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The influence of gender on clinical and social characteristics of patients at psychosis onset: a report from the Psychosis Incident Cohort Outcome Study (PICOS)

Published online by Cambridge University Press:  14 October 2011

M. Bertani ,
A. Lasalvia ,
C. Bonetto ,
S. Tosato ,
D. Cristofalo ,
S. Bissoli ,
K. De Santi ,
R. Mazzoncini ,
L. Lazzarotto  and
M. Santi
...Show all authors
M. Bertani
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
A. Lasalvia*
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
C. Bonetto
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
S. Tosato
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
D. Cristofalo
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
S. Bissoli
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
K. De Santi
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
R. Mazzoncini
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
L. Lazzarotto
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Santi
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
A. Sale
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
D. Scalabrin
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Abate
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Tansella
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
M. Ruggeri
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
*
*Address for correspondence: A. Lasalvia, M.D., Ph.D., Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Ospedale Policlinico ‘GB. Rossi’, Piazzale L. A. Scuro 10, 37134 Verona, Italy. (Email: antonio.lasalvia@univr.it)
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Abstract

Background

This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females (by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis.

Method

A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework – a multi-site research project examining incident cases of psychosis in Italy's Veneto region.

Results

Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal caregivers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.

Conclusions

These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.

Keywords

First-episode psychosisgender differencesneeds for carepre-morbid functioningsocial disability
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 4 , April 2012 , pp. 769 - 780
Copyright
Copyright © Cambridge University Press 2011

