The Role of Gender in Early and Very Early Onset of Psychotic DisordersAuthor(s): Robin Edward Gearing , Irfan Mian
This study examines the impact of gender and very early onset on the prognosis of a psychotic disorder. Methods: Eighty-seven youths under 18 years of age, 36 (41%) female and 51 (59%) male, hospitalized with first-episode psychosis were investigated in a multi-site, longitudinal, retrospective follow-up cohort design. An exploratory examination of the subjects was undertaken to assess the impact of very early transition to psychosis on prognosis. Data at Time 1 (time of discharge) were retrospectively collected using a standardized questionnaire from patients’ hospital records, and follow-up data at Time 2 (a minimum interval of two years post discharge) were obtained using a mailout questionnaire. Subjects were followed for at least two years (3.9±1.3 years). Results: Females with very early onset (<13 years) were more likely to have a poorer prognostic course and experience relapse resulting in hospital readmission than older females (13–18 years). Conversely, older males were more likely than younger males to experience relapse. Kaplan-Meier survival curves found that females were more likely to relapse than males. Breslow-Day test found that very early-onset females were more likely to relapse than younger males, older males, or older females. Conclusions: Findings supported by existing research indicate that very young age of onset and female gender predicted a greater chance of relapse. Poor prognosis in very early-onset females may result from a lack of the protective influence of estrogen, earlier brain maturation, or lack of development of help-seeking behaviors. More research is warranted to understand these relationships. Findings and research are outlined in order to promote the prospective investigation of these phenomena.