Skip to main content Accessibility help
×
Home

Gender differences in schizophrenia: rehospitalization and community survival

  • Matthias C. Angermeyer (a1), Jill M. Goldstein (a1) and Ludwig Kuehn (a1)

Synopsis

This study tested the hypothesis that schizophrenic men experience a poorer course than schizophrenic women. A representative sample from Hannover, FRG, including 278 first admission DSM-III schizophrenics, were followed for three years. Findings demonstrated that schizophrenic women experience fewer rehospitalizations, shorter lengths of stay, and survive longer in the community than schizophrenic men. Implications of the role of gender for schizophrenia are discussed.

Copyright

Corresponding author

1Address for correspondence Dr J. M. Goldslein, Psychiatry Service (116A) Brockton-West Roxbury V. A. Medical Center, 940 Belmont Street, Brockton, MA 02401, USA.

References

Hide All
Achté, K. A. (1967). On prognosis and rehabilitation in schizophrenic and paranoid psychoses. Acta Psychiatrica Scandinavica Supplement 196.
Achté, K. A & Apo, M. (1967). Schizophrenic patients in 1950–1952 and 1957–1959. Psychiatric Quarterly 41, 422441.
Affleck, J. W., Burns, J & Forrest, A. D. (1976). Long-term followup of schizophrenic patients in Edinburgh. Acta Psychiatrica Scandinavica 53, 227237.
American Psychiatric Association (1980/1986). Diagnostic and Statistical Manual of Mental Disorders, (DSM-III)/DSM-III-R. American Psychiatric Association: Washington D.C.
Angermeyer, M. C., Hofmann, J. & Robra, B. P. (1982). Geschlechtsunterschiede in der Institutionskarriere Schizophrener - ein Beitrag zur Sozialepidemiologie psychischer Erkrankungen. Psychiatrische Praxis 9, 2733.
Auch, W. (1963). Becinflußt die Psychopharmakotherapie die Aufnahmeentwicklung, die stationeare Behandlungsdauer und den Verlauf endogener Psychosen? Eine Untersuchung am Aufnahmekrankengut des Rheinischen Landeskrankenhauses Bonn der Jahre 1946–1960. Fortschritte der Neurologie, Psychiatrie und their Grenzgebiete 31, 548565.
Bellodi, L., Bussoleni, C., Scorza-Smeraldi, R., Grassi, G., Zacchetti, L. & Smeraldi, E. (1986). Family study of schizophrenia: exploratory analysis for relevant factors. Schizophrenia Bulletin 12, 120128.
Biehl, H., Maurer, K., Schubarl, C., Krumm, B. & Jung, E. (1986). Prediction of outcome and utilization of medical services in a prospective study of first onset schizophrenics: Results of a prospective 5-year follow-up study European Archives of Psychiatry and Neurological Sciences 236, 139147.
Bland, R C. (1977). Demographic aspects of functional psychoses in Canada Acta Psychiatrica Scandinavica 55, 369380.
Bland, R. C. & Orn, H. (1978). 14-year outcome in early schizophrenia. Acta Psychiatrica Scandinavica 58, 327338.
Bleuler, M. (1978). The Schizophrenic Disorders: Long-term Patient and Family Studies. (Translated by Clemens, S..) Yale University Press: New Haven.
Bromet, E., Harrow, M. & Tucker, G. J. (1971) Factors related to short-term prognosis in schizophrenia and depression Archives of General Psychiatry 25. 148154
Brown, G. W.. Carstairs, C M. & Topping, G. (1958). Posthospital adjustment of chronic mental patients. Lancet ii, 685689.
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorder a replication British Journal of Psychiatry 121, 241251
Ciompi, L. & Mueller, C. (1976). Lebensweg und Alter der Schizophrenen. Springer: Berlin
Clausen, J. A., Pfeffer, N. G. & Huffine, C. L. (1982). Help-seeking in severe mental illness. In Symptoms. Illness Behavior, und Help- Seeking (ed. Mechanic, D.), pp. 135155. Neale Watson Academic Publications: New York.
Cole, J. O., Bonato, R. & Goldberg, S. C. (1968). Non-specific factors in the drug therapy of schizophrenic patients. In Non- Specific Factors in Drug Therapy (ed. Rickels, K.), pp. 19211941. C. C. Thomas: Springfield.
