Social Psychiatry and Psychiatric Epidemiology

, Volume 39, Issue 12, pp 1017–1022

Influence of diagnostic classification on gender ratio in schizophrenia

A meta-analysis of youths hospitalized for psychosis
ORIGINAL PAPER

Abstract

Background

The research literature on hospital admissions for psychoses in youths was reviewed in order to test whether there was a gender ratio discrepancy in diagnostic subgroups; the effect of the diagnostic criteria classification on this measure was also investigated.

Method

A meta-analysis was conducted on 12 primary studies by assessing the male/female odds ratio (OR) in the schizophrenia and mood disorders with psychosis subgroups as well as the amount of variability between studies. Study inclusion criteria were: patients between the ages of 8 and 19, at least 15 patients with psychosis and a standardized diagnostic criteria classification system such as DSM, ICD or RDC.

Results

The male/female OR measured in this meta-analysis implies that a male subject with psychosis is 1.7 times as likely to obtain a diagnosis of schizophrenia; conversely, a female subject with psychosis is 2.1 times as likely to be assigned in the mood disorders with psychosis subgroup. Disparity in diagnostic criteria nomenclature (ICD-9 vs. DSM) could account for a statistically significant difference in male/female OR for the schizophrenia subgroup in a subset of 11 studies.

Conclusions

Under the narrower definition of schizophrenia in studies using DSM diagnostic criteria classification, the shift towards a greater proportion of patients diagnosed with mood disorders with psychosis could be explained by the time criteria; the simultaneous emergence of the gender ratio difference is discussed. This study shows that subtle changes in diagnostic criteria in psychiatric illnesses can greatly influence observational data pertaining to youths.

