Male Predominance Among Palauan Schizophrenics

Abstract

Data gathered in a three-month field study of known schizophrenics in the Palau Islands reveal a 4:1 ratio of males versus females. It si postulated that relatively rapid sociocultural changes over the last two decades have loosened traditional external restraints on behaviour, destabilised male role and gender identities, and created an environment which has been particularly schizophrenogenic for males. Statistical analysis of the age distribution of the schizophrenics is used to support the hypothesis. Evidence is also presented indicating that the gender distribution is not artifactual.

Género e saúde mental: Uma abordagem epidemiológica

“…Estes resultados aproximam-se dos encontrados pelo estudo de Kessler et al (1994) incidindo sobre distúrbios mentais graves, não revelando em género grandes diferenças. Cruzando género e proveniência geográfica, os resultados apontam igualmente taxas de 50%, muitos autores assinalam uma maior prevalência da esquizofrenia em áreas mais rurais ou das áreas urbanas mais degradadas, por questões de segregação após estabelecimento da doença (Kawders, 1982;Regier, 1982). A igualdade de resultados entre a proveniência rural e urbana é contudo muito significativa para a nossa amostra, em virtude de neste estudo não serem contemplados os sujeitos que recebem assistência através das brigadas domiciliárias deste DPSM, que se deslocam às zonas rurais, facto que aumentaria enormemente as percentagens obtidas, tendo contemplado apenas os utentes que se deslocam a estes serviços.…”

Schizophrenia in Palau

“…It is a novel methodology for anthropologists and was chosen after careful consideration of alternatives because of several methodological advantages. Previous research on the expression of schizophrenia in Palau has focused on the occurrence of symptom types in subject cohorts (Kauders, MacMurray, and Hammond 1982;Hammond, Kauders, and MacMurray 1983). The PANSS methodology is more nuanced in that it considers the severity of individual symptoms for each study participant.…”

“…The absence of a unique bio-behavioral expression of the illness in the study population suggests that contextual processes external to the study cohorts should be considered in the search for insight into the unusual rate of mental illness in Palau. Kauders, MacMurray, and Hammond (1982) postulated that recent external influences have destabilized "traditional" gender roles and contributed to a differential risk of schizophrenic morbidity of Palauan men and women. They especially emphasized the increasing anomie of Palauan males in the rapidly changing and modernizing social environment of the 1960s and 1970s.…”

“…Second, at the level of contextual behavioral response to illness, we analyze the use and abuse of psychoactive substances by people with schizophrenia in Palau. Previous researchers have suggested that the high prevalence of schizophrenia in Palau is an artifact of development manifested particularly in the arrival and widespread use of exotic drugs (Kauders, MacMurray, and Hammond 1982;Hammond, Kauders, and MacMurray 1983;Hezel and Wylie 1992). This hypothesis is widely accepted, permeating not only academic theory but also popular and medical opinion in Palau.…”

Schizophrenia in Palau: a Descriptive Study

“…(Z equals 4.742,p less than .001). (7) Study Method . One of us (FRK), assisted by a U.S.-trained Palauan nurse-interpreter, administered detailed interviews to 35 schizophrenic patients seen during a 3-month clinical rotation in 1979-80.…”