BackgroundTo assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States.MethodsData were drawn from a prospective, observational, noninterventional study of schizophrenia in the United States (US-SCAP) conducted between 7/1997 and 9/2003. Patients with and without relapse in the prior 6 months were compared on total direct mental health costs and cost components in the following year using propensity score matching method. Baseline predictors of subsequent relapse were also assessed.ResultsOf 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period. Costs for patients with prior relapse were about 3 times the costs for patients without prior relapse. Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Patients with prior relapse were younger and had onset of illness at earlier ages, poorer medication adherence, more severe symptoms, a higher prevalence of substance use disorder, and worse functional status. Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels.ConclusionsDespite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia.

Among white non-Hispanic children but not among black and Hispanic children, spanking frequency before age 2 is significantly and positively associated with child behavior problems at school age. These findings are consistent with those reported in studies of children older than 2 years but extend these findings to children who are spanked beginning at a relatively early age.

Evidence that childhood maltreatment is associated with emotional and behavioral problems throughout childhood suggests that maltreatment could lead to impaired academic performance in middle and high school. This article explores these effects using data on siblings. An index measure of the intensity of childhood maltreatment was included as a covariate in multivariate analyses of adolescents' risk for school performance impairments. Family fixed effects were used to control for unobservables linked to family background and neighborhood effects. More intense childhood maltreatment was associated with greater probability of having a low GPA (P=0.001) and problems completing homework assignments (P=0.007). Associations between maltreatment intensity and adolescent school performance were not sensitive to model specification. Additional analyses suggested that maltreatment effects are moderated by cognitive deficits related to attention problems. The implications of these findings for educators and schools are discussed.