for people living with schizophrenia.

Acknowledgements

Not applicable.

Footnotes

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, www.lww.com/annals-of-medicine-and-surgery.

Contributor Information

Hurmat Fatima Bhatti, Email: hurmatfatima01@gmail.com.

Maham Tahir, Email: mahamtahir55@gmail.com.

Muhammad Shaheer Bin Faheem, Email: mshaheerfaheem@gmail.com.

Momina Khabir, Email: mominakhabir@gmail.com.

Ali Tahir, Email: alifumc2002@gmail.com.

Muhammad Abdullah Aftab Qureshi, Email: m.abdullahmufc@gmail.com.

Danish Ali Ashraf, Email: danishaliashraf07@outlook.com.

Muhammad Saad Iqbal, Email: iqbalsaad963@gmail.com.

Sumaya Samadi, Email: dr.sumaya.hs@gmail.com.

Ethical approval

The present study does not involve direct data collection from human subjects or animals. All data used in this study were obtained from previously published and publicly available sources, adhering to the ethical guidelines of the respective studies. No identifiable patient information is presented in this study.

Consent

Not applicable.

Sources of funding

None.

Author contributions

H.F.B.: Conceptualization, Formal analysis, Software, Writing– original draft, and Visualization; M.T.: Conceptualization, Formal analysis, Software, Writing – original draft, and Visualization; M.S.B.F.: Project administration, Writing – review and editing, Writing – original draft, and Formal analysis; M.K.: Writing – review and editing; A.T.: Writing – original draft, Resources, and Methodology; M.A.A.Q.: Writing – original draft and Resources; D.A.A.: Supervision and Investigation; M.S.I.: Writing – review and editing; and S.S.: Project administration and Resources.

Conflicts of interest disclosure

None.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Muhammad Shaheer Bin Faheem.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data availability statement

Data are provided within the manuscript or supplementary information files.

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