Sex and gender differences in schizophrenic psychoses

The ABC Schizophrenia Study, a large-scale epidemiological and neurobiological research project commenced in 1987, initially pursued two aims: (1) to elucidate the possible causes of the sex difference in age at first admission for schizophrenia and (2) to analyse the early course of the disorder from onset until first contact and its implications for further course and outcome. First, transnational case-register data (for Denmark and Germany) were compared, second, a population-based sample of first-episode cases of schizophrenia (n = 232) were selected and third, the results obtained were compared with data from the WHO Determinants of Outcome Study by using a systematic methodology. A consistent result was a 3-4 years higher age of onset for women by any definition of onset, which was not explainable by social variables, such as differences in the male-female societal roles. A sensitivity-reducing effect of oestrogen on central D2 receptors was identified as the underlying neurobiological mechanism in animal experiments. Applicability to humans with schizophrenia was established in a controlled clinical study. A comparison of familial and sporadic cases showed that in cases with a high genetic load, the sex difference in age of onset disappeared due to a clearly reduced age of onset in women, whereas in sporadic cases it increased. To analyse early course retrospectively, a semistructured interview, IRAOS, was developed. The early stages of the disorder were reconstructed in comparison with age- and sex-matched controls from the same population of origin. The initial signs consisted mainly of negative and affective symptoms, which accumulated exponentially until the first episode, as did the later emerging positive symptoms. Social disability appeared 2-4 years before first admission on average. In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation. In late-onset cases, decline from initially high social statuses occurred. Socially negative illness behaviour contributed to the poor social outcome of young men. Symptomatology and other proxy variables of the disorder showed stable courses and no sex differences. Further aspects tested were the sequence of onset and the influence of substance abuse on the course of schizophrenia, primary and secondary negative symptoms, structural models and symptom clusters from onset until 5 years after first admission.

Hippocampal Volumes in First-Episode Psychosis

Does personality mediate the relationship between sex and environmentalism?

BackgroundEvidence from clinical research indicates that men and women can differ in response to drug treatment. The knowledge database Janusmed Sex and Gender was developed to illuminate potential sex and gender differences in drug therapy and, therefore, achieve a better patient safety. The database contains non-commercial evidence-based information on drug substances regarding sex and gender aspects in patient treatment. Here, we describe our experiences and reflections from collecting, analyzing, and evaluating the evidence.Janusmed Sex and GenderSubstances have been systematically reviewed and classified in a standardized manner. The classification considers clinically relevant sex and gender differences based on available evidence. Mainly biological sex differences are assessed except for gender differences regarding adverse effects and compliance. Of the 400 substances included in the database, clinically relevant sex differences were found for 20%. Sex-divided data were missing for 22% and no clinically relevant differences were found for more than half of the substances (52%). We noted that pivotal clinical studies often lack sex analyses of efficacy and adverse effects, and post-hoc analyzes are performed instead. Furthermore, most pharmacokinetic analyses use weight correction, but medicines are often prescribed in standard doses. In addition, few studies have sex differences as a primary outcome and some pharmacokinetic analyses are unpublished, which may complicate the classification of evidence.ConclusionsOur work underlines the need of sex and gender analyses, and sex-divided data in drug treatment, to increase the knowledge about these aspects in drug treatment and contribute to a more individualized patient treatment.

Public health context of women's mental health research

Using 267 repeated policy questions (962 time points), we examine gender differences in policy choices and how they have changed from the 1960s to the 1980s. The average gender difference in preferences toward policies involving the use of force have consistently been moderately large. Sex differences in opinion toward other policies—regulation and public protection, “compassion” issues, traditional values—have been approximately half as large but they also warrant more attention than in the past. Our analysis suggests that the salience of issues has increased greatly for women, and as a result differences in preferences have increased in ways consistent with the interests of women and the intentions of the women's movement.

There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice. We used a scoping review methodology. Eligible studies included participants with a mean age of 60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated. A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions. Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.

As the ongoing epidemic of adult and childhood obesity grows, it puts a greater burden on individuals and the healthcare system due to increased prevalence of obesity-associated diseases. An important area that has gained much attention recently is the sex and gender difference related to obesity and associated complications. Basic science and clinical studies have now improved our understanding of obesity and have discovered adipose tissue biology to be key in metabolism. There is evidence related to the sex dichotomy in obesity in a variety of areas including adipocyte function, sex hormone effects, genetics, and metabolic inflammation leading to critical differences in adipose tissue biology. The sex and gender difference in adipose tissue is a factor that should be considered when studying an individuals' risk for obesity and metabolic dysfunction. This understanding is important for strategizing treatment and prevention measures.

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings.

We used meta-analysis to examine recent studies of sex differences in coping. Women were more likely than men to engage in most coping strategies. The strongest effects showed that women were more likely to use strategies that involved verbal expressions to others or the self—to seek emotional support, ruminate about problems, and use positive self-talk. These sex differences were consistent across studies, supporting a dispositional level hypothesis. Other sex differences were dependent on the nature of the stressor, supporting role constraint theory. We also examined whether stressor appraisal (i.e., women's tendencies to appraise stressors as more severe) accountedfor sex differences in coping. We found some support for this idea. To circumvent this issue, we provide some data on relative coping. These data demonstrate that sex differences in relative coping are more in line with our intuitions about the differences in the ways men and women cope with distress.