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References

Addington, J, van Mastrigt, S, Addington, D (2003). Patterns of premorbid functioning in first-episode psychosis: initial presentation. Schizophrenia Research 62, 23–30.CrossRefGoogle ScholarPubMed
Aleman, A, Kahn, RS, Selten, JP (2003). Sex differences in the risk of schizophrenia. Archives of General Psychiatry 60, 565–571.CrossRefGoogle ScholarPubMed
Amaddeo, F, Tansella, M (2011). New perspectives of mental health service research. Epidemiology and Psychiatric Sciences 20, 3–6.CrossRefGoogle ScholarPubMed
Amaddeo, F, Zambello, F, Tansella, M, Thornicroft, G (2001). Accessibility and pathways to psychiatric care in a community-based mental health system. Social Psychiatry and Psychiatric Epidemiology 36, 500–507.CrossRefGoogle Scholar
Bardenstein, KK, McGlashan, TH (1990). Gender differences in affective, schizoaffective, and schizophrenic disorders. A review. Schizophrenia Research 3, 159–172.CrossRefGoogle ScholarPubMed
Beratis, S, Gabriel, J, Hoidas, S (1994). Age at onset in subtypes of schizophrenic disorders. Schizophrenia Bulletin 20, 287–296.CrossRefGoogle ScholarPubMed
Bianco, ML (2001). L'Italia delle disuguaglianze (Inequalities in Italy). Carocci: Rome.Google Scholar
Bimbi, F (2003). Differenze e disuguaglianze. Prospettive per gli studi di genere in Italia (Differences and Inequalities. Prospects for Gender Studies in Italy). Il Mulino: Bologna.Google Scholar
Castle, DJ, McGrath, J, Kulkarni, J (2000). Women and Schizophrenia. Cambridge University Press: Cambridge, UK.Google Scholar
Choi, JS, Chon, MW, Kang, DH, Jung, MH, Kwon, JS (2009). Gender difference in the prodromal symptoms of first-episode schizophrenia. Journal of Korean Medical Sciences 24, 1083–1088.CrossRefGoogle ScholarPubMed
Cotton, SM, Lambert, M, Schimmelmann, BG, Foley, DL, Morley, KI, McGorry, PD, Conus, P (2009). Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis. Schizophrenia Research 114, 17–24.CrossRefGoogle Scholar
de Girolamo, G, Bassi, M, Neri, G, Ruggeri, M, Santone, G, Picardi, A (2007). The current state of mental health care in Italy: problems, perspectives, and lessons to learn. European Archives of Psychiatry and Clinical Neuroscience 257, 83–91.CrossRefGoogle ScholarPubMed
De Lisi, L (2011). Moving on in schizophrenia research in the next decade. Schzophrenia Research 127, 14–15.CrossRefGoogle ScholarPubMed
de Salvia, D, Barbato, A, Salvo, P, Zadro, F (1993). Prevalence and incidence of schizophrenic disorders in Portogruaro. An Italian case register study. Journal of Nervous and Mental Disease 181, 275–282.CrossRefGoogle ScholarPubMed
Faraone, S, Chen, WJ, Goldstein, JM, Tsuang, MT (1994). Gender differences in age at onset of schizophrenia. British Journal of Psychiatry 164, 625–629.CrossRefGoogle ScholarPubMed
Fennig, S, Putnam, K, Bromet, EJ, Galambos, N (1995). Gender, premorbid characteristics and negative symptoms in schizophrenia. Acta Psychiatrica Scandinavica 92, 173–177.CrossRefGoogle ScholarPubMed
Foerster, A, Lewis, S, Owen, M, Murray, R (1991). Pre-morbid adjustment and personality in psychosis: effects of sex and diagnosis. British Journal of Psychiatry 158, 171–176.CrossRefGoogle ScholarPubMed
Goldberg, D (2010). The process of producing a “NICE” guideline. Epidemiologia e Psichiatria Sociale 19, 211–213.CrossRefGoogle ScholarPubMed
Goldstein, JM, Link, BG (1988). Gender and the expression of schizophrenia. Journal of Psychiatric Research 22, 141–155.CrossRefGoogle ScholarPubMed
Gorwood, P, Leboyer, M, Jay, M, Payan, C, Feingold, J (1995). Gender and age at onset in schizophrenia: impact of family history. American Journal of Psychiatry 152, 208–212.Google ScholarPubMed
Grossman, LS, Harrow, M, Rosen, C, Faull, R, Strauss, GP (2008). Sex differences in schizophrenia and other psychotic disorders: a 20-year longitudinal study of psychosis and recovery. Comprehensive Psychiatry 49, 523–529.CrossRefGoogle ScholarPubMed
Gur, RE, Petty, RG, Turetsky, BI, Gur, RC (1996). Schizophrenia throughout life: sex differences in severity and profile of symptoms. Schizophrenia Research 21, 1–12.CrossRefGoogle ScholarPubMed
Gureje, O (1991). Gender and schizophrenia: age at onset and sociodemographic attributes. Acta Psychiatrica Scandinavica 83, 402–405.CrossRefGoogle ScholarPubMed
