Women with schizophrenia in Kosovo have worse clinical presentations compared to their male counterparts: a cross-sectional study

Objective: Gender differences have been reported in schizophrenia and suggested that later onset, predominant affective symptoms and better functioning are reported in women, while there is a higher prevalence with more severe negative symptoms and a higher comorbidity for substance abuse in men. However, since the majority of data comes from high-income countries, it is almost unknown whether gender differences exist in people with schizophrenia from socially and economically diverse contexts. The objective of this study is to explore gender differences in socio-demographic and clinical characteristics in a sample of people with schizophrenia in Kosovo, a low- and middle-income country (LMIC). Materials and methods: The study included 101 patients with schizophrenia recruited from community services. Data on demographics, socio-economic characteristics, use of psychological therapy, and medication was collected through direct interviews. Clinical symptoms were assessed by using a combination of self-rated and researcher-rated measures. Gender differences were examined using chi-square test, independent sample t-tests, and univariate analysis of variance. Results: The sample was composed of 31.7% (n=32) women. Most demographic characteristics did not differ by gender, apart from marital status (a higher proportion of women were separated; p=0.010). Women presented with more depressive (p=0.010) and paranoid symptoms (p=0.011), and attended psychological therapy less frequently (50% women vs 80% men; p=0.014). For both genders, attending psychological therapy was associated with lower negative symptoms (p=0.002). Conclusion: Women with schizophrenia had worse clinical presentation compared with men, and reported lower psychological therapy attendance. More research is needed to better describe schizophrenia in LMICs, and to understand whether access to mental health services, particularly psychological therapy, is attributable to clinical or contextual factors. Offering psychological therapy to people with schizophrenia of either gender could alleviate the burden of negative symptoms.