Gender & Culture Bias - Schizophrenia

• Schizophrenia was originally believed to have equal incidence in males and females. However, it is thought that gender bias could have masked the fact that women have a very different experience of schizophrenia than men.
• Women with schizophrenia are more likely to experience affective symptoms, such as depression and anxiety, while men are more likely to experience negative symptoms, such as social withdrawal and apathy.
• Women with schizophrenia tend to have better overall functioning and a more favourable prognosis compared to men.
• Men with schizophrenia tend to have an earlier age of onset compared to women.
• Men with schizophrenia tend to have a higher prevalence of substance abuse comorbidity compared to women.
• Women with schizophrenia tend to have a higher likelihood of having a later age of onset compared to men.
• Men with schizophrenia tend to have a higher prevalence of positive symptoms, such as hallucinations and delusions, compared to women.
• Gender bias is the tendency to ignore or exaggerate symptoms in both men and women, so that the true picture is often distorted.
• Castle et al (1993) found that the male incidence of schizophrenia was twice that of females using diagnostic criteria from DSM-IV.
• Lewine et al (1984) found that if clearer criteria was used, fewer females were diagnosed with schizophrenia, suggesting that there may have been an earlier bias towards women.
• There are clear differences in the age of onset for schizophrenia, with males showing typical symptoms around their late teens and females in the mid to late 20s.
• If women are diagnosed with schizophrenia in their late 50s it is likely to be more chronic than acute. This could be linked to the menopause and may indicate that oestrogen may protect women until the levels drop at menopause.
• Kulkarni et al (2001) found that oestradiol (from oestrogen) added into antipsychotic medication helped women more than the antipsychotic alone.
• The differences between men and women in their experience of schizophrenia have been ignored until recently. It is now clear that women respond better to the medication and have a better outcome because they are typically in relationships and have support at the onset of the disorder.
• Castle et al (1991) argue that there are gender differences in the experience of schizophrenia. Females typically have a less severe experience but are more likely to show negative symptoms. Whereas males have a more severe experience and typically describe more positive symptoms.
• The fact that there are clear differences in the age of onset for schizophrenia, and how the disorder is experienced by men and women suggest that there are problems with the validity of diagnosis.
• Angermeyer & Kuhn (1988) reviewed 50 studies of schizophrenia and found women had fewer re-hospitalisations, fewer admissions and shorter hospital stays.
• Goldstein (1988) agrees that women have a better prognosis when it comes to schizophrenia than men.
• Seeman (1986) reviewed literature from the 1980s concerning gender differences in the social outcome of people with schizophrenia. Seeman concluded that women with schizophrenia live better lives than men with schizophrenia.
• A limitation of schizophrenia diagnosis is the existence of gender bias.
• The misdiagnosis of women with schizophrenia is a gender bias and indicates that women may not be receiving the treatment they need.
• Cultural bias refers to the tendency to over diagnose members of other ethnic groups as having schizophrenia because their typical behaviours might be seen as abnormal by clinicians.
• Problems with cultural bias could be the result of communication issues in how the patient describes their symptoms and lifestyle.
• In the UK people are more likely to be diagnosed with schizophrenia if they are of African-Caribbean descent.
• Sugarman & Craufurd (1994) found that as successive generations came and settled in the UK from the Caribbean, their risk of being diagnosed with schizophrenia increased.
• Kirkbride et al (2008) contest the idea of bias because of the consistent pattern that has been found over successive generations. They conclude that migratory factors may be important.
• Whaley (2004) believes that cultural bias may affect diagnosis as each culture has a different way of expressing their symptoms, which could lead to misinterpretation by clinicians from another culture.
• The DSM 5 has a section the acknowledges there has been cultural bias in diagnosis in the past and brings attention to the understanding that different cultures describe their illnesses in different ways.
• In many cultures it is normal to claim to have heard voices or seen people who have recently died. Rack (1982) suggests that people showing this behaviour in western society are more likely to be perceived as psychotic and diagnosed with schizophrenia.
• Cochrane (1983) suggests that mothers in immigrant families to Western Europe may have caught influenza when they became pregnant, as flu is not a common illness in the Caribbean.
• Cultural bias is a limitation of schizophrenia diagnosis.
• Pinto & Jones (2008) claim that British people of African-Caribbean origin are up to 9 times as likely to receive a diagnosis of schizophrenia as white British people.