Key words

ICD-9 DSM sex child adolescent odds ratio 

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References

  1. 1.
    Adams M, Kutcher S, Antoniw E, Bird D (1996) Diagnostic utility of endocrine and neuroimaging screening tests in first-onset adolescent psychosis. J Am Acad Child Adolesc Psychiatry 35:67–73PubMedGoogle Scholar
  2. 2.
    Aleman A, Kahn RS, Selten J-P (2003) Sex differences in the risk of schizophrenia. Evidence from meta-analysis. Arch Gen Psychiatry 60:565–571PubMedGoogle Scholar
  3. 3.
    American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington DC, American Psychiatric AssociationGoogle Scholar
  4. 4.
    American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised. Washington DC, American Psychiatric AssociationGoogle Scholar
  5. 5.
    Andreasen N (1994) Schizophrenia and other psychotic disorders. In: Widiger TA, Frances AJ, Pincus HA, First MB, Ross R, Davis W (eds) DSM-IV Sourcebook Vol 1, Washington, D. C. American Psychiatric Association, pp 343–349Google Scholar
  6. 6.
    Angermeyer MC, Kuhn L (1988) Gender differences in age at onset of schizophrenia. An overview. Eur Arch Psychiatry Neurol Sci 237:351–364PubMedGoogle Scholar
  7. 7.
    Carlson GA, Fennig S, Bromet EJ (1994) The confusion between bipolar disorder and schizophrenia in youth:where does it stand in the 1990s? J Am Acad Child Adolesc Psychiatry 33:453–460PubMedGoogle Scholar
  8. 8.
    Castle DJ, Wessely S, Murray RM (1993) Sex and schizophrenia: effects of diagnostic stringency, and association with premorbid variables. Br J Psychiatry 162:658–664PubMedGoogle Scholar
  9. 9.
    Cawthron P, James A, Dell J, Seagroatt V (1994) Adolescent onset psychosis. A clinical and outcome study. J Child Psychol Psychiatry 35:1321–1332PubMedGoogle Scholar
  10. 10.
    Copolov DL, McGorry PD, Singh BS, Proeve M, Van Riel R (1990) The influence of gender on the classification of psychotic disorders—a multidiagnostic approach. Acta Psychiatr Scand 82:8–13PubMedGoogle Scholar
  11. 11.
    Friedman RC, Clarkin JF, Corn R, Aronoff MS, Hurt SW, Murphy MC (1982) DSM-III and affective pathology in hospitalized adolescents. J Nerv Ment Dis 170:511–521PubMedGoogle Scholar
  12. 12.
    Fung DS, Aw SC (1999) A clinical study of 100 new admissions to an adolescent psychiatric inpatient unit in Singapore. Singpore Med J 40:91–95Google Scholar
  13. 13.
    Gagnon A, Beauchamp G (1999) Seasonality in hospital prevalence of adolescent psychoses: absence of variation. Can J Psychiatry 44:606–607Google Scholar
  14. 14.
    Galdos PM, van Os JJ, Murray RM (1993) Puberty and the onset of psychosis. Schizophr Res 10:7–14PubMedGoogle Scholar
  15. 15.
    Gillberg C, Wahlstrom J, Forsman A, Hellgren L, Gillberg IC (1986) Teenage psychoses–epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Child Psychol Psychiatry 27:87–98PubMedGoogle Scholar
  16. 16.
    Hafner H, Fatkenheuer B, an der Heiden W, Loffler W, Maurer K, Munk-Jorgensen P, Riecher A (1991) Sex differences in age of onset, symptomatology and evolution of schizophrenia. Sante Ment Que 16:77–98PubMedGoogle Scholar
  17. 17.
    Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. Academic Press London UK, pp 147–164Google Scholar
  18. 18.
    Iacono WG, Beiser M (1992) Are males more likely than females to develop schizophrenia? Am J Psychiatry 149:1070–1074PubMedGoogle Scholar
  19. 19.
    Jarbin H, Ott Y, von Knorring A-L (2003) Adult Outcome of Social Function in Adolescent-Onset Schizophrenia and Affective Psychosis. J Am Acad Child Adolesc Psychiatry 42:176–183PubMedGoogle Scholar
  20. 20.
    Lay B, Schmidt MH, Blanz B (1997) Course of adolescent psychotic disorder with schizoaffective episodes. Eur Child Adolesc Psychiatry 6:32–41PubMedGoogle Scholar
  21. 21.
    Lewine RR (1994) Comments on ‘Puberty and the onset of psychosis’ by Galdos PM, et al. Schizophr Res 13:81–83:85–86Google Scholar
  22. 22.
    Makowski D, Waternaux C, Lajonchere CM, Dicker R, Smoke N, Koplewicz H, Min D, Mendell NR, Levy DL (1997) Thought disorder in adolescent-onset schizophrenia. Schizophr Res 23:147–165PubMedGoogle Scholar
  23. 23.
    Mattanah JJF, Becker DF, Levy KN, Edell WS, McGlashan TH (1995) Diagnostic stability in adolescents followed up 2 years after hospitalization. Am J Psychiatry 152:889–894PubMedGoogle Scholar
  24. 24.
    Nicole L, Lesage A, Lalonde P (1992) Lower incidence and increased male: female ratio in schizophrenia. Br J Psychiatry 161:556–557PubMedGoogle Scholar
  25. 25.
    Normand SL (1999) Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med 18:321–359PubMedGoogle Scholar
  26. 26.
    Reddy YC, Girimaji SR, Srinath S (1993) Comparative study of classification of psychosis of childhood and adolescent onset. Acta Psychiatr Scand 87:188–191PubMedGoogle Scholar
  27. 27.
    Rosenthal R (1979) The “file-drawer problem” and tolerance for null results. Psychol Bull 86:638–641Google Scholar
  28. 28.
    Shulman GI, Hammer J (1988) Social characteristics, the diagnosis of mental disorders, and the change from DSM II to DSM III. Social Health Illness 10:543–560Google Scholar
  29. 29.
    Szymanski S, Lieberman JA, Alvir JM, Mayerhoff D, Loebel A, Geisler S, Chakos M, Koreen A, Jody D, Kane J, Woerner M, Cooper T (1995) Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. Am J Psychiatry 152:698–703PubMedGoogle Scholar
  30. 30.
    Turner TH, Dossetor DR, Bates RE (1986) The early outcome of admission to an adolescent unit: a report on 100 cases. J Adolesc 9:367–382PubMedGoogle Scholar
  31. 31.
    Van Os J, Jones P, Sham P, Bebbington P, Murray RM (1998) Risk factors for onset and persistence of psychosis. Soc Psychiatry Psychiatr Epidemiol 33:596–605PubMedGoogle Scholar
  32. 32.
    Werry JS, McClellan JM, Chard L (1991) Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. J Am Acad Child Adolesc Psychiatry 30:457–465PubMedGoogle Scholar
  33. 33.
    World Health Organization (1978) Manual of the International Classification of Diseases, Injuries, and Causes of death, 9th Revision. Geneva, World Health OrganizationGoogle Scholar
  34. 34.
    Zubieta JK, Dannals RF, Frost JJ (1999) Gender and age influences on human brain mu-opioid receptor binding measured by PET. Am J Psychiatry 156:842–848PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  1. 1.Collège de l’OutaouaisGatineau (QC)Canada J8Y 6M5
  2. 2.Centre Hospitalier Pierre-JanetGatineau (QC)Canada

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