Goldstein, J
|Goldstein, J.M. (1988) |
|‘Gender differences in the course of schizophrenia’ |
|American Journal of Psychiatry 145, 684–9 |
[Study provides evidence for following areas; schizophrenia, secondary data, validity, reliability, longitudinal studies and the DSM. If you asked in the exam about a study investigating SCHIZOPHRENIA this is the one to write about.]
|Background |
|Goldstein wanted to answer the question; |
| |
|‘DO SCHIZOPHRENIC WOMEN HAVE A LESS SEVERE EXPERIENCE THAN SCHIZOPHRENIC MEN?’ |
| |
|Before the study, Goldstein looked at 21 longitudinal studies following patients from 1st admission; only 1 showed no gender differences at outcome. In |
|general, studies show women with schizophrenia experienced fewer re-hospitalisations, shorter hospital stays, better social and work functioning and less |
|severe outcomes. Most of these studies used the DSM II to diagnose, and Goldstein suggested the DSM III would give a different diagnosis for less severe cases.|
|Aims (X3) |
| |
|To see if there are gender differences with regard to the re hospitalisation of people with schizophrenia and to the length of their hospital stays. |
|To consider social factors, mainly factors present before diagnosis, to see if they had an impact on the course of the disorder with regard to gender. |
|To look at DSM II and DSM III diagnosis to see if there were differences and to test the DSM for reliability and validity. |
|Procedure |
|Sample |
|The study used the DSM III to look at gender differences in schizophrenic patients who were in the early stages of the disorder and were followed for 10 years.|
|Data was collected in the mid 1970s at a private psychiatric teaching hospital in New York. Patients chosen were those who between 1972 and 1973; |
|Had a hospital diagnosis of schizophrenia or acute schizophrenia on admission and on discharge, using DSM II |
|Had a hospital stay of less than 6 months |
|Expected to return to their families |
|Had no other mental health issues |
|No drug or alcohol misuse |
|Aged between 18 to 45 |
| |
|Re-diagnosis |
|Patients were diagnosed using the DSM III. Hospital records gave detailed histories for the re-diagnosis and a single blind technique was used, where the |
|psychiatrist was blind to the hypothesis. Goldstein also carried out re-diagnosis and she was not blind to the hypothesis, two other experts carried out |
|re-diagnosis of a random sample of patients (4 men and 4 women – achieved a 0.80 agreement and only one case disagreed with Goldstein’s diagnosis) to test for |
|reliability. Out of an original 199 patients who had schizophrenia, acute schizophrenia or schizoaffective disorder according to the DSM II, 169 met the |
|criteria of the DSM III for schizophrenia, schizophreniform disorder or schizoaffective disorder. |
| |
|Features of the sample |
|The study looked at first time admissions and found 52 of these. This was too small, so Goldstein then added those who had had one previous hospitalisation = |
|38, giving a sample size of 90 (58 men and 32 women) out of 169 patients. The samples mean age was 24. All had a high level of education, 75 patients had never|
|married and 87 were non-Hispanic white and middle class. The men and women did not differ much in terms of age, education or class, but they did differ in job |
|status, with more women in white-collar jobs and employed. |
|The diagnoses of the sample included; |
|Schizophrenia paranoid: 33 |
|Schizophrenia non-paranoid: 33 |
|Schizophreniform disorder: 13 |
|Schizoaffective disorder depressed or manic type: 11 |
| |
|Gathering data about the disorder |
|Goldstein gathered information about symptoms, functioning before the diagnosis (premorbid functioning) and the course of the illness using interviews and |
|questionnaires. |
| |
|SYMPTOMS |
|Symptoms were rated by trained interviewers using specially developed questions. Areas covered included hallucinations, paranoia, isolation, withdrawal, |
|anxiety. Depressive mood, somatic (physical) complaints, impulsivity, inability to function, obsessive thought and behaviour and agitation. These all give an |
|idea of the characteristics of the schizophrenia and other related mental illnesses. |
| |
|PREMORBID FUNCTIONING |
|Premorbid functioning (before the onset of the illness) was measured by questionnaire dealing with isolation, peer relationships, and interests from the ages |
|of 6-13 and 14-20. Overall ratings were then found. |
| |
|COURSE OF ILLNESS |
|Course of the illness was operationalised by the number of re-hospitalisations and lengths of stay in hospital, with data being obtained over a 10 year period,|
|with results being considered at the 5 year and 10 year stages of the study. Statistical information about the re-hospitalisations and lengths of stay were |
|obtained from the New York State Department of Mental Health (secondary data). |
|Results |
|The research question was whether men had a higher mean number of re-hospitalisations and longer stays in hospital over a 10-year period of the study than |
|women. It was found they did. Schizophrenic women had a significantly lower mean number of re-hospitalisations and shorter stays in hospital from 1973-1983 |
|than men. The effect is even stronger of the 5 year period is looked at. |
| |
|Outcome |
|Mean |
| |
|Number of re-hospitalisations |
| |
|0-5 years |
| |
|Men |
|1.4 |
| |
|Women |
|0.59 |
| |
|0-10 years |
| |
|Men |
|2.24 |
| |
|Women |
|1.12 |
| |
|Length of hospital stay (days) |
| |
|0-5 years |
| |
|Men |
|267.41 |
| |
|Women |
|129.97 |
| |
|0-10 years |
| |
|Men |
|417.83 |
| |
|Women |
|206.81 |
| |
| |
|All the findings were significant, sometimes strongly significant. For both measures, men had higher numbers than women. |
| |
|It was found that 13% of the gender effect on re-hospitalisation was due to premorbid functioning. However premorbid functioning only accounted for 4.3% of the|
|effect of gender on length of stays. |
|Conclusion |
|Females with schizophrenia experienced fewer re-hospitalisations and shorter lengths of stay over a 5 and 10 year period than males. |
|The gender difference was strong enough even when the DSM III (more stringent than DSM II) was used, given the relatively small sample. |
|Gender differences seemed to start early in the disorder. |
|This study suggests males have poorer outcomes than females. |
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