Hostname: page-component-f554764f5-c4bhq Total loading time: 0 Render date: 2025-04-18T17:02:45.368Z Has data issue: false hasContentIssue false
  • English
  • Français

Gender difference in age at onset of schizophrenia: a meta-analysis

Published online by Cambridge University Press:  08 May 2012

S. V. Eranti ,
J. H. MacCabe ,
H. Bundy  and
R. M. Murray
S. V. Eranti*
Affiliation:
Newham Early Intervention Service, East London Foundation Trust, Stratford Office Village, London, UK
J. H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, de Crespigny Park, London, UK
H. Bundy
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, de Crespigny Park, London, UK
R. M. Murray
Affiliation:
Institute of Psychiatry, King's College London, de Crespigny Park, London, UK
*
*Address for correspondence: S. V. Eranti, Newham Early Intervention Service, East London Foundation Trust, Unit 9, Stratford Office Village, 4 Romford Road, London E15 4EA, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Most studies reporting the gender difference in age at onset of schizophrenia show an earlier onset in males, but vary considerably in their estimates of the difference. This may be due to variations in study design, setting and diagnostic criteria. In particular, several studies conducted in developing countries have found no difference or a reversed effect whereby females have an earlier onset. The aim of the study was to investigate gender differences in age of onset, and the impact of study design and setting on estimates thereof.

Method

Study methods were a systematic literature search, meta-analysis and meta-regression.

Results

A total of 46 studies with 29218 males and 19402 females fulfilled the inclusion criteria and were entered into a meta-analysis. A random-effects model gave a pooled estimate of the gender difference of 1.07 years (95% confidence interval 0.21–1.93) for age at first admission of schizophrenia, with males having earlier onset. The gender difference in age at onset was not significantly different between developed and developing countries. Studies using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria showed a significantly greater gender difference in age at onset than studies using International Classification of Diseases (ICD) criteria, the latter showing no difference.

Conclusions

The gender difference in age of onset in schizophrenia is smaller than previously thought, and appears absent in studies using ICD. There is no evidence that the gender difference differs between developed and developing countries.

