title: Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses.
abstract: BACKGROUND
  We conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time).
  
  
  OBJECTIVE
  To determine variation in incidence of several psychotic disorders as above.
  
  
  METHODS
  Published and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication.
  
  
  METHODS
  Published 1950-2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence.
  
  
  METHODS
  People, 16-64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis.
  
  
  METHODS
  Title, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I²-statistic.
  
  
  RESULTS
  83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6-40.9), 23.2 (95%CI: 18.3-29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9-19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0-17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I²: 0.54-0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4-9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3-6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3-4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.
  
  
  CONCLUSIONS
  Incidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results.
  
  
  CONCLUSIONS
  Incidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning.
authors.affiliation: Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, United Kingdom. jbk25@cam.ac.uk
authors.forename: James B
authors.initials: JB
authors.lastname: Kirkbride
authors.forename: Antonia
authors.initials: A
authors.lastname: Errazuriz
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Croudace
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.forename: Daniel
authors.initials: D
authors.lastname: Jackson
authors.forename: Jane
authors.initials: J
authors.lastname: Boydell
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
mesh_terms: D003628:Database Management Systems; D004739:England / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000208:ethnology; D012559:Schizophrenia / Q000453:epidemiology* / Q000208:ethnology