SpringerLink
Log in

The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Although some studies have suggested that women with schizophrenia are more likely to achieve positive outcomes, the evidence-base is fraught with inconsistencies. In this study we compare the long-term course and outcomes for men and women living with schizophrenia in rural Ethiopia.

Methods

The Butajira course and outcome study for severe mental disorders is a population-based cohort study. Community ascertainment of cases was undertaken between 1998 and 2001, with diagnostic confirmation by clinicians using the Schedules for Clinical Assessment in Neuropsychiatry. Findings from annual outcome assessments were combined with clinical records, patient and caregiver report, and psychiatric assessments at 10–13 years using the Longitudinal Interval Follow-up Evaluation- LIFE chart. For the sub-group of people with schizophrenia (n = 358), we compared course of illness and treatment, co-morbidity, recovery, social outcomes and mortality between men and women. Multivariable analyses were conducted for modelling associations identified in bivariate analyses according to blocks shaped by our a priori conceptual framework of the biological and social pathways through which gender might influence the course and outcome of schizophrenia.

Results

Looking into over 10–13 years of follow-up data, there was no difference in the functioning or recovery in women compared to men (AOR = 1.79, 95% CI = 0.91, 3.57). Women were less likely to report overall life satisfaction (AOR = 0.22, 95% CI = 0.09, 0.53) or good quality of spousal relationships (AOR = 0.09, 95% CI = 0.01–1.04). Men were more likely to have co-morbid substance use and there was a trend towards women being more likely to be prescribed an antidepressant (AOR = 2.38, 95% CI = 0.94, 5.88). There were no gender differences in the course of illness, number of psychotic episodes or adherence to medications.

Conclusion

In this rural African setting, we found little evidence to support the global evidence indicating better course and outcome of schizophrenia in women. Our findings are suggestive of a gendered experience of schizophrenia which varies across contexts. Further investigation is needed due to the important implications for the development of new mental health services in low and middle-income country settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Haro JM et al (2011) Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. Br J Psychiatry 199(3):194–201

    PubMed  Google Scholar 

  2. Novick D et al (2016) Sex differences in the course of schizophrenia across diverse regions of the world. Neuropsychiatr Dis Treat 12:2927–2939

    PubMed  PubMed Central  Google Scholar 

  3. Ran MS et al (2015) Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study. Br J Psychiatry 206(4):283–288

    PubMed  PubMed Central  Google Scholar 

  4. Grossman LS et al (2008) Sex differences in schizophrenia and other psychotic disorders: a 20-year longitudinal study of psychosis and recovery. Compr Psychiatry 49(6):523–529

    PubMed  PubMed Central  Google Scholar 

  5. Morgan VA, Castle DJ, Jablensky AV (2008) Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust N Z J Psychiatry 42(1):74–82

    PubMed  Google Scholar 

  6. Goldstein RZ et al (2002) Neurocognitive correlates of response to treatment in formal thought disorder in patients with first-episode schizophrenia. Neuropsychiatry Neuropsychol Behav Neurol 15(2):88–98

    PubMed  Google Scholar 

  7. Thara R, Rajkumar S (1992) Gender differences in schizophrenia. Results of a follow-up study from India. Schizophr Res 7(1):65–70

    PubMed  CAS  Google Scholar 

  8. Bergh S et al (2016) Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders, 10years after baseline: The OPUS study. Schizophr Res 175(1–3):57–63

    PubMed  Google Scholar 

  9. Morgan C et al (2014) Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychol Med 44(13):2713–2726

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Newman SC, Bland RC, Thompson AH (2012) Long-term course and outcome in schizophrenia: a 34-year follow-up study in Alberta, Canada. Psychol Med 42(10):2137–2143

    PubMed  CAS  Google Scholar 

  11. Harrison G et al (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 178:506–517

    PubMed  CAS  Google Scholar 

  12. Munk-Jorgensen P, Mortensen PB (1992) Social outcome in schizophrenia: a 13-year follow-up. Soc Psychiatry Psychiatr Epidemiol 27(3):129–134

    PubMed  CAS  Google Scholar 

  13. Morgan C et al (2016) The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad. Psychol Med 46(9):1923–1933

    PubMed  CAS  Google Scholar 

  14. Harvey CA et al (2007) The Camden Schizophrenia Surveys III: Five-year outcome of a sample of individuals from a prevalence survey and the importance of social relationships. Int J Soc Psychiatry 53(4):340–356

    PubMed  Google Scholar 

  15. Kebede D et al (2003) Onset and clinical course of schizophrenia in Butajira-Ethiopia—a community-based study. Soc Psychiatry Psychiatr Epidemiol 38(11):625–631

    PubMed  CAS  Google Scholar 

  16. Leff J et al (1992) The international pilot study of Schizophrenia: five-year follow-up findings. Psychol Med 22(1):131–145

    PubMed  CAS  Google Scholar 

  17. Gureje O, Bamidele R (1999) Thirteen-year social outcome among Nigerian outpatients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 34(3):147–151

    PubMed  CAS  Google Scholar 

  18. Gureje O, Bamidele RW (1998) Gender and schizophrenia: association of age at onset with antecedent, clinical and outcome features. Aust N Z J Psychiatry 32(3):415–423

