Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study
Konstantinos Ν. Fountoulakis, Elena Dragioti, Theofilidis Antonis, Tobias Wiklund, Xenofon Atmatzidis, Ioannis Nimatoudis, E Thys, Martien Wampers, Luchezar Hranov, Trayana Hristova, Daniil Aptalidis, Roumen Milev, Felicia Iftene, Filip Španiel, Pavel Knytl, Petra Fürstová, Tiina From, Henry Karlsson, Maija Walta, Raimo K. R. Salokangas, Jean‐Michel Azorin, Justine Bouniard, J. Montant, Georg Juckel, Ida S. Haussleiter, Athanasios Douzenis, Ioannis Michopoulos, Panagiotis Ferentinos, Nikolaos Smyrnis, Leonidas Mantonakis, Zsófia Nemes, Xénia Gonda, Dóra Vajda, Anita Juhász, Amresh Shrivastava, John L. Waddington, Maurizio Pompili, Anna Comparelli, Valentina Corigliano, Elmārs Rancāns, Alvydas Navickas, Jan Hilbig, Laurynas Bukelskis, Lidija Injac Stevović, Sanja Vodopić, Oluyomi Esan, Oluremi Oladele, Christopher Osunbote, Janusz Rybakowski, Paweł Wójciak, Klaudia Domowicz, Maria Luísa Figueira, Ludgero Linhares, Joana Crawford, Anca-Livia Panfil, Daria Smirnova, O. V. Izmailova, Dušica Lečić‐Toševski, Henk Temmingh, Fleur M. Howells, Julio Bobes, María Paz García‐Portilla, Leticia García-Álvarez, Gamze Erzın, Hasan Karadağ, Avinash De Sousa, Anuja Bendre, Cyril Höschl, Cristina Bredicean, Ion Papavă, Olivera Vuković, Bojana Pejušković, Vincent Russell, Loukas Athanasiadis, Anastasia Konsta, Nikolaos K. Fountoulakis, Dan J. Stein, Michael Berk, Olivia Dean, Rajiv Tandon, Siegfried Kasper, Marc D. Binder
Abstract
Abstract Background The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. Methods Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. Results There was a 3-year later age at onset for females ( P < .001) and lower rates of negative symptoms ( P < .01) and higher depression/anxiety measures ( P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages ( P = .001). No significant effects were found concerning duration of illness. Discussion Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.