Sex Differences in Recovery-Related Outcomes and Needs for Psychiatric Rehabilitation in People With Schizophrenia Spectrum Disorder

Marine Dubreucq, MSc; Julien Plasse, MSc; Franck Gabayet, MSc; Olivier Blanc, MD; Isabelle Chereau, MD; Sophie Cervello, MD; Geoffroy Couhet, MD; Caroline Demily, MD, PhD; Nathalie Guillard-Bouhet, MD; Benjamin Gouache, MD; Nemat Jaafari, MD, PhD; Guillaume Legrand, MD; Emilie Legros-Lafarge, MD; Geneviève Mora, MD; Romain Pommier, MD; Clélia Quilès, MD; Hélène Verdoux, MD, PhD; Francis Vignaga, MD; Catherine Massoubre, MD, PhD; Nicolas Franck, MD, PhD; Julien Dubreucq, MD, PhD

J Clin Psychiatry 2021;82(4):20m13732

ABSTRACT

Background: Female sex/gender has been associated with better longitudinal outcomes in schizophrenia spectrum disorders (SSDs). Few studies have investigated the relationships between female gender and recovery-related outcomes. Women’s specific psychiatric rehabilitation needs remain largely unknown.

Objective: The objectives of the present study are to investigate sex differences in (1) objective and subjective aspects of recovery and (2) psychiatric rehabilitation needs in a multicenter non-selected psychiatric rehabilitation SSD sample.

Methods: 1,055 outpatients with SSD (DSM-5) were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and November 2019. Evaluation included standardized scales for quality of life, satisfaction with life, and well-being and a broad cognitive battery. Socially valued roles at enrollment were recorded. Functional recovery was measured using the Global Assessment of Functioning scale (GAF) and personal recovery with the Stages of Recovery Instrument (STORI).

Results: Female sex was the best predictor of having more than 2 socially valued roles in the multivariate analysis (P < .001; OR [95% CI] = 5.42 [2.34–13.06]). No sex differences were found for functional recovery or personal recovery. Female gender was positively associated with self-stigma (P = .036) and suicidal history (P < .001) and negatively correlated with quality of life (P = .004) and satisfaction with interpersonal relationships (P = .029), an area in which women reported more unmet needs (P = .004).

Conclusions: The present study found that women had poorer subjective recovery-related outcomes and more unmet needs than men. It would therefore be beneficial to develop recovery-oriented interventions addressing women’s specific needs and implement these in psychiatric rehabilitation services.

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References (67)