Coryell, R. & Tsuang, M (1986). Outcome after 40 years in DSMIII schizophreniform disorder. Archives of General Psychiatry 43, 324328
Cox, D (1972). Regression models and life tables. Journal of the Royal Statistical Society Series B 34, 187220.
Cropley, A. L. & Gazan, A (1969). Some data concerning readmission of discharged schizophrenic patients. British Journal of Social and Clinical Psychology 8, 286289.
Dixon, W. J., Brown, M., Engelman, L., Frane, J., Hill, M., Jenrich, R. & Toporek, J. (1981). BMDP Statistical Software University of California Press: Berkeley.
Ellendorf, C. (1975). Studie zur Validierung der diagnostischen Sichtlochkarten Kartei (DiaSika). Medical dissertation, University of Munich.
Fallik, A. & Liron, R. (1976) A follow-up on schizophrenics from various social subgroups seven years after initial hospilalization. Israel Annals of Psychiatry and Related Disciplines 14, 229239.
Farina, A., Garmezy, N. & Barry, H. III (1963). Relationship of marital status to incidence and prognosis of schizophrenia. Journal of Abnormal and Social Psychology 67, 624630.
Fleiss, J. L., Dunner, D. L., Stallone, F. & Fieve, R. R. (1976). The life table: A method of analyzing longitudinal studies. Archives of General Psychiatry 33, 107112.
Forrest, A. D. & Hay, A. J. (1972). The influence of sex on schizophrenia. Acta Psychiatrica Scandinavica 48, 4957.
Fowler, R., Tsuang, M., Cadoret, R., Monnelly, E & McCabe, M. (1974). A clinical and family comparison of paranoid and nonparanoid schizophrenia. British Journal of Psychiatry 124. 346351.
Fuller, R. G. (1930). Expectation of hospital life and outcome for mental patients on first admission. Psychiatric Quarterly 4, 295323.
Fuller, R. G (1935). What happens to mental patients after discharge from hospital. Psychiatric Quarterly 90, 95104.
Gam, J. (1980). A 5-year retrospective investigation of all first admitted schizophrenics to Danish psychiatric institutions in the fiscal year from April 1st, 1970 to April 1st, 1971. In Epidemiological Research as Basis for the Organization of Extramural Psychiatry, (ed. Stromgren, E.Dupont, A. and Nielsen, J.). Acta Psychiatrica Scandinavica Suppl. 285, pp. 332336.
Gittelman-Klein, R. & Klein, D. F. (1969). Premorbid asocial adjustment and prognosis in schizophrenia. Journal of Psychiatric Research 7, 3553.
Goldberg, S. C., Schooler, N. R., Davidson, E. M. & Kayce, M. M. (1966). Sex and race differences in response to drug treatment among schizophrenics. Psychophurmacologia 9, 3147.
Goldstein, M. J., Rodnick, E. H., Evans, J. R., May, P. R. A. & Steinberg, M. R. (1977). Drug and family therapy in the aftercare of acute schizophrenics. Archives ofGeneral Psychiatry 34, 171194.
Goldstein, J. & Link, B. (1988). Gender and the expression of schizophrenia Journal of Psychiatric Research, 22, 141155.
Goldstein, J. (1988). Gender differences in the course of schizophrenia. American Journal of Psychiatry 145, 684689.
Goldstein, J. & Kreisman, D. (1988) Gender, family environment and schizophrenia. Psychological Medicine, 18, 861872.
Goldstein, J., Faraone, S., Tolomieczenko, G., Chen, W. & Tsuang, M. (1989). Gender differences in the familial transmission of schizophrenia. (In preparation.)
Goncalves, N. (1978). ‘Schwund’ bei ambulanten behandelten Schizophrenen. Nervenarzt 49, 5864.
Haefner, H., an der Heiden, W., Klug, J. & Pfeifer-Kurda, M. (1985). Hat die moderne Schizophreniebehandlung Folgen fuer das Schicksal der Kranken und fuer das Schicksal ihrer Versorg- ungseinrichtungen? In Perspektiven der Schizophrenie-Forschung, (ed Pflug, B.). pp. 143163. Fischer Stuttgart.
Harris, A. & Lubin, A. (1954). The prognosis of functional psychoses. Monatsschrift für Psychiatric und Neurologie 124, 126145.
