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. 2016 Nov 14:12:2927-2939.
doi: 10.2147/NDT.S101151. eCollection 2016.

Sex differences in the course of schizophrenia across diverse regions of the world

Diego Novick  1 , William Montgomery  2 , Tamas Treuer  3 , Maria Victoria Moneta  4 , Josep Maria Haro  4
Affiliations

Sex differences in the course of schizophrenia across diverse regions of the world

Diego Novick et al. Neuropsychiatr Dis Treat. .

Abstract

This study explores sex differences in the outcomes of patients with schizophrenia (clinical/functional remission and recovery) across diverse regions of the world (Northern Europe, Southern Europe, Central and Eastern Europe, Latin America, East Asia, and North Africa and the Middle East). Data (n=16,380 for this post hoc analysis) were taken from the World-Schizophrenia Health Outcomes Study. In most regions, females had a later age at first service contact for schizophrenia, a lower level of overall/negative symptom severity, lower rates of alcohol/substance abuse and paid employment, and higher percentages of having a spouse/partner and independent living. Overall, females had slightly higher rates of clinical remission (58.0% vs 51.8%), functional remission (22.8% vs 16.0%), and recovery (16.5% vs 16.0%) at 36 months (P<0.001 for all). This pattern was consistently observed in Southern Europe and Northern Europe even after controlling for baseline sex differences, but not in other regions. In Central and Eastern Europe, rates of clinical remission were higher in females at 36 months, but those of functional remission and recovery were similar between males and females. The opposite was observed for Latin America. In East Asia, sex differences were rarely observed for these outcomes. Finally, in North Africa and the Middle East, sex differences in these outcomes were pronounced only in regression analyses. These regional variations shed light on the importance of psychosocial and cultural factors and their effects on sex in the prognosis of schizophrenia.

Keywords: recovery; region; remission; schizophrenia; sex; world.

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Conflict of interest statement

DisclosureDN, WM, and TT are employees of Eli Lilly and Company. JMH has acted as a consultant, received grants, or acted as a speaker in activities sponsored by the following companies: Astra-Zeneca, Eli Lilly and Company, Glaxo-Smith-Kline, and Lundbeck. MVM conducted the statistical analysis under a contract between Fundació Sant Joan de Déu and Eli Lilly and Company. The authors declare no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Rates of clinical remission by sex in each region. Notes: (A) Northern Europe, (B) Southern Europe, (C) Central and Eastern Europe, (D) Latin America, (E) East Asia, and (F) Africa and the Middle East. The numbers with an asterisk (*) indicate a statistically significant difference between males and females (ie, P<0.05); otherwise, NS. Abbreviation: NS, nonsignificant.
Figure 2
Figure 2
Rates of functional remission by sex in each region. Notes: (A) Northern Europe, (B) Southern Europe, (C) Central and Eastern Europe, (D) Latin America, (E) East Asia, and (F) Africa and the Middle East. The numbers with an asterisk (*) indicate a statistically significant difference between males and females (ie, P<0.05); otherwise, NS. Abbreviation: NS, nonsignificant.
Figure 3
Figure 3
Rates of recovery by sex in each region. Notes: (A) Northern Europe, (B) Southern Europe, (C) Central and Eastern Europe, (D) Latin America, (E) East Asia, and (F) Africa and the Middle East. The numbers with an asterisk (*) indicate a statistically significant difference between males and females (ie, P<0.05); otherwise, NS. Abbreviation: NS, nonsignificant.
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