The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort
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ORIGINAL PAPER
The effect of gender on the long‑term course and outcome of schizophrenia in rural Ethiopia: a population‑based cohort Rosie Mayston1 · Derege Kebede2 · Abebaw Fekadu3,4,5 · Girmay Medhin6 · Charlotte Hanlon1,4 · Atalay Alem4 · Teshome Shibre7 Received: 24 January 2019 / Accepted: 25 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Schizophrenia · Gender · Course · Outcome · Butajira-cohort
Introduction Findings across a range of different outcomes are broadly consistent with a more positive course and outcome of illness for women living with schizophrenia compared to men diagnosed with the disorder [1, 2]. There is some heterogeneity in results and this is sometimes attributed to t
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