    PubMed  CAS  Google Scholar 

  19. Alem A et al (2009) Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia. Schizophr Bull 35(3):646–654

    PubMed  Google Scholar 

  20. Shibre T et al (2015) Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort. Schizophr Res 161(2–3):414–420

    PubMed  Google Scholar 

  21. Charlson FJ et al (2018) Global epidemiology and burden of Schizophrenia: Findings from the global burden of disease study 2016. Schizophr Bull 44(6):1195–1203

    PubMed  PubMed Central  Google Scholar 

  22. Kebede D et al (2004) The sociodemographic correlates of schizophrenia in Butajira, rural Ethiopia. Schizophr Res 69(2–3):133–141

    PubMed  Google Scholar 

  23. Teferra S et al (2011) Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry 11:165

    PubMed  PubMed Central  Google Scholar 

  24. Fekadu A et al (2015) Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia. Br J Psychiatry 206(4):289–296

    PubMed  Google Scholar 

  25. Eranti SV et al (2013) Gender difference in age at onset of schizophrenia: a meta-analysis. Psychol Med 43(1):155–167

    PubMed  CAS  Google Scholar 

  26. Kebede D et al (2005) Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia. Schizophr Res 78(2–3):171–185

    PubMed  CAS  Google Scholar 

  27. Shibre T et al (2008) Traditional treatment of mental disorders in rural Ethiopia. Ethiop Med J 46(1):87–91

    PubMed  Google Scholar 

  28. Alem A et al (2004) Comparison of computer assisted scan diagnoses and clinical diagnoses of major mental disorders in Butajira, rural Ethiopia. Ethiop Med J 42(2):137–143

    PubMed  Google Scholar 

  29. Sartorius N, Janca A (1996) Psychiatric assessment instruments developed by the World Health Organization. Soc Psychiatry Psychiatr Epidemiol 31(2):55–69

    PubMed  CAS  Google Scholar 

  30. Andreason NC (1984) Scale for the assessment of negative symptoms/scale for the assessment of positive symptoms. University of Iowa Press, Iowa City

    Google Scholar 

  31. Jones SH et al (1995) A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 166(5):654–659

    PubMed  CAS  Google Scholar 

  32. Keller MB et al (1987) The longitudinal interval follow-up evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 44(6):540–548

    PubMed  CAS  Google Scholar 

  33. Birmaher B, Axelson D (2006) Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literature. Dev Psychopathol 18(4):1023–1035

    PubMed  Google Scholar 

  34. Ojserkis R et al (2017) The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD. Psychiatry Res 258:78–82

    PubMed  PubMed Central  Google Scholar 

  35. Kebede D et al (2019) The 10-year functional outcome of schizophrenia in Butajira, Ethiopia. Heliyon 5(3):e01272

    PubMed  PubMed Central  Google Scholar 

  36. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  PubMed Central  CAS  Google Scholar 

  37. Pai S, Kapur RL (1981) The burden on the family of a psychiatric patient: development of an interview schedule. Br J Psychiatry 138:332–335

    PubMed  CAS  Google Scholar 

  38. Ohaeri JU (1993) Long-term outcome of treated schizophrenia in a Nigerian cohort. Retrospective analysis of 7-year follow-ups. J Nerv Ment Dis 181(8):514–516

    PubMed  CAS  Google Scholar 

  39. Jaaskelainen E et al (2013) A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull 39(6):1296–1306

    PubMed  Google Scholar 

  40. Shibre T et al (2001) Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol 36(6):299–303

    PubMed  CAS  Google Scholar 

  41. Thara R, Kamath S (2015) Women and schizophrenia. Indian J Psychiatry 57(Suppl 2):S246–S251

    PubMed  PubMed Central  CAS  Google Scholar 

  42. Ran M et al (2001) Natural course of schizophrenia: 2-year follow-up study in a rural Chinese community. Br J Psychiatry 178:154–158

    PubMed  CAS  Google Scholar 

  43. Morgan C et al (2015) Searching for psychosis: INTREPID (1): systems for detecting untreated and first-episode cases of psychosis in diverse settings. Soc Psychiatry Psychiatr Epidemiol 50(6):879–893

    PubMed  PubMed Central  Google Scholar 

  44. Hanlon C et al (2016) Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial. Trials 17:76

    PubMed  PubMed Central  Google Scholar 

  45. Lund C et al (2015) Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM. Epidemiol Psychiatr Sci 24(3):233–240

    PubMed  PubMed Central  CAS  Google Scholar 

  46. Mugisha J et al (2017) Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis. Int J Ment Health Syst 11:7

    PubMed  PubMed Central  Google Scholar 

  47. Mayston R et al (2016) Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia. Health Policy Plan 31(3):367–376

    PubMed  Google Scholar 

  48. Padmanathan P, De Silva MJ (2013) The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med 97:82–86

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

    Rosie Mayston & Charlotte Hanlon

  2. Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Derege Kebede

  3. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Abebaw Fekadu

  4. Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Abebaw Fekadu, Charlotte Hanlon & Atalay Alem

  5. Department of Global Health & Infection, Brighton & Sussex Medical School, Brighton, UK

    Abebaw Fekadu

  6. Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia

    Girmay Medhin

  7. Department of Psychiatry, Horizon Health Network, Fredericton, NB, Canada

    Teshome Shibre

Authors
  1. Rosie Mayston
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Derege Kebede
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abebaw Fekadu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Girmay Medhin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charlotte Hanlon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atalay Alem
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Teshome Shibre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Teshome Shibre.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 55, 1581–1591 (2020). https://doi.org/10.1007/s00127-020-01865-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01865-1

Keywords

Search

Navigation