Harrow, M., Tucker, G. J. & Bromet, E. (1969). Short-term prognosis of schizophrenic patients. Archives of General Psychiatry 21, 195202.
Helgason, T. (1964). Epidemiology of mental disorders in Iceland. Acta Psychiatria Scandinavica Supplement 173.
Hinterhuber, H. (1973). Zur Katamnese der Schizophrenien. Fortschritte der Neurologic, Psychiatrie und ihrer Grenzgebiete 41, 527558.
Hogarty, G. E., Goldberg, S C., Schooler, N. R. & Ulrich, R. F. (1974). Drug and sociotherapy in the aftercare of schizophrenic patients. II. Two year relapse rates. Archives of General Psychiatry 31, 603618.
Hogarty, G E. (1985). Expressed emotion and schizophrenic relapse: implications from the Pittsburgh Study. In Controversies in Schizophrenia, (ed. Alpert, M.), pp. 354365. Guilford Press: New York.
Holding, T. A., Urbane, S. & Kay, D. W. K. (1983). Social outcome after first admission for schizophrenia in Tasmania A study of matched pairs. Social Psychiatry 18, 145152
Huber, G., Gross, G. & Schuettler, R. (1980). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin 6, 592605.
Hurley, P. I. & Conwell, M. (1967). Public mental hospital release rates in live states, 1954 and 1960. Public Health Report 82, 4960.
Israel, R. H. & Johnson, N. A. (1956). Discharge and readmission rates in 4,254 consecutive first admissions of schizophrenia. American Journal ot Psychiatry. 112. 903909.
Jakubaschk, J. (1982). Patienenbestand, Aufenthaltsdauer und Wiederaufnahme-Raten Indikatoren der Enlwicklung in der stationaeren psychiatrischen Behandlung? Schmeizer Archiv für Neurologie, Neurothirurgie und Psychiatrie 31, 261288
Keller, M., Shapiro, R., Lavori, P & Wolfe, N. (1982). Recovery in major depressive disorder. Analysis with the life table and regression models. Archives of General Psychiatry 39, 905910, 911–915.
Kessler, R.Reuter, J. & Greenley. J. (1979). Sex differences in the use of psychiatric outpatient facilities. Social Forces 58. 557571.
Kimura, S., Asai, S., Wakeno, M. & Aoki, N. (1978). On early and mid-adolescent schizophrenia. Part 1: Phenomenological aspects. Folia Psychiatrica et Neurologica Japonica 32, 4156
Kormendy, E. & Schäfer, E. (1983). Empirische Verlaufsuntersuchung schizophrener Erkrankungen im Bereich eines kommunalen psychiatrischen Dienstes. Nervrnarzt 54, 347353.
Langfeldt, G. (1953). Some points regarding the symptomatology and diagnosis of Schizophrenia. Acta Psychiatrica Scandinavica Supplement 80.
Lassenius, B., Ottoson, J.-O & Rapp, W. (1973). Prognosis in schizophrenia the need for institutionalized care Acta Psychiatrica Scandinavica 49. 294305.
Lee, E. (1980). Statistical Methods for Survival Data Analysis Lifetime Learning Pub: California.
Lee, E. & Desu, M. (1972). A computer program for comparing K samples with right-censored data. Computer Programs in Biomedicine 2, 315321
Lehrman, N. S. (1960). A state hospital population five years after admission: a yardstick for evaluative comparison of follow-up studies. Psychiatric Quarterly 34, 658668.
Lewine, R. & Meltzer, H. (1985). Negative symptoms and platelet monoamine oxidase activity in male schizophrenics. Psychiatry Research 12, 99109.
Lewine, R. (1985). Schizophrenia: an amotivational syndrome in men. Canadian Journal of Psychiatry 30. 316318.
Lewine, R. R. J. (1981). Sex differences in schizophrenia: Timing or subtype? Psychological Bulletin 90, 432444
Linsky, A. A. (1970). Who shall be excluded: The influence of personal attributes in community reaction to the mentally ill. Social Psychiatry 5, 166171.
Locke, B. Z. (1962). Outcome of first hospitalization of patients with schizophrenia. Public Health Report 77, 801804.
Loranger, A. (1984). Sex differences in age of onset of schizophrenia. Archives of General Psychiatry 41, 157161