Gureje, O, Bamidele, RW (1998). Gender and schizophrenia: association of age at onset with antecedent, clinical and outcome features. Australian and New Zealand Journal of Psychiatry 32, 415–423.CrossRefGoogle ScholarPubMed
Häfner, H, an der Heiden, W (1991). Evaluating effectiveness and cost of community care for schizophrenic patients. Schizophrenia Bulletin 17, 441–451.CrossRefGoogle ScholarPubMed
Häfner, H, an der Heiden, W, Behrens, S, Gattaz, WF, Hambrecht, M, Löffler, W, Maurer, K, Munk-Jørgensen, P, Nowotny, B, Riecher-Rössler, A, Stein, A (1998). Causes and consequences of the gender difference in age at onset of schizophrenia. Schizophrenia Bulletin 24, 99–113.CrossRefGoogle ScholarPubMed
Häfner, H, Maurer, K, Löffler, W, Riecher-Rössler, A (1993). The influence of age and sex on the onset and early course of schizophrenia. British Journal of Psychiatry 162, 80–86.CrossRefGoogle ScholarPubMed
Häfner, H, Nowotny, B (1995). Epidemiology of early-onset schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 245, 80–92.CrossRefGoogle ScholarPubMed
Jablensky, A, Cole, SW (1997). Is the earlier age of onset of schizophrenia in males a confounded finding? Results from a cross-cultural investigation. British Journal of Psychiatry 70, 234–240.CrossRefGoogle Scholar
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 1–97.CrossRefGoogle ScholarPubMed
Judd, F, Armstrong, S, Kulkarni, J (2009). Gender-sensitive mental health care. Australasian Psychiatry 17, 105–111.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes. Findings from the 3-center ÆSOP Study. Archives of General Psychiatry 63, 250–258.CrossRefGoogle ScholarPubMed
Køster, A, Lajer, M, Lindhardt, A, Rosenbaum, B (2008). Gender differences in first episode psychosis. Social Psychiatry and Psychiatric Epidemiology 43, 940–946.CrossRefGoogle ScholarPubMed
Larsen, TK, McGlashan, TH, Johannessen, JO, Vibe-Hansen, L (1996). First-episode schizophrenia: II Premorbid patterns by gender. Schizophrenia Bulletin 22, 257–269.CrossRefGoogle ScholarPubMed
Lasalvia, A, Bonetto, C, Bertani, M, Bissoli, S, Cristofalo, D, Marrella, G, Ceccato, E, Cremonese, C, De Rossi, M, Lazzarotto, L, Marangon, V, Morandin, I, Zucchetto, M, Tansella, M, Ruggeri, M, on behalf of the PICOS-Veneto Group (2009). Influence of perceived organizational factors on job burnout: survey of community mental health staff. British Journal of Psychiatry 195, 537–544.CrossRefGoogle ScholarPubMed
Lasalvia, A, Gentile, B, Ruggeri, M, Marcolin, A, Nosè, F, Cappellari, L, Lamonaca, D, Toniolo, E, Busana, C, Campedelli, A, Cuccato, G, Danieli, A, De Nardi, F, De Nardo, V, Destro, E, Favaretto, G, Frazzingaro, S, Giacopuzzi, M, Pristinger, P, Pullia, G, Rodighiero, S, Tito, P, Aprile, F, Nicolaou, S, Coppola, G, Garzotto, N, Gottardi, U, Lazzarin, E, Migliorini, G, Pavan, L, Ramaciotti, F, Roveroni, P, Russo, S, Urbani, P, Tansella, M; Gruppo PICOS-Veneto (2007). Heterogeneity of the Departments of Mental Health in the Veneto region ten years after the National Plan 1994–96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project (article in Italian). Epidemiologia e Psichiatria Sociale 16, 59–70.CrossRefGoogle Scholar
Lasalvia, A, Tansella, M (2010). Acute in-patient care in modern, community-based mental health services. Where and how? Epidemiologia e Psichiatria Sociale 19, 275–281.CrossRefGoogle ScholarPubMed
Leung, A, Chue, P (2000). Sex differences in schizophrenia, a review of the literature. Acta Psychiatrica Scandinavica 101, 3–38.CrossRefGoogle Scholar
Lewine, RR, Strauss, JS, Gift, TE (1981). Sex differences in age at first hospital admission for schizophrenia: fact or artifact? American Journal of Psychiatry 138, 440–444.Google ScholarPubMed
McCrone, P, Leese, M, Thornicroft, G, Schene, A, Knudsen, HC, Vázquez-Barquero, JL, Tansella, M, Becker, T (2001). A comparison of needs of patients with schizophrenia in five European countries: the EPSILON Study. Acta Psychiatrica Scandinavica 103, 370–379.CrossRefGoogle ScholarPubMed
McGlashan, TH, Bardenstein, KK (1990). Gender differences in affective, schizoaffective, and schizophrenic disorders. Schizophrenia Bulletin 16, 319–329.CrossRefGoogle ScholarPubMed
McGrath, JJ (2006). Variations in the incidence of schizophrenia: data versus dogma. Schizophrenia Bulletin 32, 195–197.CrossRefGoogle ScholarPubMed
