Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study
Authors: Fountoulakis Konstantinos N. , Dragioti Elena , Theofilidis Antonis T. , Wiklund Tobias , Atmatzidis Xenofon , Nimatoudis Ioannis , Thys Erik , Wampers Martien , Hranov Luchezar , Hristova Trayana , Aptalidis Daniil , Milev Roumen , Iftene Felicia , Spaniel Filip , Knytl Pavel , Furstova Petra , From Tiina , Karlsson Henry , Walta Maija , Salokangas Raimo K. R. , Azorin Jean-Michel , Bouniard Justine , Montant Julie , Juckel Georg , Haussleiter Ida S. , Douzenis Athanasios , Michopoulos Ioannis , Ferentinos Panagiotis , Smyrnis Nikolaos , Mantonakis Leonidas , Nemes Zsófia , Gonda Xenia , Vajda Dora , Juhasz Anita , Shrivastava Amresh , Waddington John , Pompili Maurizio , Comparelli Anna , Corigliano Valentina , Rancans Elmars , Navickas Alvydas , Hilbig Jan , Bukelskis Laurynas , Stevovic Lidija I. , Vodopic Sanja , Esan Oluyomi , Oladele Oluremi , Osunbote Christopher , Rybakowski Janusz K. , Wojciak Pawel , Domowicz Klaudia , Figueira Maria L. , Linhares Ludgero , Crawford Joana , Panfil Anca-Livia , Smirnova Daria , Izmailova Olga , Lecic-Tosevski Dusica , Temmingh Henk , Howells Fleur , Bobes Julio , Garcia-Portilla Maria P. , García-Alvarez Leticia , Erzin Gamze , Karadağ Hasan , De Sousa Avinash , Bendre Anuja , Hoschl Cyril , Bredicean Cristina , Papava Ion , Vukovic Olivera , Pejuskovic Bojana , Russell Vincent , Athanasiadis Loukas , Konsta Anastasia , Fountoulakis Nikolaos K. , Stein Dan , Berk Michael , Dean Olivia , Tandon Rajiv , Kasper Siegfried , De Hert Marc 
Published: August 2021

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.