Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T06:54:18.709Z Has data issue: false hasContentIssue false
  • English
  • Français

Systematic review and collaborative recalculation of 133 693 incident cases of schizophrenia

Published online by Cambridge University Press:  19 December 2012

M. van der Werf ,
M. Hanssen ,
S. Köhler ,
M. Verkaaik ,
F. R. Verhey ,
R. van Winkel ,
J. van Os ,
J. Allardyce  and
RISE Investigators
M. van der Werf*
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
M. Hanssen
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands Regional Centre for Ambulant Mental Health Maastricht, Maastricht, The Netherlands
S. Köhler
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
M. Verkaaik
Affiliation:
Regional Centre for Ambulant Mental Health Maastricht, Maastricht, The Netherlands
F. R. Verhey
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
R. van Winkel
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
J. van Os*
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK
J. Allardyce
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
*
*Address for correspondence: J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (location VIJV), 6200 MD, Maastricht, The Netherlands. (Email: j.vanos@maastrichtuniversity.nl)
*Address for correspondence: J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (location VIJV), 6200 MD, Maastricht, The Netherlands. (Email: j.vanos@maastrichtuniversity.nl)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This systematic review and collaborative recalculation was set up to recalculate schizophrenia incidence rates from previously published studies by age and sex.

Method

PubMed, EMBASE and PsycINFO databases were searched (January 1950 to December 2009) for schizophrenia incidence studies. Numerator and population data were extracted by age, sex and, if possible, study period. Original data were requested from the authors to calculate age- and sex-specific incidence rates. Incidence rate ratios (IRRs) with their 95% confidence intervals (CIs) were computed by age and sex from negative binomial regression models.

Results

Forty-three independent samples met inclusion criteria, yielding 133 693 incident cases of schizophrenia for analysis. Men had a 1.15-fold (95% CI 1.00–1.31) greater risk of schizophrenia than women. In men, incidence peaked at age 20–29 years (median rate 4.15/10 000 person-years, IRR 2.61, 95% CI 1.74–3.92). In women, incidence peaked at age 20–29 (median rate 1.71/10 000 person-years, IRR 2.34, 95% CI 1.66–3.28) and 30–39 years (median rate 1.24/10 000 person-years, IRR 2.25, 95% CI 1.55–3.28). This peak was followed by an age–incidence decline up to age 60 years that was stronger in men than in women (χ2 = 57.90, p < 0.001). The relative risk of schizophrenia was greater in men up to age 39 years and this reversed to a greater relative risk in women over the age groups 50–70 years. No evidence for a second incidence peak in middle-aged women was found.

Conclusions

Robust sex differences exist in the distribution of schizophrenia risk across the age span, suggesting differential susceptibility to schizophrenia for men and women at different stages of life.

