Sex differences in the clinical presentation of early psychosis in a primary care setting

Brooke Carter¹, Rebecca Rodrigues¹, Jennifer Reid², Suzanne Archie³, Amanda L Terry^{1

4}, Lena Palaniyappan^{5

6}, Arlene G MacDougall^{1

5}, Aristotle Voineskos⁷, Saadia Hameed Jan⁴, Liisa Jaakkimainen^{2

8}, Branson Chen², Neo Sawh², Kelly K Anderson^{9

10

11}

Affiliations

¹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
² ICES, Toronto, ON, Canada.
³ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁴ Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁵ Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
⁷ Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.
⁸ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada. kelly.anderson@schulich.uwo.ca.
¹⁰ ICES, Toronto, ON, Canada. kelly.anderson@schulich.uwo.ca.
¹¹ Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. kelly.anderson@schulich.uwo.ca.

PMID: 37266694
DOI: 10.1007/s00737-023-01329-w

Sex differences in the clinical presentation of early psychosis in a primary care setting

Brooke Carter et al. Arch Womens Ment Health. 2023 Aug.

. 2023 Aug;26(4):485-493.

doi: 10.1007/s00737-023-01329-w. Epub 2023 Jun 2.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
² ICES, Toronto, ON, Canada.
³ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁴ Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁵ Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
⁷ Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.
⁸ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada. kelly.anderson@schulich.uwo.ca.
¹⁰ ICES, Toronto, ON, Canada. kelly.anderson@schulich.uwo.ca.
¹¹ Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. kelly.anderson@schulich.uwo.ca.

PMID: 37266694
DOI: 10.1007/s00737-023-01329-w

Abstract

Primary care is an important part of the help-seeking pathway for young people experiencing early psychosis, but sex differences in clinical presentation in these settings are unexplored. We aimed to identify sex differences in clinical presentation to primary care services in the 1-year period prior to a first diagnosis of psychotic disorder. We identified first-onset cases of non-affective psychotic disorder over a 10-year period (2005-2015) using health administrative data linked with electronic medical records (EMRs) from primary care (n = 465). Detailed information on encounters in the year prior to first diagnosis was abstracted, including psychiatric symptoms, other relevant behaviours, and diagnoses recorded by the family physician (FP). We used modified Poisson regression models to examine sex differences in the signs, symptoms, and diagnoses recorded by the FP, adjusting for various clinical and sociodemographic factors. Positive symptoms (PR = 0.76, 95%CI: 0.58, 0.98) and substance use (PR = 0.54, 95%CI: 0.40, 0.72) were less prevalent in the medical records of women. Visits by women were more likely to be assigned a diagnosis of depression or anxiety (PR = 1.18, 95%CI: 1.00, 1.38), personality disorder (PR = 5.49, 95%CI: 1.22, 24.62), psychological distress (PR = 11.29, 95%CI: 1.23, 103.91), and other mental or behavioral disorders (PR = 3.49, 95%CI: 1.14, 10.66) and less likely to be assigned a diagnosis of addiction (PR = 0.33, 95%CI: 0.13, 0.87). We identified evidence of sex differences in the clinical presentation of early psychosis and recorded diagnoses in the primary care EMR. Further research is needed to better understand sex differences in clinical presentation in the primary care context, which can facilitate better understanding, detection, and intervention for first-episode psychotic disorders.

Keywords: Electronic medical records; First-episode psychosis; Primary care; Sex differences; Symptoms.

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References

1. Abel KM, Drake R, Goldstein JM (2010) Sex differences in schizophrenia. Int Rev Psychiatry 22(5):417–428. https://doi.org/10.3109/09540261.2010.515205 - DOI - PubMed
1. Alegría M, Bijl RV, Lin E, Walters EE, Kessler RC (2000) Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Arch Gen Psychiatry 57(4):383–391. https://doi.org/10.1001/archpsyc.57.4.383 - DOI - PubMed
1. Anderson KK, Flora N, Archie S, Morgan C, McKenzie K (2014) Race, ethnicity, and the duration of untreated psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 49(7):1161–1174. https://doi.org/10.1007/s00127-013-0786-8 - DOI - PubMed
1. Anderson KK, Archie S, Booth RG, Cheng C, Lizotte D, MacDougall AG, Norman RMG, Ryan BL, Terry AL, Rodrigues R (2018) Understanding the role of the family physician in early psychosis intervention. Bjpsych Open 4(6):447–453. https://doi.org/10.1192/bjo.2018.67 - DOI - PubMed - PMC
1. Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P (2019) Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services. Psychol Med 49(12):2091–2099. https://doi.org/10.1017/S0033291718002933 - DOI - PubMed

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Sex differences in the clinical presentation of early psychosis in a primary care setting

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Sex differences in the clinical presentation of early psychosis in a primary care setting

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials