Linda Grossman, Ph.D., a professor of psychology at the University of
Illinois: "I believe that we have a very important, unique data
set." Joan Arehart-Treichel
Women with schizophrenia fare better than do men with the illness, various
retrospective studies have found. Now a longitudinal investigation further
supports these results.
The study was headed by Linda Grossman, Ph.D., a professor of psychology in
the Department of Psychiatry at the University of Illinois at Chicago.
Grossman reported the results at APA's 2006 annual meeting in Toronto in May.
The results are also published in the June Psychiatric Services.
Grossman and her colleagues recruited 239 young adults, average age 23
years, who were hospitalized for a psychiatric illness. Of the 239 subjects,
69 had schizophrenia, 56 had other types of psychosis, and 114 had
nonpsychotic illnesses (notably depression, bipolar disorder, a substance use
disorder, an eating disorder, or a personality disorder).
All of the subjects were originally evaluated during hospitalization and
then at five follow-up points—two, five, eight, 10, and 15
years—for illness course and recovery. Recovery was defined as the
absence of major symptoms and evidence of adequate psychosocial functioning,
including working half time or more in the year before each follow-up. The
assessment tools included a standardized battery of semistructured interviews,
questionnaires, and psychological tests.
Grossman and her group then compared outcomes for the three subject groups,
classified by gender, considering age at illness onset, antipsychotic
medication use, and other possibly confounding factors. Controlling for age of
onset was especially crucial, they explained in their study report,"
because older age before a first psychotic break allows time for
development of greater knowledge, social skills, and experience. In addition,
older age at first break may suggest greater internal resiliency."
Gender differences in outcome were found for patients with schizophrenia
and for those with other psychotic disorders, with women consistently showing
better functioning over time, more periods of recovery, and fewer and shorter
rehospitalizations. In other words, while the analyses did not produce
uniformly significant results in each area at each follow-up, many gender
differences were significant, and all analyses showed that the men's outcome
was poorer than the women's.
In contrast, there were no significant gender differences in outcome among
subjects with psychiatric illnesses other than psychosis.
Thus, women seem to have an edge when it comes to combating schizophrenia
or other psychotic illnesses, yet this advantage does not appear to extend to
coping with nonpsychotic conditions, Grossman and her group concluded.
Why this might be the case is not known. However, they proposed several
possible explanations for why being female might help combat psychosis. For
example, more women with schizophrenia marry than men with schizophrenia do,
and having a partner might help them cope with serious mental illness. Women
with schizophrenia are less likely to abuse substances than are men with
schizophrenia, and lack of substance abuse in turn may speed healing and
recovery. Female hormones may likewise boost women's ability to cope with
psychosis. Psychopathology has been shown to improve when estrogen levels
rise, and vice versa. In fact, it is conceivable that estrogen inhibits
postsynaptic dopamine transmission and thereby serves as a"
In any event, it appears that being female is not enough to counter
psychosis in all instances. The outcome differences between women and men with
schizophrenia were found to be only moderate, rather than very large, and only
a small number of women with schizophrenia demonstrated complete recovery at
all five follow-up points.
The study was funded by the National Institute of Mental Health.
"Sex Differences in Outcome and Recovery for Schizophrenia and
Other Psychotic and Nonpsychotic Disorders" is posted at<http://ps.psychiatryonline.org>
under the June issue. ▪