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Sex Differences in Outcome and Recovery for Schizophrenia and Other Psychotic and Nonpsychotic Disorders

OBJECTIVE: It is generally believed by the field of psychiatry that women with schizophrenia have better outcomes and higher rates of recovery than their male counterparts, because many studies on the topic support this finding. Fewer data are available to assess potential sex differences among individuals with other psychotic disorders. This study used longitudinal data on sex differences previously unavailable to the field to examine long-term global outcome, potential recovery, course of illness, and rehospitalization for schizophrenia, other psychotic disorders, and nonpsychotic disorders. METHODS: A total of 239 young psychiatric patients (mean age of 23.4 years) were assessed prospectively at the index hospitalization and then followed over 15 years at five follow-up points (at a mean of two, 4.5, 7.5, ten, and 15 years). The sample consisted of 69 patients with schizophrenia, 56 with other psychotic diagnoses, and 114 with nonpsychotic psychiatric disorders. RESULTS: Sex differences in outcome were found for both patients with schizophrenia and those with other psychotic disorders, with women consistently showing better functioning over time, more frequent periods of good functioning and periods of recovery, less likelihood of uniformly poor outcome, and fewer and shorter rehospitalizations. Unlike both groups of patients who were psychotic, the patients with nonpsychotic disorders showed no significant sex differences in outcome. CONCLUSIONS: Both longitudinally and at each individual follow-up point, the data suggest that women with schizophrenia and with other types of psychotic disorders generally show better outcome than men with similar diagnoses. The sex differences in outcome for patients with schizophrenia were consistent over time. However, these sex differences were only moderate in size compared with the much larger difference in outcome between the diagnostic groups. The longitudinal data add a new dimension to previous research and suggest that sex differences in outcome are not specific to patients with schizophrenia but rather occur among patients with psychotic disorders in general.

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