Seeman MV. Does gender influence outcome in schizophrenia? Psychiatr Q. 2019;90(1):173–184. PubMed CrossRef
Leamy M, Bird V, Le Boutillier C, et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–452. PubMed CrossRef
Leonhardt BL, Huling K, Hamm JA, et al. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions. Expert Rev Neurother. 2017;17(11):1117–1130. PubMed CrossRef
Albert N, Bertelsen M, Thorup A, et al. Predictors of recovery from psychosis Analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years. Schizophr Res. 2011;125(2–3):257–266. PubMed CrossRef
Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42(3):595–606. PubMed CrossRef
Jääskeläinen E, Juola P, Hirvonen N, et al. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013;39(6):1296–1306. PubMed CrossRef
Thorup A, Albert N, Bertelsen M, et al. Gender differences in first-episode psychosis at 5-year follow-up–two different courses of disease? Results from the OPUS study at 5-year follow-up. Eur Psychiatry. 2014;29(1):44–51. PubMed CrossRef
Seeman MV, Gupta R. Selective review of age-related needs of women with schizophrenia. Clin Schizophr Relat Psychoses. 2015;9(1):21–29. PubMed CrossRef
Arvidsson H. Gender differences in needs and care of severely mentally ill persons: findings from a Swedish cross-sectional and longitudinal study. Int J Soc Psychiatry. 2010;56(4):424–435. PubMed CrossRef
Mancuso SG, Morgan VA, Mitchell PB, et al. A comparison of schizophrenia, schizoaffective disorder, and bipolar disorder: results from the Second Australian National Psychosis Survey. J Affect Disord. 2015;172:30–37. PubMed CrossRef
Comacchio C, Howard LM, Bonetto C, et al; GET UP Group. The impact of gender and childhood abuse on age of psychosis onset, psychopathology and needs for care in psychosis patients. Schizophr Res. 2019;210:164–171. PubMed CrossRef
Bertani M, Lasalvia A, Bonetto C, et al. The influence of gender on clinical and social characteristics of patients at psychosis onset: a report from the Psychosis Incident Cohort Outcome Study (PICOS). Published correction appears in Psychol Med. 2012 Apr;42(4). Psychol Med. 2012;42(4):769–780. PubMed CrossRef
Ho RWH, Chang WC, Kwong VWY, et al. Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention. Schizophr Res. 2018;195:463–468. PubMed CrossRef
Song LY. Predictors of personal recovery for persons with psychiatric disabilities: an examination of the Unity Model of Recovery. Psychiatry Res. 2017;250:185–192. PubMed CrossRef
Caqueo-Urízar A, Fond G, Urzúa A, et al. Gender differences in schizophrenia: a multicentric study from three Latin-America countries. Psychiatry Res. 2018;266:65–71. PubMed CrossRef
Mayston R, Kebede D, Fekadu A, et al. The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort. Soc Psychiatry Psychiatr Epidemiol. 2020;55(12):1581–1591. PubMed CrossRef
Carpiniello B, Pinna F, Tusconi M, et al. Gender differences in remission and recovery of schizophrenic and schizoaffective patients: preliminary results of a prospective cohort study. Schizophr Res Treatment. 2012;2012:576369. PubMed CrossRef
Franck N, Bon L, Dekerle M, et al. Satisfaction and needs in serious mental illness and autism spectrum disorder: The REHABase Psychosocial Rehabilitation Project. Psychiatr Serv. 2019;70(4):316–323. PubMed CrossRef
Dubreucq J, Plasse J, Gabayet F, et al; REHABAse Network. Self-stigma in serious mental illness and autism spectrum disorder: results from the REHABase national psychiatric rehabilitation cohort. Eur Psychiatry. 2020;63(1):e13. PubMed CrossRef
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-49, HHS Publication No. (SMA) 14-4887. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Press; 2013.
Startup M, Jackson MC, Bendix S. The concurrent validity of the Global Assessment of Functioning (GAF). Br J Clin Psychol. 2002;41(Pt 4):417–422. PubMed CrossRef
Andresen R, Caputi P, Oades L. Stages of recovery instrument: development of a measure of recovery from serious mental illness. Aust N Z J Psychiatry. 2006;40(11-12):972–980. PubMed CrossRef
Haro JM, Kamath SA, Ochoa S, et al; SOHO Study Group. The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand suppl. 2003;107(416):16–23. PubMed CrossRef
Birchwood M, Smith J, Drury V, et al. A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand. 1994;89(1):62–67. PubMed CrossRef
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42(3):241–247. PubMed CrossRef
Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31–49. PubMed CrossRef
Lecomte T, Corbière M, Laisné F. Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form. Psychiatry Res. 2006;143(1):99–108. PubMed CrossRef
Wallace CJ, Lecomte T, Wilde J, et al. CASIG: a consumer-centered assessment for planning individualized treatment and evaluating program outcomes. Schizophr Res. 2001;50(1–2):105–119. PubMed CrossRef
Auquier P, Simeoni MC, Sapin C, et al. Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: the S-QoL. Schizophr Res. 2003;63(1–2):137–149. PubMed CrossRef
Tennant R, Hiller L, Fishwick R, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes. 2007;5(1):63. PubMed CrossRef
Wechsler D. WAIS IV Nouvelle version de l’échelle d’intelligence de Weschler pour adultes. 4th ed. Paris, France: Edition de Centre de Psychologie Appliquée; 2008.
Deweer B, Poitrenaud J, Kalafat M, et al. Manuel du California Verbal Learning Test. Paris, France: les Editions du Centre de Psychologie Appliquée; 2008.
Van der Linden M, Coyette F, Poitrenaud J, et al. L’épreuve de rappel libre/rappel indicé à 16 items (RL/RI-16). In: Van der Linden M, Adam S, Ag-niel A, et Membres du GRENEM, Eds. L’évaluation des troubles de la mémoire: présentation de quatre tests de mémoire épisodique avec leur étalonnage. 2004; Marseille, France: Sola; 25–47.
Brickenkamp R, Schmidt-Atzert L, Liepmann D. D2-R: Test d’attention concentrée révisée. Paris, France: Editions Hogrefe; 2015.
