Gender difference in age at onset of schizophrenia among inpatients: a descriptive cross-sectional clinical study

Mereeza Joseph, Neethi Valsan, Saibunnisa Beevi Kunjubava


Background: Emil Kraepelin many years ago had observed that there is late age at onset in women for schizophrenia compared to men. This finding has been replicated in later several studies too. But there are no such studies conducted in Kerala to our best knowledge. Thus it is relevant to evaluate gender difference in age at onset of schizophrenia in a hospital-based population in Central Kerala.

Methods: In this descriptive cross sectional clinical study conducted at Jubilee Mission Medical College and Research Institute, Thissur, all schizophrenia patients consecutively admitted with sample size of 100 (50 males and 50 females) and diagnosis confirmed as per mini international neuropsychiatric interview English Version 5.0.0 (M. I. N. I. PLUS) were included. Semi structured questionnaire was used to collect data. To test the significance, Mann-Whitney U test was applied and correlation was tested using Pearson’s correlation coefficient.

Results: Our study results shows that mean age at onset of psychotic symptoms, mean age at first contact with a health care provider, mean age at index hospitalization in male patients was approximately 5 years earlier than that of female patients.

Conclusions: Our study results shows a gender difference in age at onset of schizophrenia, with males having an earlier age at onset and lower average age of first admission than females.



Schizophrenia, Gender difference, Age at onset

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GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-858.

Kraepelin, E. Dementia praecox and paraphrenia. Huntington, NY: Krieger. 1971.

Faraone SV, Chen WJ, Goldstein JM, and Tsuang MT. Gender differences in age at onset of schizophrenia.Br J Psychiatry. 1994;164:625-629.

Ran MS, Xiang MZ, Li SX, San YH, Huang MS, Li SG, et al. Prevalence and course of schizophrenia in a Chinese rural area. Aust N Z J Psychiatry. 2003;37:452-457.

Dube KC. A study of prevalence and biosocial variable in Mental Illness in a Rural and an Urban Community in Uttar Pradesh India. Acta. Psychiat Scand.1970;46:327-359.

Braatøy T. Männer zwischen 15 und 25 Jahren: mentalhygenische Untersuchungen mit besonderer Berücksichtigung der Schizophrenie. Fabritius and Søonner. 1934.

WORLD HEALTH ORGANIZATION. International classification of diseases, 10th edn. Geneva: WHO. 1992. Last accessed on 1st December, 2020.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revised. Washington: American Psychiatric Association. 2000. Last accessed on 1st December, 2020.

Barbato A. Schizophrenia and Public Health. Geneva: World Health Organisation. 1998. Last accessed on 1st December, 2020.

Galderisi S, Bucci P, Uc P, and Peuskens J. No gender differences in social outcome in patients suffering from schizophrenia. European Psychiatry. 2012;27(6):406-8.

Varma VK, Wig NN, Phookun HR, Misra AK, Khare CB, Tripathi BM, et al. First-onset schizophrenia in the community: Relationship of urbanization with onset, early manifestations and typology. Acta Psychiatr Scand. 1997;96:431-8.

Räsänen S, Pakaslahty A, Syvälahti R, Jones PB, Isohanni M. Sex differences in schizophrenia: a review. Nord J Psychiatry. 2000;54,:37-45.

Riecher-Rossler A, Pfluger M, Borgwardt S. Schizophrenia in women. In: Kohen,D. (Ed.), Oxford Textbook of Women and Mental Health. Oxford University Press, Oxford. 2010;102-11.

Falkenburg J, Tracy DK. Sex and schizophrenia: a review of gender differences.Psychos. Psychol. Soc. Integr. Approaches. 2014;6(1):61-9.

World Health Organization. Schizophrenia - An international follow-up study. Chichester: Wiley. 1979.

Thara R, Henrietta M, Joseph A. Ten year course of schizophrenia: the Madras longitudinal study. Acta Psychiatr Scand. 1988;90:329-36.

Murthy GVS, Janakiramaiah N, Gangadhar BN. Sex difference in age at onset: a discrepant finding from India. Acta Psychiatr Scand. 1998;97:321-5.

Subbakrishna DK, Murali N, Gangadhar BN. Younger age at onset of schizophrenia in females: a replicative study. In: Subbakrishna DK, Kaliaperumal VG, editors. Statistical methods and application in biology and medicine. Bangalore: NIMHANS. 2001;253-260.

Gangadhar BN, Pannerselvan C, Subbakrishna DK. Age at onset and schizophrenia: reversed gender effect. Acta Psychiatr Scand. 2002;105:317-319.

Rangaswamy T. Twenty-five years of schizophrenia: The Madras longitudinal study. Indian journal of psychiatry. 2012;54(2):134.

Thirthalli J, Channaveerachari NK, Subbakrishna DK, Cottler LB, Varghese M, Gangadhar BN. Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India. Indian journal of psychiatry. 2011;53(4):319.

Jablensky A. Schizophrenia: Manifestations, incidence and course in different cultures -A World Health Organisation ten-country study. Psychol Med. 1992;20:1-97.

Hafner H, Riecher A, Maurer K. How does gender influence age at first hospitalization for schizophrenia? A transnational case register study. Psychological Medicine. 1989;19:903-18.

Chandramouli C, General R. Census of india 2011. Provisional Population Totals. New Delhi: Government of India. 2011:409-13.

Pollock HM. Frequency of dementia praecox in relation to sex, age, environment, nativity, and race Ment Hygiene. 1926;10:596-611.

Nyman AK. Non-regressive schizophrenia: Clinical course and outcome Acta Psychiatr Scand. 1978;272.

Thorup A, Waltoft BL, Pedersen CB, Mortensen PB, Nordentoft M. Young males have a higher risk of developing schizophrenia: a Danish register study. Psychological Medicine. 2007b;37:479-84.

Ruiz A, Blanco R, Santander J, Miranda E. Relationship between sex differences in onset of schizophrenia and puberty. J Psychiatr Res. 2000;34:349-53.

Seeman MV, Lang M. The role of oestrogens in schizophrenia gender differences. Schizophrenia Bulletin. 1990;16:185-94.