Although gender differences in schizophrenia are well known, this topic in delusional disorder (DD) has been poorly studied. Previous studies have shown an earlier mean age at onset in men than in women, and in those with depressive co-morbidity.

To examine demographic and clinical differences by gender in DD.

To compare depressive co-morbidity and suicidality between men and women.

Ninety-seven patients with delusional disorder (DSM-IV-RT), attended at the Department of Psychiatry (Hospital Clinic-BCN) from 2000 to 2012, were included and followed up for one year. Demographic and clinical features at index admission, pharmacological treatment, compliance, presence of depressive co-morbidity and suicidal behaviour at follow-up were recorded. For comparisons, T, Chi-square tests and analysis of covariance (ANCOVA) were used.

Seventy-six per cent were women and the most common delusional idea was delusion of persecution (74.2%). Gender differences regarding demographic features and depressive co-morbidity were not found. 22.7% of the sample presented suicidal ideation and 12.4% attempted suicide during follow-up. Women became ill later than men (50.07 vs.44.57 years), but when ANCOVA model is used with age at onset as dependent variable, sex as factor, and depressive co-morbidity and suicidal behaviour as covariates, this difference was not significant for sex effect. Women attempted suicide more often than men (13.5% vs. 8.7%) and showed less compliance during the evaluation period.

No gender differences in age at onset, types of DD, presence of depression and severity of global functioning were found. Women showed higher suicidal behaviour.