Based on the publication records of journal articles indexed in the Web of Science Social Sciences Citation Index, our analysis examines the underlying factors influencing the usage of ‘sex differences’ over ‘gender differences’ in Titles and Author Keywords. Our search query identified 16,362 articles published in 1971–2021 that use either of the phrases and have at least one of their Research Areas belonging to the Social Sciences. In concurrence with earlier research, we find a substantial shift towards using ‘gender’ in the 1980s. However, for records published after 1992, the Publication Year has a negligible aggregate impact on the likelihood of ‘gender’ over ‘sex’, although meaningful trend differences occur across subsets defined by article-level disciplinary associations. Using the available publication meta-data (Publication Year, Research Area, Publication Journal) as well as the results of topic modelling (LDA) on Titles and Abstracts, we implement multi-level regression modelling to demonstrate that the likelihood of referring to ‘gender’ rather than ‘sex’ is strongly influenced by article-level disciplinary associations and their topical classification. We find that Psychology articles, by far the most numerous, exhibit a lower propensity to use ‘gender’ than all the other Social Sciences, especially when collaborating with Life Sciences & Biomedicine.

The chapter reports evidence to suggest that children’s singing is characterised by both sex and gender differences. Sex differences are evidenced in the relative size of the vocal anatomy and physiology, with boys tending to have slightly larger vocal instruments compared to girls throughout childhood. Gender differences are evidenced in the ways that such sex differences are reflected in the socio-cultural shaping of children’s developing vocal behaviours over time. Girls tend to be relatively more accomplished in their singing than boys at an earlier age in Western cultures, but there are also diverse cultural examples (such as in the UK, Afghanistan and South Africa) where there are strong traditions of accomplished boys’ singing. For both sexes, highly skilled singing is more likely to be evidenced where selected children participate in an extensive programme of singing development, such as offered by the Cathedral choirs in the UK since the first millennium. Within the chapter, gender similarities and differences are illustrated by data from three longitudinal studies, one in Italy and two in England, including an ongoing evaluation of the English National Singing Programme Sing Up. In the latter study, data analyses based on the sung products of approximately 10,000 individual children indicate that those with successful experience of the programme – both girls and boys – tend to be significantly more developed in their singing competency than those outside the programme. However, gender differences persist in both groups in favour of girls, although these are mediated by age and experience. When questioned about their attitudes to singing, clear gender differences also emerged, with girls tending to be more positive than boys, although again with age as a mediating factor, with younger children of both sexes generally more positive than older children. Nevertheless, the potential benefit of appropriate educational experience in addressing these general trends is evidenced by examples of individual schools where boys are at least as successful as their female peers, and demonstrate equally positive attitudes to singing.

Two highly prevalent pulmonary diseases, lung cancer and chronic obstructive lung disease (COPD), show both sex and gender differences in their presentations and outcomes. Sex differences are defined as biological differences associated with the male vs female genotype, and gender differences are defined as behavioral or social differences that primarily arise because of gender identity. The incidence of both lung cancer and COPD has increased dramatically in women over the past 50 years, and both are associated with chronic pulmonary inflammation. Development of COPD is also a risk factor for lung cancer. In this review, the main differences in lung cancer and COPD biology observed between men and women will be summarized. Potential causative factors will be discussed, including the role of estrogen in promoting pro-growth and inflammatory phenotypes which may contribute to development of both lung cancer and COPD. Response of the innate and adaptive immune system to estrogen is a likely factor in the biology of both lung cancer and COPD. Estrogen available from synthesis by reproductive organs as well as local pulmonary estrogen synthesis may be involved in activating estrogen receptors expressed by multiple cell types in the lung. Estrogenic actions, although more pronounced in women, may also have importance in the biology of lung cancer and COPD in men. Effects of estrogen are also timing and context dependent; the multiple cell types that mediate estrogen action in the lungs may confer both positive and negative effects on disease processes.

Gender differences and disparities in all-cause and coronary heart disease mortality: Epidemiological aspects

In 2001 the Institute of Medicine of the National Academy of Sciences United States published a report, “Exploring the Biological Contributions to Human Health: Does Sex Matter?”, which addressed and highlighted the role of biological sex differences in health and disease, including especially sex differences in non-reproductive areas of the male and female. The report aroused considerable interest and comment and had a significant role in stimulating the generation of a growing body of basic and clinical research on fundamental aspects of sex differences and its role in disease susceptibility, development, and aging. Sex is the most common human polymorphism that affects health and illness through the life cycle. This perspective provides a brief overview of the importance of the critical interlinked interactions of nature (genes and sex hormones) and nurture (environment and experience) on behavior and perception. Differences in gene expression in the male and female appear in the early embryo, before differentiation of the fetal gonads into a testis or ovary, the latter a consequence of the testis-determining SRY gene on the Y chromosome (a developmental switch). Gonadal differentiation results in a striking sex difference in the fetal sex steroid milieu and the phenotypic differences in the internal and external genital tracts that follows. Recent data provide evidence that in addition to the classic brain masculinizing effects of testosterone in the fetus, XX and XY brain cells show different patterns of gene expression even before gonadal differentiation. The functional and structural significance and magnitude of these brain sex differences are uncertain. The X chromosome contains a higher number of genes that have a major role in the development of general cognitive ability. Further, we now know that estrogen formed mainly in extragonadal tissues has an important multifaceted role in boys at puberty and in men.