The Difference Blog by Dan4th ([info]differenceblog) wrote,
@ 2008-02-27 08:53:00
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Entry tags:mental health, mental illness, psychology, schizophrenia

Incidence and Prevalence: Schizophrenia
Saha et al, 2005 report that their meta-analysis of studies from 1965-2002 found no significant difference in the prevalence of schizophrenia between men and women. This is especially curious given the same group's reporting of the male/female odds ratio for incidence at 1.40 in the previous year (McGrath et al, 2004). As incidence examines new cases and prevalence examines existing cases, this disparity may indicate some difference in the way men and women are affected by the disorder. In fact, Leung and Chue's 2000 review indicates that the course of schizophrenia is more severe in men. Saha et al predicted that this would lead to fewer recoveries, and therefore a higher prevalence in men. However, it is possible that this leads to higher mortality and a lower prevalence.


I was really sure I remembered sex differences in schizophrenia rates from class, but clearly I was wrong. Both of the intro textbooks I could lay my hands on agreed that men and women are about equally affected by schizophrenia (Davison et al, 2003; Bernstein et al, 1999). Sometimes I really need to check an intro book for the "best guess" because the primary articles are so busy trying to make their work look groundbreaking that I have no idea what the accepted model actually is.

Since most mental illness affects more women than men, it seems like a greater percentage of male patients than female patients would be getting treated for schizophrenia. Maybe I'm remembering that? Sadly, I'm probably just making the association because I've only met men (well, one man) who disclosed their schizophrenia diagnosis. I hate how little I can trust my memory. Stupid brain. *pokes it with a Q-tip*

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[info]beckyzoole
2008-02-27 06:15 pm UTC (link)
Since most mental illness affects more women than men

I don't think that's true. I think that more women than men seek treatment for depression and neuroses, but that's because women are more likely than men seek treatment for just about anything. As far as I know, both sexes are equally affected by mental illness in general.

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[info]differenceblog
2008-02-27 06:55 pm UTC (link)
I'm not sure what you're questioning - whether the people who reach diagnostic criteria for any disorder are disproportionately women, or whether people who seek treatment are disproportionately women, or both.

I think I meant both, although part of that is a problem in the way the DSM definitions are written. the tendency of women to seek treatment makes it more likely that my guess about distribution-of-diagnosis-within-gender-groups-of-patients is accurate, but I don't think it's the whole of the issue.

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[info]beckyzoole
2008-02-27 07:10 pm UTC (link)
You said that "most mental illness affects more women than men". That would mean that more women than men reach diagnostic criteria for mental disorders.

What I am saying is that no, that's not correct.

You may see more women than men under treatment for certain mental disorders, but that is simply because of the tendency for more women than men to seek treatment for just about anything.

According to NIMH, schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.

ETA: After more poking around the NIMH site, it seems that men tend to show symptoms about ten years before women do, while they are still teens. Since their parents are likely to get treatment for them, and since it is easier to force treatment on a minor than on an adult, I'd guess that would lead to more men than women being treated for schizophrenia.

Edited at 2008-02-27 07:13 pm UTC

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[info]differenceblog
2008-02-27 08:10 pm UTC (link)
According to NIMH, schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.

Right. That's (roughly) the point of today's post - the link you provide cites Muesere and McGurk's 2004 review in the Lancet, which also comments on the differences in the course of schizophrenia between men and women, but they do report that the incidence is similar - a difference from Saha & McGrath's finding, certainly. But that's just for schizophrenia.

As for my claim about the overall gender split of mental disorder sufferers, I think the best source is probably Kessler et al (2005). Kessler et al conducted face-to-face interviews with a sample selected to be as nationally representative as possible, which I hope would rule out "seeking treatment" bias. Some quotes:

"Anxiety disorders were the most prevalent class of disorders (28.8%), followed by impulse-control disorders (24.8%), mood disorders (20.8%), and substance use disorders (14.6%)."

"Women had a significantly higher risk than men of anxiety and mood disorders. Men had a significantly higher risk than women of impulse-control and substance use disorders"

Kessler reports a very slight difference in odds ratio for "any disorder" based on gender: 1.1 (1.0-1.2). This appears in a table, and it's not discussed in the text, so I would suspect it's a non-significant statistic.

Honestly, when I was doing the guesswork in my head, based on my recollection of the most common disorders and the gender splits within those disorders, I plumb forgot about substance abuse, which is a huge one. So, you are probably right that any historical difference may be attributable to help-seeking. However, with the converging rates of substance abuse (women are abusing more, not men abusing less), I would be surprised if that little difference in the O.R. doesn't increase.

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