Fournet N, Demazières-Pelletier Y, Favier S, et al. Test des commissions révisé. GREMOIRE II Tests et échelles des maladies neurologiques avec symptomatologie cognitive. Paris, France: De Boeck-Solal; 2015.
Shallice T, Burgess PW. Deficits in strategy application following frontal lobe damage in man. Brain. 1991;114(pt 2):727–741. PubMed CrossRef
Dziobek I, Fleck S, Kalbe E, et al. Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord. 2006;36(5):623–636. PubMed CrossRef
Combs DR, Penn DL, Wicher M, et al. The Ambiguous Intentions Hostility Questionnaire (AIHQ): a new measure for evaluating hostile social-cognitive biases in paranoia. Cogn Neuropsychiatry. 2007;12(2):128–143. PubMed CrossRef
R Core Team. R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. 2015. https://www.R-project.org/
Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry. 2017;4(2):146–158. PubMed CrossRef
Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? the potential role of sex hormones. Lancet Psychiatry. 2017;4(1):73–82. PubMed CrossRef
Miranda-Mendizabal A, Castellví P, Parés-Badell O, et al. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. 2019;64(2):265–283. PubMed CrossRef
Tew J, Ramon S, Slade M, et al. Social factors and recovery from mental health difficulties: a review of the evidence. Br J Soc Work. 2012;42(3):443–460. CrossRef
Firmin RL, Zalzala AB, Hamm JA, et al. How psychosis interrupts the lives of women and men differently: a qualitative comparison [published online ahead of print November 20, 2020]. Psychol Psychother. 2020. PubMed
Haarmans M, McKenzie K, Kidd SA, et al. Gender role strain, core schemas, and psychotic experiences in ethnically diverse women: a role for sex- and gender-based analysis in psychosis research? Clin Psychol Psychother. 2018;25(6):774–784. PubMed CrossRef
García-Mieres H, Montesano A, Villaplana A, et al. Common and differential dimensions of personal identity between psychosis and depression: The relevance of gender and depressive mood. J Psychiatr Res. 2020;127:48–56. PubMed CrossRef
Lysaker PH, Pattison ML, Leonhardt BL, et al. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry. 2018;17(1):12–23. PubMed CrossRef
Badcock JC, Di Prinzio P, Waterreus A, et al. Loneliness and its association with health service utilization in people with a psychotic disorder. Schizophr Res. 2020;223:105–111. PubMed CrossRef
Hanlon MC, Campbell LE, Single N, et al. Men and women with psychosis and the impact of illness-duration on sex-differences: the second Australian national survey of psychosis. Psychiatry Res. 2017;256:130–143. PubMed CrossRef
Farrelly S, Clement S, Gabbidon J, et al; MIRIAD study group. Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry. 2014;14(1):157. PubMed CrossRef
Pellet J, Golay P, Nguyen A, et al. The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: a longitudinal study. Psychiatry Res. 2019;275:115–119. PubMed CrossRef
Jeffery D, Clement S, Corker E, et al. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry. 2013;13(1):120. PubMed CrossRef
Lacey M, Paolini S, Hanlon MC, et al. Parents with serious mental illness: differences in internalised and externalised mental illness stigma and gender stigma between mothers and fathers. Psychiatry Res. 2015;225(3):723–733. PubMed CrossRef
Lappin JM, Heslin M, Lomas B, et al. Early sustained recovery following first episode psychosis: evidence from the AESOP10 follow-up study. Schizophr Res. 2018;199:341–345. PubMed CrossRef
Villeneuve K, Potvin S, Lesage A, et al. Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophr Res. 2010;121(1-3):266–270. PubMed CrossRef
Charlson FJ, Ferrari AJ, Santomauro DF, et al. Global epidemiology and burden of schizophrenia: findings from the Global Burden of Disease Study 2016. Schizophr Bull. 2018;44(6):1195–1203. PubMed CrossRef
Dubreucq J, Ycart B, Gabayet F, et al; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group. Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort. Eur Arch Psychiatry Clin Neurosci. 2019;269(5):599–610. PubMed CrossRef
Ferrari M, Flora N, Anderson KK, et al; ACE Project Team. Gender differences in pathways to care for early psychosis. Early Interv Psychiatry. 2018;12(3):355–361. PubMed CrossRef
Fond G, Boyer L, Leboyer M, et al; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group. Influence of Venus and Mars in the cognitive sky of schizophrenia: results from the first-step national FACE-SZ cohort. Schizophr Res. 2018;195:357–365. PubMed CrossRef
Li AWY, Hui CLM, Lee EHM, et al. Gender differences in correlates of cognition in first-episode psychosis. Psychiatry Res. 2019;271:412–420. PubMed CrossRef
Revier CJ, Reininghaus U, Dutta R, et al. Ten-year outcomes of first-episode psychoses in the MRCÆSOP-10 Study. J Nerv Ment Dis. 2015;203(5):379–386. PubMed CrossRef
Austin SF, Mors O, Secher RG, et al. Predictors of recovery in first episode psychosis: the OPUS cohort at 10 year follow-up. Schizophr Res. 2013;150(1):163–168. PubMed CrossRef
Hache-Labelle C, Abdel-Baki A, Lepage M, et al. Romantic relationship group intervention for men with early psychosis: a feasibility, acceptability and potential impact pilot study [published online ahead of print June 23, 2020]. Early Interv Psychiatry. 2020. PubMed CrossRef
Müller AD, Gjøde ICT, Eigil MS, et al. VIA Family—a family-based early intervention versus treatment as usual for familial high-risk children: a study protocol for a randomized clinical trial. Trials. 2019;20(1):112. PubMed CrossRef
Lysaker PH, Dimaggio G. Metacognitive capacities for reflection in schizophrenia: implications for developing treatments. Schizophr Bull. 2014;40(3):487–491. PubMed CrossRef
de Jong S, van Donkersgoed RJM, Timmerman ME, et al. Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychol Med. 2019;49(2):303–313. PubMed CrossRef