Sex Differences in Recovery-Related Outcomes and Needs for Psychiatric Rehabilitation in People With Schizophrenia Spectrum Disorder

Dubreucq, Marine; Plasse, Julien; Gabayet, Franck; Blanc, Olivier; Chéreau, Isabelle; Cervello, Sophie; Couhet, Geoffroy; Demily, Caroline; Guillard-Bouhet, Nathalie; Gouache, Benjamin; Jaafari, Nemat; Legrand, Guillaume; Legros-Lafarge, Émilie; Mora, G; Pommier, Romain; Quilès, Clélia; Verdoux, Hélène; Vignaga, F.; Massoubre, Catherine; Franck, Nicolás; Dubreucq, Julien

doi:10.4088/jcp.20m13732

Cited by 21 publications

(23 citation statements)

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“…There are limitations. First, while some sample characteristics (age, gender ratio, illness duration) are comparable to larger studies from the REHABase network (3,6), the nature of the sample recruited could affect the transferability of our findings to people with SMI beyond the study sample (e.g., people with SMI in functional remission not enrolled in the REHABase cohort). Second, although the absence of matching between male and female participants could have reduced the possibility to observe potential gender differences in anticipated challenges and needs, the present study is to our knowledge the first to investigate these issues in a predominantly male sample.…”

Section: Limitationsmentioning

confidence: 92%

“…Given persons with SMI can see becoming involved in a relationship as a big risk and having a child as an even bigger risk, service provision should include health communication approaches promoting self-determination and person-centered care, e.g., shared-decision making or as recently proposed by Zisman-Ilani (13), shared risk-taking, where patient and provider jointly reflect on the inherent risks of this kind of major life-changing decisions (13). However, mental health providers' (MHPs) often report feelings of discomfort about discussing these topics with persons with SMI (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). These feelings could compromise provider initiation of shared decision-making and lead to more paternalistic approaches, e.g., risk management (13,14).…”

Section: Introductionmentioning

confidence: 99%

“…Research has mostly focused on the barriers to meaningful intimate relationships and the parenting role (e.g., social isolation, stigma and self-stigma, low self-esteem) ( 1 , 2 ). These barriers might be more pronounced for people with SMI enrolled in psychiatric rehabilitation, where only a minority of persons report to be in relationship or to be parent–one in five men and one in four women in the French REHABase national cohort ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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A qualitative exploration of stakeholders’ perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent

2023

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BackgroundWhile many persons with serious mental illness (SMI) consider intimate relationships and becoming parent as central parts of their lives deeply affecting wellbeing and recovery, others anticipate facing multiple challenges in these life domains. This qualitative study sought to explore the perspectives of persons with SMI and mental health providers (MHPs) with diverse backgrounds and practices on the experiences, challenges, needs and expectations of persons with SMI as they consider finding a partner or becoming parent.MethodsFor this qualitative study, we conducted five focus groups between March and December 2020 for a total number of 22 participants (nine persons with SMI and thirteen MHPs) recruited from a center for psychiatric rehabilitation and a community mental health center in France. We used the inductive six-step process by Braun and Clarke for the thematic analysis.ResultsParticipants reported some challenges related to intimate relationships, stigma/self-stigma, disclosure and decision-making about start a family. Their expectations included: (i) psychoeducation about decision-making about finding a partner and starting a family; (ii) support in making empowered decisions about finding a partner, starting a family or disclosure to a prospective partner or their child; (iii) peer-support interventions; (iv) enhancing coping strategies; (v) integrated service provision including home treatment interventions, training to recovery-oriented practices and access to dedicated resources for providers.ConclusionIn short, intimate relationships and desire to start a family for persons with SMI should be more considered in psychiatric rehabilitation and additional support and interventions should therefore be provided.

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Section: Limitationsmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A qualitative exploration of stakeholders’ perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent

2023

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“… 7 However, occasionally, females with schizophrenia present worse outcome data than males, as is the case with quality of life. Females report lower quality of life than males, 8 including in global circumstances, health status and financial resources. 9 …”

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confidence: 99%

Gender differences in quality of life and the course of schizophrenia: national study

et al. 2022

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Background Evidence from various sources suggests that females with schizophrenia tend to report lower quality of life than males with schizophrenia despite having a less severe course of the disorder. However, studies have not examined this directly. Aims To examine gender differences in the association between quality of life and the risk of subsequent psychiatric hospital admissions in a national sample with schizophrenia. Method The sample consisted of 989 (60.90%) males and 635 (39.10%) females with an ICD-10 diagnosis of schizophrenia. Quality of life was assessed and scored using the Manchester Short Assessment of Quality of Life. The course of schizophrenia was assessed from the number of psychiatric hospital admissions. Participants completed the quality of life assessment and were then followed up for 18-months for subsequent psychiatric admissions. Hazard ratios (HR) from Cox proportional hazards regression models were estimated unadjusted and adjusted for covariates (age at schizophrenia onset and birth year). Analyses were computed for males and females separately, as well as for the entire cohort. Results A subsample of 93 males and 55 females was admitted to a psychiatric hospital during follow-up. Higher quality of life scores were significantly (P < 0.05) associated with a reduced risk of subsequent admissions among males (unadjusted: HR = 0.96, 95% CI 0.93–0.99; adjusted HR = 0.96, 95% CI 0.93–0.99) but not among females (unadjusted: HR = 0.97, 95% CI 0.93–1.02; adjusted HR = 0.97, 95% CI 0.93–1.02). Conclusions Quality of life in schizophrenia is a gender-specific construct and should be considered as such in clinical practice and future research.

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“…Although male patients experience more negative symptoms, females have more affective symptoms (Ochoa, Usall, Cobo, Labad, & Kulkarni, 2012). Aggression towards others is more common in males, whereas self-harm and suicide attempts are more common among female patients (Dama et al, 2019; Dubreucq et al, 2021; Jongsma, Turner, Kirkbride, & Jones, 2019; Sommer et al, 2020). Although the later age of onset and lower comorbidity with substance abuse in women may lead to better functioning in the early stages of the illness (Usall, Ochoa, Araya, & Márquez, 2003), this benefit is not maintained in the more chronic phase and advantages for women even seem to reverse after the age of 50 (Mayston et al, 2020; Shlomi Polachek et al, 2017; Thorup, Waltoft, Pedersen, Mortensen, & Nordentoft, 2007).…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic medication for women with schizophrenia spectrum disorders

et al. 2021

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There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.

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Sex Differences in Recovery-Related Outcomes and Needs for Psychiatric Rehabilitation in People With Schizophrenia Spectrum Disorder

Cited by 21 publications

References 0 publications

A qualitative exploration of stakeholders’ perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent

A qualitative exploration of stakeholders’ perspectives on the experiences, challenges, and needs of persons with serious mental illness as they consider finding a partner or becoming parent

Gender differences in quality of life and the course of schizophrenia: national study

Antipsychotic medication for women with schizophrenia spectrum disorders

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