Keywords

Age at onsetgender differenceschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 1 , January 2013 , pp. 155 - 167
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Albus, M, Scherer, J, Hueber, S, Lechleuthner, T, Kraus, G, Zausinger, S, Burkes, S (1994). The impact of familial loading on gender differences in age at onset of schizophrenia. Acta Psychiatrica Scandinavica 89, 132–134.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Kuhn, L (1988). Gender differences in age at onset of schizophrenia. An overview. European Archives of Psychiatry and Neurological Sciences 237, 351–364.CrossRefGoogle ScholarPubMed
Barrett, R, Loa, P, Jerah, E, Nancarrow, D, Chant, D, Mowry, B (2005). Rates of treated schizophrenia and its clinical and cultural features in the population isolate of the Iban of Sarawak: a tri-diagnostic approach. Psychological Medicine 35, 281–293.CrossRefGoogle ScholarPubMed
Bradburn, MJ, Deeks, JJ, Altman, DG (1998). sbe24: metan – an alternative meta-analysis command. Stata Technical Bulletin 44, 4–15.Google Scholar
Castle, D, Sham, P, Murray, R (1998). Differences in distribution of ages of onset in males and females with schizophrenia. Schizophrenia Research 33, 179–183.CrossRefGoogle ScholarPubMed
Chaves, AC, Seeman, MV, Mari, JJ, Maluf, A (1993). Schizophrenia: impact of positive symptoms on gender social role. Schizophrenia Research 11, 41–45.CrossRefGoogle ScholarPubMed
Cohen, RZ, Gotowiec, A, Seeman, MV (2000). Duration of pretreatment phases in schizophrenia: women and men. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie 45, 544–547.CrossRefGoogle ScholarPubMed
Cohen, RZ, Seeman, MV, Gotowiec, A, Kopala, L (1999). Earlier puberty as a predictor of later onset of schizophrenia in women. American Journal of Psychiatry 156, 1059–1064.CrossRefGoogle ScholarPubMed
Dernovsek, MZ, Tavcar, R (1999). Age at onset of schizophrenia and neuroleptic dosage. Social Psychiatry and Psychiatric Epidemiology 34, 622–626.CrossRefGoogle ScholarPubMed
Everitt, B (2003). Bayesian methods and meta-analysis. In Modern Medical Statistics – A Practical Guide(ed. Everitt, B.), pp. 133–153. Oxford University Press Inc.: London.Google Scholar
Faraone, SV, Chen, WJ, Goldstein, JM, Tsuang, MT (1994). Gender differences in age at onset of schizophrenia. British Journal of Psychiatry 164, 625–629.CrossRefGoogle ScholarPubMed
Folnegovic-Smalc, V, Folnegovic, Z, Kulcar, Z (1994). Age of disease onset in Croatia's hospitalized schizophrenics. British Journal of Psychiatry 156, 368–372.CrossRefGoogle Scholar
Gangadhar, BN, Panner Selvan, C, Subbakrishna, DK, Janakiramaiah, N (2002). Age-at-onset and schizophrenia: reversed gender effect. Acta Psychiatrica Scandinavica 105, 317–319.CrossRefGoogle ScholarPubMed
Goldstein, JM, Faraone, SV, Chen, WJ, Tsuang, MT (1989). Gender and the familial risk for schizophrenia. Disentangling confounding factors. Schizophrenia Research 7, 135–140.CrossRefGoogle Scholar
Gorwood, P, Leboyer, M, Jay, M, Payan, C, Feingold, J (1995). Gender and age at onset in schizophrenia: impact of family history. American Journal of Psychiatry 152, 208–212.Google ScholarPubMed
Guerguerian, R, Lewine, RR (1998). Brain torque and sex differences in schizophrenia. Schizophrenia Research 30, 175–181.CrossRefGoogle ScholarPubMed
Gureje, O, Bamidele, RW (1998). Gender and schizophrenia: association of age at onset with antecedent, clinical and outcome features. Australian and New Zealand Journal of Psychiatry 32, 415–423.CrossRefGoogle ScholarPubMed
Harbord, RM, Higgins, JPT (2008). Meta-regression in STATA. Stata Journal 8, 293–519.CrossRefGoogle Scholar
Kebede, D, Alem, A, Shibre, T, Negash, A, Fekadu, A, Fekadu, D, Deyassa, N, Jacobsson, L, Kullgren, G (2003). Onset and clinical course of schizophrenia in Butajira-Ethiopia – a community-based study. Social Psychiatry and Psychiatric Epidemiology 38, 625–631.CrossRefGoogle ScholarPubMed
Kendler, KS, Walsh, D (1995). Gender and schizophrenia. Results of an epidemiologically-based family study. British Journal of Psychiatry 167, 184–192.CrossRefGoogle ScholarPubMed
Kennedy, N, Boydell, J, Kalidindi, S, Fearon, P, Jones, PB, van Os, J, Murray, RM, Kennedy, N, Boydell, J, Kalidindi, S, Fearon, P, Jones, PB, van Os, J, Murray, RM (2005). Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. American Journal of Psychiatry 162, 257–262.CrossRefGoogle Scholar
