Universal but not at the same frequency around the world. International pilot study of schizophrenia (ipss) - 9 countries, 15-25 year follow up after initial hospitalization. Collaborative study of the determinants of outcome of severe mental disorders (dos) - in 6 of the same countries as ipss a few years later. Ipss and dos divided countries into developing or developed based on prevailing socioeconomic conditions. Clinical and social outcomes were significantly better for schizophrenic patients in developing countries than developed countries. Schizophrenia is expressed in terms of similar symptoms across different cultures. More favorable outcomes in certain countries may be a product of greater tolerance and acceptance for those with psychotic symptoms in developing countries. Consistent with evidence that frequency of relapse is related to patterns of family communication. Siblings and children share on average 50% of genes. Risk for second degree greater than 1% reported for the gen pop. However, can"t separate genetic and environmental factors with family.