The influence of gender on clinical and social characteristics of patients at psychosis onset: a report from the Psychosis Incident Cohort Outcome Study (PICOS)

Abstract

BACKGROUND. This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females(by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis. METHOD. A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework – a multi-site research project examining incident cases of psychosis in Italy's Veneto region. RESULTS. Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal care givers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.CONCLUSIONS. These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.

Sex differences in first-episode psychosis and in people at ultra-high risk

“…No statistically significant differences by gender were seen in symptoms at presentation as assessed on the Positive and Negative Syndrome Scale (Kay et al, 1987). However, males reported greater pre-morbid functioning and higher social disability at illness onset, but fewer unmet needs in the functioning domain than females did (Bertani et al, 2012). No study has investigated sex differences in Italian samples of UHR patients so far.…”

“…Bertani et al (2012) analyzed a large epidemiologically representative cohort of first episode of psychosis (FEP) patients (n ¼517) who were assessed within a multi-site research project examining incident cases of psychosis in the Veneto region of Italy, and found that males were nearly 3 years younger and had longer DUP than female patients. No statistically significant differences by gender were seen in symptoms at presentation as assessed on the Positive and Negative Syndrome Scale (Kay et al, 1987).…”

“…Obstetric complications and substance use are expected to be more frequent in male patients than in female ones and might impact on the severity of symptoms or level of functioning at presentation. Longer DUP was related to male sex and younger age of onset (Bertani et al, 2012;Chang et al, 2012). Conversely, suicidal behavior or traumatic events could accelerate referral to treatment for cases with an ongoing psychosis ).…”

The Role of Experienced and Anticipated Discrimination in the Lives of People With First-Episode Psychosis

“…This cross-sectional study was conducted within the framework of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite collaborative study that examined the relative roles of clinical, social, genetic, and morpho-functional factors in predicting outcomes among patients experiencing a first episode of psychosis who were in contact with public mental health services in the Veneto Region, northeast Italy (22,26). This study assessed experiences of discrimination in a sample of first-episode patients recruited from a subset of sites (30%) participating in PICOS; sites were selected on the basis of availability of local resources to perform these evaluations.…”

“…In fact, the literature reports a substantial difference between the clinical and social needs of this group and those of patients with illnesses of longer duration. The former are generally young, living with their families, attending educational or training systems, and seeking to enter the labor market (21,22). Patients experiencing a first episode of psychosis may therefore report more discrimination in life domains pertaining to young people's social world (such as training or education, friendship, and family relations), but empirical data are lacking.…”