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; |

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|‘DO SCHIZOPHRENIC WOMEN HAVE A LESS SEVERE EXPERIENCE THAN SCHIZOPHRENIC MEN?’ |

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|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) |

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|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 |

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|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. |

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|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. |

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|Outcome |

|Mean |

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|Number of re-hospitalisations |

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|0-5 years |

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|Men |

|1.4 |

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|Women |

|0.59 |

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|0-10 years |

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|Men |

|2.24 |

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|Women |

|1.12 |

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|Length of hospital stay (days) |

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|0-5 years |

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|Men |

|267.41 |

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|Women |

|129.97 |

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|0-10 years |

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|Men |

|417.83 |

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|Women |

|206.81 |

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|All the findings were significant, sometimes strongly significant. For both measures, men had higher numbers than women. |

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|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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