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Archives of General Psychiatry 63, 250–258.CrossRefGoogle ScholarPubMed
Kleinhaus, K, Harlap, S, Perrin, M, Manor, O, Weiser, M, Lichtenberg, P, Malaspina, D (2011). Age, sex and first treatment of schizophrenia in a population cohort. Journal of Psychiatric Research 45, 136–141.CrossRefGoogle Scholar
Lane, A, Colgan, K, Moynihan, F, Burke, T, Waddington, JL, Larkin, C, O'Callaghan, E (1996). Schizophrenia and neurological soft signs: gender differences in clinical correlates and antecedent factors. Psychiatry Research 64, 105–114.CrossRefGoogle ScholarPubMed
Larsen, TK, McGlashan, TH, Johannessen, JO, Vibe-Hansen, L (1996). First-episode schizophrenia: II. Premorbid patterns by gender. Schizophrenia Bulletin 22, 257–269.CrossRefGoogle ScholarPubMed
Lauriello, J, Hoff, A, Wieneke, MH, Blankfeld, H, Faustman, WO, Rosenbloom, M, DeMent, S, Sullivan, EV, Lim, KO, Pfefferbaum, A (1997). Similar extent of brain dysmorphology in severely ill women and men with schizophrenia. American Journal of Psychiatry 154, 819–825.Google ScholarPubMed
Leboyer, M, Filteau, MJ, Jay, M, Campion, D, Rochet, T, D'Amato, T, Feingold, J, Des Lauriers, A, Widlocher, D (1992). No gender effect on age at onset in familial schizophrenia? American Journal of Psychiatry 149, 1409.Google ScholarPubMed
Lee, KY, Ahn, YM, Joo, E-J, Joo, YH, Chang, JS, Yoo, HY, Kim, YS (2006). Partial evidence of an association between epidermal growth factor A61G polymorphism and age at onset in male schizophrenia. Neuroscience Research 56, 356–362.CrossRefGoogle ScholarPubMed
Lewine, R, Haden, C, Caudle, J, Shurett, R (1997). Sex-onset effects on neuropsychological function in schizophrenia. Schizophrenia Bulletin 23, 51–61.CrossRefGoogle ScholarPubMed
McCreadie, RG, Connolly, MA, Williamson, DJ, Athawes, RW, Tilak-Singh, D (1994). The Nithsdale Schizophrenia Surveys. XII. ‘Neurodevelopmental’ schizophrenia: a search for clinical correlates and putative aetiological factors. British Journal of Psychiatry 165, 340–346.CrossRefGoogle ScholarPubMed
Morgan, VA, Castle, DJ, Jablensky, AV (2008). Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Australian and New Zealand Journal of Psychiatry 42, 74–82.CrossRefGoogle ScholarPubMed
Moriarty, PJ, Lieber, D, Bennett, A, White, L, Parrella, M, Harvey, PD, Davis, KL (2001). Gender differences in poor outcome patients with lifelong schizophrenia. Schizophrenia Bulletin 27, 103–113.CrossRefGoogle ScholarPubMed
Murphy, BM, Burke, JG, Bray, JC, Walsh, D, Kendler, KS (1994). An analysis of the clinical features of familial schizophrenia. Acta Psychiatrica Scandinavica 89, 421–427.CrossRefGoogle ScholarPubMed
Murthy, GV, Janakiramaiah, N, Gangadhar, BN, Subbakrishna, DK (1998). Sex difference in age at onset of schizophrenia: discrepant findings from India. Acta Psychiatrica Scandinavica 97, 321–325.CrossRefGoogle ScholarPubMed
O'Callaghan, E, Gibson, T, Colohan, HA, Buckley, P, Walshe, DG, Larkin, C, Waddington, JL (1992). Risk of schizophrenia in adults born after obstetric complications and their association with early onset of illness: a controlled study. BMJ 305, 1256–1259.CrossRefGoogle ScholarPubMed
Ohaeri, JU (1992). Age at onset in a cohort of schizophrenics in Nigeria. Acta Psychiatrica Scandinavica 86, 332–334.CrossRefGoogle Scholar
Ohara, K, Xu, HD, Mori, N, Suzuki, Y, Xu, DS, Wang, ZC (1997). Anticipation and imprinting in schizophrenia. Biological Psychiatry 42, 760–766.CrossRefGoogle ScholarPubMed
Pulver, AE, Brown, CH, Wolyniec, P, McGrath, J, Tam, D, Adler, L, Carpenter, WT, Childs, B (1990). Schizophrenia: age at onset, gender and familial risk. Acta Psychiatrica Scandinavica 82, 344–3451.CrossRefGoogle ScholarPubMed
Rabinowitz, J, Fennig, S (2002). Differences in age of first hospitalization for schizophrenia among immigrants and nonimmigrants in a national case registry. Schizophrenia Bulletin 28, 491–499.CrossRefGoogle Scholar
Rabinowitz, J, Levine, SZ, Hafner, H (2006). A population based elaboration of the role of age of onset on the course of schizophrenia. Schizophrenia Research 88, 96–101.CrossRefGoogle ScholarPubMed
Ran, M-S, Xiang, M-Z, Li, S-X, Shan, Y-H, Huang, M-S, Li, S-G, Liu, Z-R, Chen, EY-H, Chan, CL-W (2003). Prevalence and course of schizophrenia in a Chinese rural area. Australian and New Zealand Journal of Psychiatry 37, 452–457.CrossRefGoogle Scholar
