Abstract
Using three different schizophrenic populations from Northern
Finland, gender differences in some sociodemographic variables,
age at onset, incidence, treatment, outcome and deinstitutionalization
of schizophrenia were examined. The first study population comprises
the Northern Finland 1966 Birth Cohort, which is an unselected,
general population birth cohort. We followed prospectively 11017 subjects
from 16 to 28 years of age by means of the Finnish Hospital Discharge
Register. From this study population gender differences at the age
of onset and incidence of schizophrenia were calculated. The second
study population was formed of 1525 patients who had their first
treatment episodes at the closed therapeutic community ward situated
at the Department of Psychiatry, University of Oulu during 1977
- 1993. Gender differences were assessed in relation to age at first admission,
some sociodemographic variables, degree of active participation
of the patients in individual, group, and milieu therapy and institutional
outcome of the patients with schizophrenia. The third study population
consisted of all the 253 long-stay psychiatric inpatients treated
for at least six months without a break during 1992 in the Department
of Psychiatry, Oulu University Hospital. From this study population
gender differences at the age of onset and in relation to some sociodemographic
and clinical variables were studied. The placements after the last
discharge and at the end of the follow-up and factors predicting
hospitalization after the follow-up were also monitored.
There were no statistically significant gender differences
regarding age at onset in any of these three different study populations.
The time lag between the first psychotic symptoms and the first psychiatric
hospitalization was minimal. In the Northern Finland 1966 Birth
Cohort study the annual incidence rate of DSM-III-R schizophrenia
was relatively high, 7.9 per 10 000 in men and 4.4 in women by the
age of 28. In men it was highest in the age group of the 20-24 year-olds
while in women the peak occurred earlier in the age group of the
16-19 year-olds.
In the Therapeutic community study there were no statistically
significant gender differences in the sociodemographic variables,
in the length of stay and in the number of treatment episodes in
this ward in any of the diagnostic groups. Differences with regard
to male and female participation in individual, group and milieu
therapy and the institutional outcome were minimal, some trends, however,
favoring females.
In the long-stay patients study almost two-thirds of these
patients were men. Very few gender differences were found in relation
to sociodemographic and clinical characteristics or regarding the utilization
of psychiatric hospital care.
About 70% of the long-stay patients were discharged
during the four year follow-up period and only 15% were
able to live without continuous support. Marital status (being not
married), dwelling place (living in city), absence of negative symptoms
and severity of the illness were associated with hospitalization
at the end of the follow-up. Gender did not predict hospitalization
at the end of the follow-up period.
The results of this study indicate that there are probably
different subgroups of schizophrenia in which there are no gender
differences regarding age at onset and in the clinical picture of
the disturbance or there are regional differences in the manifestation
of the illness. In Finland patients are hospitalized earlier after
the onset of the first psychotic symptoms than in many other countries. According
to the Northern Finland 1966 Birth Cohort study the incidence of
schizophrenia is higher among young men than women and the total
life-time incidence of schizophrenia may be smaller in women. The
results from the Therapeutic community study suggest that therapeutic
community treatment may level out the gender differences in the
treatment process and outcome. The long-stay patient study showed
that long-term patients are dependent on considerable support and
that the most seriously ill patients are in fact in hospital. Alternative
residential facilities have been a presupposition to the deinstitutionalization
of the long-stay patients.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-5655-7 |
| Date | 12 May 2000 |
| Creators | Räsänen, S. (Sami) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2000 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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