Sex Differences in the Risk of Schizophrenia: Evidence From Meta-analysis

Aleman, André; Kahn, René S.; Selten, Jean-Paul

doi:10.1001/archpsyc.60.6.565

Cited by 818Schizophrenia research and treatmentMental Health and PsychiatryPsychopathy, Forensic Psychiatry, Sexual Offending

Sex Differences in the Risk of Schizophrenia: Evidence From Meta-analysis

Aleman, André, Kahn, René S., Selten, Jean-Paul·2003·Archives of General Psychiatry

DOI 10.1001/archpsyc.60.6.565

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Abstract

BACKGROUND: Sex differences in the risk of a particular disorder can yield important clues regarding its pathogenesis. The evidence for a sex difference in the risk of schizophrenia is inconclusive. The purpose of this study was to integrate results from the published literature and to provide a quantitative index of the male-female ratio for the incidence of schizophrenia. METHODS: The MEDLINE and PsychLIT databases were searched for English-language publications on "incidence and schizophrenia" that appeared during the period between January 1980 and September 2001. Population-based incidence studies using standard clinical diagnostic criteria were included if they reported sex-specific incidence rates. Sex-specific incidence figures were extracted directly from each study. Categorical analyses were conducted on a subset of studies that met specific methodological criteria (to minimize criterion bias, hospital bias, and age bias). Study categorization and data extraction were performed independently by 2 of us (A. A. and J.-P.S.). RESULTS: Log risk ratio meta-analysis was conducted using a random-effects model. The incidence risk ratios for men to develop schizophrenia relative to women were 1.42 (95% confidence interval [CI], 1.30-1.56) when all studies were included in the analysis (49 effect sizes), 1.31 (95% CI, 1.13-1.51) when studies that minimized selection biases were analyzed separately (23 effect sizes), and 1.39 (95% CI, 1.15-1.68) when only high-quality studies were included (11 effect sizes). The sex difference was significantly smaller in studies with sample years before 1980 than those with sample years after 1980. No significant sex differences were reported in studies from developing countries. A final analysis, limited to studies with an age cutoff of 64 years or older (16 effect sizes), yielded a mean risk ratio of 1.32 (95% CI, 1.13-1.55). CONCLUSION: This meta-analysis provides evidence for a sex difference in the risk of developing schizophrenia, as reported in the published literature from the last 2 decades.

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Many neurodevelopmental disorders also exhibit robust sex differences in diagnosis and symptomology.
“many of which also exhibit robust sex differences in diagnosis and symptomology (Aleman et al., 2003; Ramtekkar et al., 2010; Arnett et al., 2015; Halladay et al., 2015; Giordano et al., 2021; Prosperi et al., 2021).”
From Social play experience in juvenile rats is indispensable for appropriate socio-sexual behavior in adulthood in males but not females (2023) · cites this paper as Aleman et al., 2003
Males are more likely to develop schizophrenia than females (median male:female risk ratio = 1.4).
“(a) males were more likely to develop schizophrenia than females (median male:female risk ratio = 1.4);”
From A Systematic Review of the Prevalence of Schizophrenia (2005) · cites this paper as [23]

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Authors: Aleman, A., Kahn, R. S., & Selten, J.-P.
Affiliations: University Medical Center Utrecht (NL)
ORCID: Aleman, André
Kahn, René S.
Selten, Jean-Paul
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 2003-06-01
Volume: 60
Issue: 6
Pages: 565
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archpsyc.60.6.565
OpenAlex: W1996254896
Cited by: 818
References: 70
Citations by year: 2026: 28 · 2025: 28 · 2024: 49 · 2023: 34 · 2022: 32 · 2021: 38 · 2020: 51 · 2019: 40 · 2018: 53 · 2017: 34 · 2016: 44 · 2015: 37 · 2014: 40 · 2013: 35 · 2012: 42
FWCI: 13.10
Type: journal article
Language: en
Open access: closed
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords: schizophrenia, sex differences, incidence, schizophrenia pathogenesis, selection bias, older adults
MeSH terms: Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Risk Factors, Schizophrenia, Sex Factors, Incidence, Confidence Intervals, Odds Ratio, Sex Distribution

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Sex Differences in the Risk of Schizophrenia: Evidence From Meta-analysis

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