Gender differences in involuntary schizophrenia inpatients

By Eleanor McDermid, Senior medwireNews Reporter

The clinical characteristics of men and women who are involuntarily hospitalized for schizophrenia treatment differ from each other, leading to different management approaches, research shows.

“A number of our findings have implications for the education of hospital staff,” write Alexander Nawka (Charles University, Prague, Czech Republic) and co-workers in BMC Psychiatry.

Chief among these is that aggression was more frequent among women than men, at 79.6% versus 71.7%, although men were more likely to display specific types of severe aggression, such as verbal aggression and aggression against property.

The team notes that average scores on the Modified Overt Aggression Scale (MOAS) did not differ significantly between men and women. Differences only emerged when scores were split into less intense behavior (MOAS 1–7), which was more frequent among women than men, at 50.2% versus 40.2%, and intense aggressive behavior (MOAS ≥8), for which the reverse was true, at 29.0% versus 28.5%.

The study included 291 men and 231 women who were involuntarily admitted to 13 hospitals in 12 European countries, and managed according to local practice.

Social functioning, as measured on the Global Assessment of Functioning scale, was significantly worse in women than men (26.2 vs 30.5 points), which the researchers note is the reverse of the usual situation among schizophrenia outpatients.

Despite the frequency of aggressive behavior and poor social functioning among the female inpatients, relative to the men, management measures for women tended to be less intense. Women were more likely than men to receive forced medication, at 87.9% versus 74.9%, but were less often physically restrained, at 45.5% versus 66.3%, or placed in seclusion, at 2.6% versus 17.2%.

“It is possible that this may be due to less serious aggressive actions by men triggering the application of coercive measures, as aggressive behavior by men is perceived as more threatening than the same behavior expressed by women,” suggest Nawka et al.

But they cite findings showing “an equal likelihood of injuries to staff members being caused by violent female patients as by violent male patients and thus signs of an elevated risk of violence should not be ignored on the basis of gender.”

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