Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Anderson, Kelly K.

Abstract

Psychotic disorders can be variable in clinical presentation, and there may be differences by sex. The objective of this thesis was to explore sex differences in the clinical presentation of early psychosis in the context of primary care. Our systematic review and meta-analysis found that men experienced more negative symptoms and had a higher prevalence of substance use issues, whereas women experienced more depressive symptoms and had higher functioning. Our electronic medical record analysis from primary care found that positive symptoms and substance use were less prevalent in the medical records of women. We also found that visits by women were more likely to be assigned a diagnosis of depression or anxiety, personality disorder, psychological distress, and other mental or behavioural disorders, and less likely to be assigned a diagnosis of substance use. Further research is needed to better understand sex differences in clinical presentation in the primary care context.

Summary for Lay Audience

Psychotic disorders are a group of severe mental illnesses that vary in clinical presentation, which can include behaviours, symptoms, and course of illness. Psychosis is characterized by impaired cognition or perception, which may present as positive symptoms (i.e., hallucinations, delusions), negative symptoms (i.e., reduction in language, motivation, pleasure), disorganized thoughts and behaviour, and impairments in functioning. It is well- established that early intervention for psychotic disorders can help improve short- and long- term outcomes, and primary care is often the first point of contact for young people experiencing first-episode or early psychosis. Prior research indicates that men and women differ in their clinical presentation of early psychosis, but little is known about these differences as they present to primary care. Given the vital role that family physicians and primary care services play in the recognition of early psychosis, understanding how men and women present differently in these settings is important. The overall aim of this thesis was to explore sex differences in the clinical presentation of early psychosis in the context of primary care. Our first study compiled findings from 35 studies examining sex differences in symptoms of early psychosis, and found that men experienced more negative symptoms and had a higher prevalence of substance use, whereas women experienced more depressive symptoms and had higher functioning. All of the studies included in our review were from specialized mental health services, and none examined sex differences in clinical presentation from a primary care context. Our next study used health administrative data, linked with electronic medical records from primary care in Ontario from 2005-2015. We found that one year preceding the first diagnosis of psychotic disorder, positive symptoms and substance use were less prevalent in the medical records of women. We also found that visits by women were more likely to be assigned a diagnosis of depression or anxiety, personality disorder, psychological distress, and other mental or behavioural disorders, and less likely to be assigned a diagnosis of substance use. Larger studies that incorporate administrative and patient-level data are needed to better understand sex differences in the clinical presentation of early psychosis in the context of primary care.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Download

Share

COinS