Keywords

Age at onsetage–sex interactionepidemiologyincidenceschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 9 - 16
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aleman, A, Kahn, RS, Selten, JP (2003). Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry 60, 565–571.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Kuhn, L (1988). Gender differences in age at onset of schizophrenia. An overview. European Archives of Psychiatry and Neurological Sciences 237, 351–364.Google Scholar
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III). American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised (DSM-III-R). American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Bijl, RV, de Graaf, R, Ravelli, A, Smit, F, Vollebergh, WAM (2002). Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 37, 372–379.Google Scholar
Castle, DJ, Abel, K, Takei, N, Murray, RM (1995). Gender differences in schizophrenia: hormonal effect or subtypes? Schizophrenia Bulletin 21, 1–12.Google Scholar
Castle, DJ, Wessely, S, Murray, RM (1993). Sex and schizophrenia: effects of diagnostic stringency, and associations with premorbid variables. British Journal of Psychiatry 162, 658–664.CrossRefGoogle ScholarPubMed
Clarke, M, O'Callaghan, E (2003). First-episode studies in schizophrenia. In The Epidemiology of Schizophrenia (ed. Murray, R. M., Jones, P. B., Susser, E., van Os, J. and Cannon, M. E.), pp. 148–166. Cambridge University Press: Cambridge.Google Scholar
DeLisi, LE (1992). The significance of age of onset for schizophrenia. Schizophrenia Bulletin 18, 209–215.Google Scholar
Esterberg, ML, Trotman, HD, Holtzman, C, Compton, MT, Walker, EF (2010). The impact of a family history of psychosis on age-at-onset and positive and negative symptoms of schizophrenia: a meta-analysis. Schizophrenia Research 120, 121–130.CrossRefGoogle ScholarPubMed
Gangadhar, BN, Selvan, CP, Subbakrishna, DK, Janakiramaiah, N (2002). Age-at-onset and schizophrenia: reversed gender effect. Acta Psychiatrica Scandinavica 105, 317–319.CrossRefGoogle ScholarPubMed
Häfner, H, Maurer, K, Löffler, W, Riecher-Rössler, A (1993 a). The influence of age and sex on the onset and early course of schizophrenia. British Journal of Psychiatry 162, 80–86.Google Scholar
Häfner, H, Riecher, A, Maurer, K, Löffler, W, Munk-Jørgensen, P, Strömgren, E (1989). How does gender influence age at first hospitalization for schizophrenia? A transnational case register study. Psychological Medicine 19, 903–918.CrossRefGoogle ScholarPubMed
Häfner, H, Riecher-Rössler, A, an der Heiden, W, Maurer, K, Fätkenheuer, B, Löffler, W (1993 b). Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine 23, 925–940.Google Scholar
Hambrecht, M, Maurer, K, Häfner, H, Sartorius, N (1992). Transnational stability of gender differences in schizophrenia? An analysis based on the WHO study on determinants of outcome of severe mental disorders. European Archives of Psychiatry and Clinical Neuroscience 242, 6–12.Google Scholar
Harris, MJ, Jeste, DV (1988). Late-onset schizophrenia: an overview. Schizophrenia Bulletin 14, 39–55.Google Scholar
Howard, R, Rabins, PV, Seeman, MV, Jeste, DV (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. American Journal of Psychiatry 157, 172–178.Google Scholar
Jablensky, A (2003). Schizophrenia: the epidemiological horizon. In Schizophrenia, 2nd edn (ed. Hirsch, S. R. and Weinberger, D. R.), pp. 203–231. Blackwell Science: Oxford.CrossRefGoogle ScholarPubMed
Jablensky, A, Cole, SW (1997). Is the earlier age at onset of schizophrenia in males a confounded finding? Results from a cross-cultural investigation. British Journal of Psychiatry 170, 234–240.Google Scholar
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 1–97.CrossRefGoogle ScholarPubMed
Jeste, DV, Alexopoulos, GS, Bartels, SJ, Cummings, JL, Gallo, JJ, Gottlieb, GL, Halpain, MC, Palmer, BW, Patterson, TL, Reynolds, CF 3rd, Lebowitz, BD (1999). Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Archives of General Psychiatry 56, 848–853.CrossRefGoogle ScholarPubMed