Malzberg, B. (1952). Rates of discharge and rates of mortality among first admissions to the New York civil slate hospitals. Mental Hygiene 36, 104120, and 618–638.
Malzberg, B. (1953). Rates of discharge and rates of mortality among first admissions to the New York civil state hospitals Mental Hygiene 37, 619654.
Mandelbrote, B. M. & Trick, K. L. K. (1970). Social and clinical factors in the outcome of schizophrenia. Acta Psychiatrica Scandinavica 46, 2431.
Mantonakis, J. E, Jemos, J J., Christodoulou, G. N. & Lykouras, E P (1982). Short-term social prognosis of schizophrenia Acta Psychiatrica Scandinavica 66, 306310.
McCabe, M. S. (1975). Demographic differences in functional psychoses. British Journal of Psychiatry 127, 320323.
Mechanic, D. (1978) Sex, illness, illness behavior, and the use of health services Social Science and Medicine 128, 207214.
Meltzer, H. Y.Busch, D A. & Fang, V S (1983). Serum neuroleplic and prolactin levels in schizophrenic patients and clinical response. Psychiatry Research 9, 271283.
Möller, H. J., Werner-Eilert, K., Wueschner-Stockheim, M & Zerssen, D. V. (1982). Relevante Merkmale fur die 5-Jahres- Prognose von Patienten mit schizophrenen und verwandten paranoiden Psychosen. Archiv für Psychiatrie und Nervenkrankheiten 231, 305322.
Müller, P., Guenther, U. & Lehmeyer, J (1986). Behandlung und Verlaut Schizophrener Psychosen über ein Jahrzehnt. Nervenarzt (Berlin) 57, 332341.
Müller, H. W. (1971). Stoerungen des psychosozialen Milieus und ihr Einfluss auf schizophrene Krankheitsverlaeufe. In Schizophrenie und Umweli (ed. Kranz, H and Heinrich, K.). pp. 5872. Thieme Stuttgart.
Nasrallah, H., Andreasen, N, Coffman, J, Olson, S.Dunn, V., Ehrhardt, J. & Chapman, S. (1986) A controlled magnetic resonance imaging study of corpus callosum thickness in schizophrenia. Biological Psychiatry 21, 274282
Nedopil, N., Pflieger, R & Ruther, E. (1983). The prediction of acute response, remission and general outcome of neuroleptic treatment in acute schizophrenic patients. Pharmacopsychiatry 16, 201205.
Neter, J. & Wasserman, W. (1974). Applied Linear Statistical Models. Richard Irwin Illinois.
Niskanan, P. & Pfkhanen, T. A. (1972). Attitudes of the relatives of schizophrenic patients. Acta Psychiatrica Scandinavica 48, 174185.
Nyman, G. E., Nyman, A. K., & Nylander, B I (1978). Nonregressive schizophrenia. Acta Psychiatrica Scandinavica 57, 165192.
Nystrup, J. (1976). A hospital population of schizophrenic patients undergoing change. Acta Psychiatrica Scandinavica 53, 211226.
Orlinsky, N. & D'Elia, E. (1964). Rehospitalization of the schizophrenic patient. Archives of General Psychiatry 10, 4654.
Pietzcker, A., Gaebel, W. & Poppenberg, A. (1982). Prognose des Verlaufes nach Klinikentlassung bei schizophrenen Kranken. In Der Schizophrene auberhalb der Klinik (ed. Heinrich, K.), pp. 92104. Huber: Bern.
Pokorny, A. D., Kaplan, H. B. & Lorimor, R J (1983). Effects of diagnosis and treatment history on relapse of psychiatric patients. American Journal of Psychiatry 140, 15981601.
Pope, H., Lipinski, J., Cohen, B & Axelrod, D. (1980). Schizoaffective disorder: An invalid diagnosis? A comparison of schizoaffective disorder, schizophrenia, and affective disorder. American Journal of Psychiatry 137, 921927.
Pruss, U., Rose, H. K. & Zecher, A. (1984). Depotneuroleptika in der sozialpsychiatrischen Praxis. Psychiatrische Praxis 11, 101108.
Rabins, P., Pauker, S. & Thomas, J. (1984). Can schizophrenia begin after age 44? Comprehensive Psychiatry 25, 290293.
Raskin, A. & Golob, R. (1966). Occurrence of sex and social class differences in premorbid competence, symptom and outcome measures in acute schizophrenics Psychological Reports 18, 1122.
Rennie, T. A. C. (1939). Follow-up study of five hundred patients with schizophrenia admitted to the hospital from 1913 to 1923. Archives of Neurological Psychiatry 42, 877891.
