Women did better than men in early psychosis treatment, but the gap narrowed after 10 years | Research

The takeaway

Women with first-episode psychosis showed better recovery rates than men during the first 3 years of specialized treatment (50% vs 31%), but after 10 years, the difference was no longer statistically significant, possibly because specialized care had ended.

Psychiatrists, early intervention program designers, and psychosis researchers.

50% vs 31% recovery during specialized care; gap narrowed at 10 years

What the researchers found

At first contact, women were older at onset, had higher premorbid adjustment and IQ, were more often employed and living independently. During the first 3 years in specialized early intervention services (EIS), women had higher recovery rates (50% vs 30.8%) and responded better to lower antipsychotic doses. After 10 years (following discharge from EIS to community services), women only maintained an advantage in negative symptoms; recovery rates no longer differed significantly (46.7% vs 34.4%). Antipsychotic doses increased after EIS discharge. Cannabis use remained more common among men at all time points.

Why it matters

The narrowing of the sex gap after specialized care ends raises questions about whether longer-duration EIS programs could maintain women's early advantage.

The numbers in context

209 patients (95 females, 114 males). 3-year recovery: 50% women vs 30.8% men. 10-year recovery: 46.7% women vs 34.4% men (not significant). Cannabis use more common in men at all time points. Antipsychotic doses increased after EIS discharge.

How the study worked

Longitudinal cohort of 209 first-episode psychosis patients (95 females, 114 males) reassessed 8-16 years after initial contact with the PAFIP early intervention program in Spain.

What this study cannot tell us

Single EIS program. Some attrition over 10 years. Observational design. Cannabis use differences may contribute to sex differences beyond biological factors.

How to read the evidence

Long-term longitudinal cohort from a well-established EIS program, though single-site and observational.

When this study was published

2020 study with 8-16 year follow-up.

The bigger picture

This study suggests that the well-known female advantage in psychosis outcomes may partly reflect the benefit of specialized, lower-dose treatment rather than an inherent biological advantage that persists indefinitely.

Questions still open

Would longer EIS involvement maintain women's recovery advantage? Is the increase in antipsychotic doses after EIS discharge clinically justified or reflects less individualized care?

Common questions

Do women recover from psychosis better than men?

In this study, women had higher recovery rates during the first 3 years of specialized care (50% vs 31%), but after 10 years the difference was no longer significant, possibly because specialized treatment had ended.

Does cannabis affect psychosis outcomes differently by sex?

Cannabis use was more common among men at all time points (first contact, 3 years, and 10 years), which may contribute to their lower recovery rates.

Read the original research

Understanding sex differences in long-term outcomes after a first episode of psychosis.

NPJ schizophrenia, 6(1), 33

View on PubMed ↗Publisher’s paper ↗

Citation

Ayesa-Arriola, Rosa; de la Foz, Víctor Ortíz-García; Setién-Suero, Esther; Ramírez-Bonilla, María Luz; Suárez-Pinilla, Paula; Son, Jacqueline Mayoral-van; Vázquez-Bourgon, Javier; Juncal-Ruiz, María; Gómez-Revuelta, Marcos; Tordesillas-Gutiérrez, Diana; Crespo-Facorro, Benedicto. (2020). Understanding sex differences in long-term outcomes after a first episode of psychosis.. NPJ schizophrenia, 6(1), 33. https://doi.org/10.1038/s41537-020-00120-5