Kelly, BD, O'Callaghan, E, Waddington, JL, Feeney, L, Browne, S, Scully, PJ, Clarke, M, Quinn, JF, McTigue, O, Morgan, MG, Kinsella, A, Larkin, C (2010). Schizophrenia and the city: a review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophrenia Research 116, 75–89.CrossRefGoogle ScholarPubMed
Kirov, G, Jones, PB, Harvey, I, Lewis, SW, Toone, BK, Rifkin, L, Sham, P, Murray, RM (1996). Do obstetric complications cause the earlier age at onset in male than female schizophrenics? Schizophrenia Research 20, 117–124.CrossRefGoogle ScholarPubMed
Lebowitz, BD, Pearson, JL (2000). Intervention research in psychosis: prevention trials. Schizophrenia Bulletin 26, 543–549.Google Scholar
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.Google Scholar
Morgan, VA, Castle, DJ, Jablensky, AV (2008). Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Australian and New Zealand Journal of Psychiatry 42, 74–82.CrossRefGoogle ScholarPubMed
Murray, RM, O'Callaghan, E, Castle, DJ, Lewis, SW (1992). A neurodevelopmental approach to the classification of schizophrenia. Schizophrenia Bulletin 18, 319–332.CrossRefGoogle Scholar
Raz, S, Goldstein, R, Hopkins, TL, Lauterbach, MD, Shah, F, Porter, CL (1994). Sex differences in early vulnerability to cerebral injury and their neurodevelopmental implications. Psychobiology 22, 244–253.CrossRefGoogle Scholar
Riley, RD, Lambert, PC, Abo-Zaid, G (2010). Meta-analysis of individual participant data: rationale, conduct, and reporting. British Medical Journal 340, c221.CrossRefGoogle ScholarPubMed
Rosenfield, PJ, Kleinhaus, K, Opler, M, Perrin, M, Learned, N, Goetz, R, Stanford, A, Messinger, J, Harkavy-Friedman, J, Malaspina, D (2010). Later paternal age and sex differences in schizophrenia symptoms. Schizophrenia Research 116, 191–195.CrossRefGoogle ScholarPubMed
Seeman, MV (1996). The role of estrogen in schizophrenia. Journal of Psychiatry and Neuroscience 21, 123–127.Google ScholarPubMed
Shea, B, Dube, C, Moher, D (2007). Assessing the quality of reports for systematic reviews: the QUOROM statement compared to other tools. In Systematic Reviews in Health Care: Meta-Analysis in Context (ed. Egger, M., Smith, G. D. and Altman, D. G.), pp. 122–139. BMJ Books: London.Google Scholar
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
StataCorp (2009). STATA Statistical Software: Release 11.0. Stata Corporation: College Station, TX.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 283, 2008–2012.CrossRefGoogle ScholarPubMed
United Nations (2009). Human Development Report 2009. Overcoming Barriers: Human Mobility and Development (http://hdr.undp.org/en/media/HDR_2009_EN_Complete.pdf). United Nations Development Programme.Google Scholar
Vahia, IV, Palmer, BW, Depp, C, Fellows, I, Golshan, S, Kraemer, HC, Jeste, DV (2010). Is late-onset schizophrenia a subtype of schizophrenia? Acta Psychiatrica Scandinavica 122, 414–426.Google Scholar
Venkatesh, BK, Thirthalli, J, Naveen, MN, Kishorekumar, KV, Arunachala, U, Venkatasubramanian, G, Subbakrishna, DK, Gangadhar, BN (2008). Sex difference in age of onset of schizophrenia: findings from a community-based study in India. World Psychiatry 7, 173–176.CrossRefGoogle ScholarPubMed
Walker, EF, Lewine, RR (1993). Sampling biases in studies of gender and schizophrenia. Schizophrenia Bulletin 19, 1–7; discussion 9–14.Google Scholar
Weinberger, DR (1987). Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry 44, 660–669.CrossRefGoogle ScholarPubMed
WHO (1955). International Classification of Diseases, Seventh Revision (ICD-7). World Health Organization: Geneva, Switzerland.Google Scholar
WHO (1965). International Classification of Diseases, Eight Revision (ICD-8). World Health Organization: Geneva, Switzerland.Google Scholar
WHO (1977). International Classification of Diseases, Ninth Revision (ICD-9). World Health Organization: Geneva, Switzerland.Google Scholar
WHO (1992). International Classification of Diseases, 10th Revision (ICD-10). World Health Organization: Geneva, Switzerland.Google Scholar
World Bank (2010). World Development Indicators (2010) (http://data.worldbank.org/sites/default/files/wdi-final.pdf).Google Scholar
Supplementary material: File

Werf Supplementary Material

Appendix

Download Werf Supplementary Material(File)
File 67.4 KB