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Excess of non-right-handedness in schizophrenia: meta-analysis of gender effects and potential biases in handedness assessment

  • Marco Hirnstein (a1) and Kenneth Hugdahl (a2)



The notion that schizophrenia is characterised by increased non-right-handedness is a cornerstone of the theory that schizophrenia arises from, and is genetically linked to, abnormal brain lateralisation. Reviews and meta-analyses have reported higher rates of non-right-handers in patients with schizophrenia. However, this was suggested to be the result of a gender artefact or a hidden bias in self-report handedness questionnaires.


To investigate using a meta-analytical approach whether the excess of non-right-handedness is seen in both females and males, and also when handedness is assessed behaviourally.


Electronic databases were searched for studies that reported (a) the rate of female and male non-right-handers in schizophrenia compared with controls and (b) the rate of non-right-handers in schizophrenia (regardless of gender) based on behavioural handedness assessment.


The odds ratios (ORs) for females (OR = 1.63; based on 621 patients, 3747 controls) and males (OR = 1.50; based on 1213 patients, 3800 controls) differed significantly from 1.0, indicating both female and male patients were more often non-right-handed than controls. Moreover, there was an excess of non-right-handedness in patients with schizophrenia when handedness was assessed behaviourally: OR = 1.84 (1255 patients, 6260 controls). Even when both gender and behavioural handedness assessment were controlled for simultaneously, the excess of non-right-handedness persisted.


The findings clearly demonstrate that the excess of non-right-handedness in schizophrenia does not result from a gender artefact or from biased handedness questionnaires. It is a true empirical effect and may indeed reflect a genetic link between schizophrenia and brain lateralisation.

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Corresponding author

Dr Marco Hirnstein, Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway. Email:


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This work was supported by the Advanced Grant VOICE #249516 from the European Research Council (ERC) as well as the FRIPRO Program Grant #221550 and the Norment Center of Excellence Grant #22373, both from the Research Council of Norway, to K.H.

Declaration of interest




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Excess of non-right-handedness in schizophrenia: meta-analysis of gender effects and potential biases in handedness assessment

  • Marco Hirnstein (a1) and Kenneth Hugdahl (a2)


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Excess of non-right-handedness in schizophrenia: meta-analysis of gender effects and potential biases in handedness assessment

  • Marco Hirnstein (a1) and Kenneth Hugdahl (a2)
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