Rosen, B., Klein, D. F., Levenslein, S. & Shahinian, S. P. (1968). Social competence and posthospital outcome. Archives of General Psychiatry 19, 165170
Rosen, B., Klein, D. F. & Gittelman-Klein, R (1971) The prediction of rehospitalization: the relationship between age of first psychiatric treatment contact, marital status and premorbid asocial adjustment. Journal of Nervous and Mental Disease 152, 1722.
Salokangas, R. K R (1983). Prognostic implications of the sex of schizophrenic patients. British Journal of Psychiatry 142, 145151.
Schooler, N R., Goldberg, S. C, Boothe, H. & Cole, J. O. (1967). One year after discharge: Community adjustment of schizophrenic patients. American Journal of Psychiatry 123, 986995.
Seeman, M. (1985). Sex and schizophrenia. Canadian Journal of Psychiatry 30, 313315.
Seeman, M. V. (1982). Gender differences in schizophrenia. Canadian Journal of Psychiatry 27, 107111.
Shepherd, M. (1957) A Study of the Major Psychoses in an English County. Institute of Psychiatry: London.
Siede, H. (1973). Die derzeitige (1970) Situation an den psychiatrischen LKH Niedersachsen. Socialpsychiatrische Informationen 13, 1023.
Smith, M. L., Glass, G. V. & Miller, T. I. (1980). The Benefits of Psychotherapy. Johns Hopkins University Press Baltimore.
SPSSx: User's Guide. McGraw-Hill: New York.
Stern, E. S. (1970). A statistical study of departures from a mental hospital. British Journal of Psychiatry 116, 5764.
Stoffelmayr, B. E., Dillavon, D. & Hunter, J. E. (1983). Premorbid functioning and outcome in schizophrenia: a cumulative analysis. Journal of Consulting and Clinical Psychology 51, 338352
Strömgren, E. (1961) Psykiatri. Munksgaard: Copenhagen.
Stumme, W. (1975). Psychische Erkrankungen – Im Urteil der Bevoelkerung. Urban & Schwarzenberg: Muenchen.
Tsuang, M., Dempsey, T. & Rauscher, F. (1976). A study of atypical schizophrenia: comparison with schizophrenia and affective disorder by sex, age of admission, precipitant outcome, and family history. Archives of General Psychiatry 33, 11571160.
Tudor, W., Tudor, J F & Gove, W. R. (1977). The effect of sex role differences on the social control of mental illness. Journal of Health and Social Behavior 18, 98112.
Vaughn, C. I, Snyder, K. S., Jones, S., Freeman, W. B. & Falloon, I. R. H. (1984). Family factor's in schizophrenic relapse. Archives of General Psychiatry 41, 11691177.
Vaughn, C. E. & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressive neurotic patients. British Journal of Psychiatry 129, 125137.
Warren, C A. B. (1983). Mental illness in the family: a comparison of husbands' and wives' definitions. Journal of Family Issues 4, 533558.
Watt, D. C, Katz, K. & Shepherd, M. (1983). The natural history of schizophrenia: a 5-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychological Medicine 13, 663670.
Watt, D. C. & Szulecka, T. K. (1979). The effect of sex, marriage and age at first admission on the hospitalization of schizophrenics during 2 years following discharge Psychological Medicine 9, 529539.
Weissman, M (1977). Controlled versus naturalistic experiments: application of the life table method. In The Origins and Course of Psychopathology (ed. Strauss, J., Babigian, H and Roff, M.), pp 720Plenum Press: New York
Westermeyer, J. F. & Harrow, M. (1984). Prognosis and outcome using broad (DSM-III) concepts of schizophrenia. Schizophrenia Bulletin 10, 624637.
World Health Organization, (WHO). (1975). Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death 9th Revision: Geneva.
Zigler, E. & Levine, J. (1981). Age on first hospitalization of schizophrenics: A developmental approach. Journal of Abnormal Psychology 90, 458467

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed