Abstract
First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD = − 0.15, 95%CI = − 0.21, − 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation.
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Kelly Anderson is supported by a Canada Research Chair in Public Mental Health Research.
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This work was funded by an Early Researcher Award from the Ontario Ministry of Research, Innovation, and Science, and by a Project Grant from the Canadian Institutes of Health Research (PJT 153022).
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Brooke Carter and Kelly Anderson contributed to the study conception and drafting of the article. The literature search and data analysis were performed by Brooke Carter and Jared Wootten. Brooke Carter, Jared Wootten, Kelly Anderson, Suzanne Archie, and Amanda Terry provided input on interpretation and critically revised the work.
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Carter, B., Wootten, J., Archie, S. et al. Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Arch Womens Ment Health 25, 679–691 (2022). https://doi.org/10.1007/s00737-022-01247-3
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DOI: https://doi.org/10.1007/s00737-022-01247-3