Rasanen, S, Veijola, J, Hakko, H, Joukamaa, M, Isohanni, M (1999). Gender differences in incidence and age at onset of DSM-III-R schizophrenia. Preliminary results of the Northern Finland 1966 birth cohort study. Schizophrenia Research 37, 197–198.Google ScholarPubMed
Raymont, V, Bettany, D, Frangou, S (2003). The Maudsley bipolar disorder project. Clinical characteristics of bipolar disorder I in a catchment area treatment sample. European Psychiatry: Journal of the Association of European Psychiatrists 18, 13–17.CrossRefGoogle Scholar
Salokangas, RKR, Honkonen, T, Saarinen, S (2003). Women have later onset than men in schizophrenia – but only in its paranoid form. Results of the DSP project. European Psychiatry: Journal of the Association of European Psychiatrists 18, 274–281.CrossRefGoogle ScholarPubMed
Stöber, G, Franzek, E, Haubitz, I, Pfuhlmann, B, Beckmann, H (1998). Gender differences and age of onset in the catatonic subtypes of schizophrenia. Psychopathology 31, 307–312.CrossRefGoogle ScholarPubMed
Subbakrishna, DK, Murali, N, Gangadhar, BN, Janakiramaiah, N (2001). Younger age at onset of schizophrenia in females: a replicative study. In Statistical Methods and Application in Biology and Medicine(ed. Subbakrishna, D. K. K. and Kaliaperumal, V. G.), pp. 253–260. NIMHANS: Bangalore, India.Google Scholar
Tang, Y-L, Gillespie, CF, Epstein, MP, Mao, P-X, Jiang, F, Chen, Q, Cai, Z-J, Mitchell, PB (2007). Gender differences in 542 Chinese inpatients with schizophrenia. Schizophrenia Research 97, 88–96.CrossRefGoogle ScholarPubMed
Thara, R, Henrietta, M, Joseph, A, Rajkumar, S, Eaton, WW (1994). Ten-year course of schizophrenia – the Madras longitudinal study. Acta Psychiatrica Scandinavica 90, 329–336.CrossRefGoogle ScholarPubMed
Thorup, A, Petersen, L, Jeppesen, P, Ohlenschlaeger, J, Christensen, T, Krarup, G, Jorgensen, P, Nordentoft, M (2007 a). Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. Journal of Nervous and Mental Disease 195, 396–405.CrossRefGoogle ScholarPubMed
Thorup, A, Waltoft, BL, Pedersen, CB, Mortensen, PB, Nordentoft, M (2007 b). Young males have a higher risk of developing schizophrenia: a Danish register study. Psychological Medicine 37, 479–484.CrossRefGoogle ScholarPubMed
United, Nations (2001). Human Development Report. United Nations: New York.Google Scholar
Usall, J, Araya, S, Ochoa, S, Busquets, E, Gost, A, Marquez, M; Assessment Research Group in Schizophrenia (2001). Gender differences in a sample of schizophrenic outpatients. Comprehensive Psychiatry 42, 301–305.CrossRefGoogle Scholar
Usall i Rodié, J (2002). Sex and brain: morphological and functional differences between women and men (article in Spanish). Actas Espanolas de Psiquiatria 30, 189–194.Google Scholar
Valigi Björck, M, Själin, M, Nordin, C (2000). Neurological soft signs in schizophrenic patients: influence of age, age at onset, sex, and family history of schizophrenia. Nordic Journal of Psychiatry 54, 437–440.CrossRefGoogle Scholar
Venkatesh, BK, Thirthalli, J, Naveen, MN, Kishorekumar, KV, Arunachala, U, Venkatasubramanian, G, Subbakrishna, DK, Gangadhar, BN (2008). Sex difference in age of onset of schizophrenia: findings from a community-based study in India. World Psychiatry 7, 173–176.CrossRefGoogle ScholarPubMed
Viguera, AC, Baldessarini, RJ, Tondo, L (2001). Response to lithium maintenance treatment in bipolar disorders: comparison of women and men. Bipolar Disorders 3, 245–252.CrossRefGoogle ScholarPubMed
Waddington, JL, Youssef, HA (1996). Familial-genetic and reproductive epidemiology of schizophrenia in rural Ireland: age at onset, familial morbid risk and parental fertility. Acta Psychiatrica Scandinavica 93, 62–68.CrossRefGoogle ScholarPubMed
Weiser, M, Reichenberg, A, Rabinowitz, J, Kaplan, Z, Mark, M, Nahon, D, Davidson, M (2000). Gender differences in premorbid cognitive performance in a national cohort of schizophrenic patients. Schizophrenia Research 45, 185–190.CrossRefGoogle Scholar
Wieselgren, IM, Lindstrom, LH (1996). A prospective 1–5 year outcome study in first-admitted and readmitted schizophrenic patients; relationship to heredity, premorbid adjustment, duration of disease and education level at index admission and neuroleptic treatment. Acta Psychiatrica Scandinavica 93, 9–19.CrossRefGoogle ScholarPubMed