Sex and schizophrenia: a review of gender differences

Abstract

Gender differences in schizophrenia have been noted since conceptualisation of the illness. Female onset is typically later, with a second peak post-menopause. Whilst incidence is higher in men, prevalence does not differ. Research has explored possible biopsychosocial causes of these differences. Evidence for genetic and neurodevelopmental factors is weak but support has garnered for the “estrogen hypothesis,” which emphasises the possible neuroprotective effect of estrogen in women. Differences have also been attributed to a differing psychological vulnerability between men and women based on symptomatology: “negative” symptoms are more common in men, whilst “positive” symptoms differ in content between the genders. Social factors might also play a role: whilst women experience more sexual assault, socioeconomic disadvantage and provide more care for dependents, men experience less familial engagement and more environmental hostility. The relevance of gender differences in schizophrenia has meaning beyond academic interest, since they can affect treatment: recent research has, for instance, begun to explore the efficacy of estrogen therapy. The aetiology of gender differences in schizophrenia is only partially understood and more research is needed to elucidate the causal roles of Biopsychosocial factors: understanding these will ultimately improve the treatment of all who suffer from this serious mental illness.