Abstract
Gender differences in schizophrenia have been reported in different aspect of the course of disease and may urge special clinical interventions for female patients. Current literature provides insufficient information to design guidelines for treating women with schizophrenia. We aim to quantify the clinical course of schizophrenia in men and women on premorbid hospitalizations and prescription drugs, age at diagnosis, pharmacological treatment, comorbidity, number of re-hospitalizations, and mortality. Our nationwide cohort study included all patients admitted for the first time to hospital during 2000–2014 for schizophrenia or schizo-affective disorder in Finland. Gender differences were compared with logistic regression, by calculating incidence rates, and mortality was assessed with Cox proportional hazard model. We included 7142 women and 9006 men with schizophrenia/schizo-affective disorder and found that both women (71%) and men (70%) had often been hospitalized for another psychiatric disorder in the 5 years before diagnosis. In women, the last psychiatric hospitalization before schizophrenia/schizo-affective diagnosis was often for mood disorders (62%, OR 2.56, 95% CI 2.28–2.87). Men were diagnosed earlier (mean 34.4 [SD12.6] vs. 38.2 [SD 13.8]) with peak incidence around 22, while incidence in women declining only slowly between age 18 and 65. During ten years follow-up, 69.5% of both genders needed at least one re-hospitalization, with slightly more hospitalizations in women. Women were less often prescribed clozapine or long-acting antipsychotics. Mortality was lower in women (HR = 0.54, 95% CI 0.50–0.60), with fewer suicide and cardiovascular deaths, but more cancer deaths. These results suggest a diagnostic delay for women, which might be shortened by screening women aged 20–65 participating in affective disorder programs. As number of hospitalizations is not lower for women, clinicians should take care not to undertreat women with schizophrenia.
Highlights
Gender differences in schizophrenia affect many domains, including premorbid trajectory, incidence, symptoms, comorbidity, outcome, and mortality[1,2,3]
We investigated the clinical trajectory of SSD in women and men using the Finnish Hospital Discharge Register maintained by the National Institute of Health and Welfare
Our incidence gender ratio of 1:1.3 is close to the 1:1.4 of Jongsma et al.[11] and the gender difference in incidence rates between 1.28 and 1.56 reported for Quebec[12]
Summary
Gender differences in schizophrenia affect many domains, including premorbid trajectory, incidence, symptoms, comorbidity, outcome, and mortality[1,2,3]. Gender differences are present in schizophrenia, with most consistent findings for later onset in women and less consistent data on a possibly better course in and lower mortality in women. This raises the question: if schizophrenia expresses itself different in women than in men, should we develop different guidelines for (early) diagnosis and treatment of women? We aim to describe the clinical course of schizophrenia in both genders, including hospitalizations and psychiatric medication use in the premorbid period, age at diagnosis, pharmacological treatment, comorbidity, number of re-hospitalizations, and mortality in the same persons. Since schizo-affective disorder may represents ‘the more female form of schizophrenia’, restricting
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