Moriarty, N, Stough, C, Tidmarsh, P, Eger, D, Dennison, S (2001). Deficits in emotional intelligence underlying adolescent sex offending. Journal of Adolescence 24, 743–751.CrossRefGoogle ScholarPubMed
Mueser, KT, Bellack, AS, Morrison, RL, Wade, JH (1990). Gender, social competence, and symptomatology in schizophrenia: a longitudinal analysis. Journal of Abnormal Psychology 99, 138–147.CrossRefGoogle ScholarPubMed
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.CrossRefGoogle ScholarPubMed
Ochoa, S, Haro, JM, Usall, J, Autonell, J, Vicens, E, Asensio, F, NEDES group (2005). Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia. Schizophrenia Research 75, 129–134.CrossRefGoogle Scholar
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Phelan, M, Slade, M, Thornicroft, G, Dunn, G, Holloway, F, Wykes, T, Strathdee, G, Loftus, L, McCrone, P, Hayward, P (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589–595.CrossRefGoogle ScholarPubMed
Piccinelli, M, Gomez Homen, F (1997). Gender Differences in the Epidemiology of Affective Disorders and Schizophrenia. World Health Organization: Geneva.Google Scholar
Preston, NJ, Orr, KG, Date, R, Nolan, L, Castle, DJ (2002). Gender differences in premorbid adjustment of patients with first episode psychosis. Schizophrenia Research 55, 285–290.CrossRefGoogle ScholarPubMed
Rabinowitz, J, Levine, SZ, Häfner, H (2006). A population based elaboration of the role of age of onset on the course of schizophrenia. Schizophrenia Research 88, 96–101.CrossRefGoogle ScholarPubMed
Ring, N, Tantam, D, Montague, L, Newby, D, Black, D, Morris, J (1991). Gender differences in the incidence of definite schizophrenia and atypical psychosis: focus on negative symptoms of schizophrenia. Acta Psychiatrica Scandinavica 84, 489–496.CrossRefGoogle ScholarPubMed
Ruggeri, M, Lora, A, Semisa, D, SIEP-DIRECT'S Group (2008). The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services. Epidemiologia e Psichiatria Sociale 17, 358–368.CrossRefGoogle ScholarPubMed
Szymanski, S, Lieberman, JA, Alvir, JM, Mayerhoff, D, Loebel, A, Geisler, S, Chakos, M, Koreen, A, Jody, D, Kane, J (1995). Gender differences in onset of illness, treatment response, course and biologic indexes in first-episode schizophrenic patients. American Journal of Psychiatry 152, 698–703.Google ScholarPubMed
Tang, YL, Gillespie, CF, Epstein, MP, Mao, PX, Jiang, F, Chen, Q, Cai, ZJ, Mitchell, PB (2007). Gender differences in 542 Chinese inpatients with schizophrenia. Schizophrenia Research 97, 88–96.CrossRefGoogle ScholarPubMed
Tansella, M, Balestrieri, M, Meneghelli, G, Micciolo, R (1991). Trends in the provision of psychiatric care 1979–1988. Psychological Medicine. Monograph Supplement 19, 5–16.CrossRefGoogle Scholar
Usall, J, Haro, JM, Ochoa, S, Márquez, M, Araya, S, Needs of Patients with Schizophrenia group (2002). Needs of Patients with Schizophrenia group. Influence of gender on social outcome in schizophrenia. Acta Psychiatrica Scandinavica 106, 337–342.CrossRefGoogle ScholarPubMed
van Os, J, Rutten, BP, Poulton, R (2008). Gene–environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 1066–1082.CrossRefGoogle ScholarPubMed
Vázquez-Barquero, JL, Cuesta Nuñez, MJ, de la Varga, M, Herrera Castanedo, S, Gaite, L, Arenal, A (1995). The Cantabria first episode schizophrenia study: a summary of general findings. Acta Psychiatrica Scandinavica 91, 156–162.CrossRefGoogle ScholarPubMed
Wattie, BJ, Kedward, HB (1985). Gender differences in living conditions found among male and female schizophrenic patients on a follow-up study. International Journal of Social Psychiatry 31, 205–216.CrossRefGoogle ScholarPubMed
Wessely, S, Castle, D, Der, G, Murray, RM (1991). Schizophrenia and Afro-Caribbeans. A case–control study. British Journal of Psychiatry 159, 795–801.CrossRefGoogle ScholarPubMed
WHO (1992). Schedules for Clinical Assessment in Neuropsychiatry (SCAN); Version 1.0. World Health Organization: Geneva.Google Scholar
WHO (1988). Disability Assessment Schedule-II (DAS). World Health Organization: Geneva.Google Scholar
WHO (2001). Madrid Seminar on Gender Mainstreaming Health Policies in Europe. World Health Organization: Geneva.Google Scholar
Wiersma, D (2006). Needs of people with severe mental illness. Acta Psychiatrica Scandinavica Supplementum 429, 115–119.CrossRefGoogle Scholar
Women's Health Council (2007). A Guide to Creating Gender-Sensitive Health Services – 2nd edn. The Women's Health Council: Dublin.Google Scholar