Download Undergraduate Category: Health Sciences Psychology Abstract ID #1107

Undergraduate
Category: Health Sciences
Psychology
Abstract ID #1107
Gender, Culture, & Schizophrenia: Sociocultural Influences on the Presentation & Experience of Psychosis
Kelsey Johnson1, Lindsey Parnarouskis1, Christina Borba1, 2, Claire E. Oppenheim2
1Massachusetts
General Hospital, The Chester M. Pierce, MD Division of Global Psychiatry, Boston, MA, 2 Department of Psychiatry, Boston Medical Center, Boston, MA
Abstract
Results (cont.)
Participant Demographics
Objective
Many medical disorders present differently in women and men, for reasons that
are both biological and cultural. Schizophrenia has been widely acknowledged to
present equally across genders, with negligible differences in the lifetime
prevalence of the disorder. However, this does not mean that schizophrenia is
exempt of gender differences. Sociocultural disparities for gender and racial
minorities have a drastic influence on psychosis. This study sought to examine
the ways each participant’s gender and culture impacted their experiences with
mental illness.
Methods
In-depth qualitative interviews were conducted with 20 participants diagnosed
with schizophrenia or schizoaffective disorder. All interviews were transcribed
verbatim and are currently undergoing qualitative thematic analysis
Results
Of the 20 participants in this study, 50% identified as male, 45% identified as
female, and 5% identified as transgender. In our preliminary findings, women
and racial minorities were more likely to experience abuse in their lifetimes.
These populations were subsequently more likely to develop psychotic
symptoms following adverse life events. Many participants reported a
diminished adherence to gender roles due to their disorder, resulting from
reduced financial stability in men and heightened social inhibition in women. In
addition, women and racial minorities reported higher levels of comfort when
treated by a doctor of their same gender or cultural background.
Conclusion
Gender and cultural minorities show clear differences in their presentation and
experience of schizophrenia. Culturally relevant interventions are imperative
to increasing both the efficacy and accessibility of psychiatric care, and must
be integrated to improve quality of treatment for minority populations.
The Destruction of Gender Roles
Total Participants
Across all cultures represented in this study, one point showed near-universal
agreement: schizophrenia makes it difficult to uphold traditional gender
roles. While this may seem straightforward, the dynamics at work behind this
statement are fairly complex
N (%)
Gender
Male
Female
Transgender
10 (50%)
9 (45%)
1 (5%)
Race
White/Caucasian
Black/African
Asian
Multiracial
9 (45%)
6 (30%)
4 (20%)
1 (5%)
Religious Views
No Preference/Agnostic
Catholic
Protestant/Baptist
Christian
Jewish
Other
6 (30%)
4 (20%)
3 (15%)
3 (15%)
2 (10%)
2 (10%)
Abuse Victims
1.) What does it mean to be a “good man/woman” in society?
2.) Do you feel that schizophrenia has affected your ability to be a good
man/woman?
3.) How do other men/women you know who have schizophrenia act?
Previously or
Currently Homeless
Marital Status
Single
Married
Divorced
Men
Women
v
17 (85%)
1 (5%)
1 (5%)
Psychiatric Diagnosis
Schizophrenia
15 (75%)
Schizoaffective Disorder
4 (20%)
Not sure
1 (5%)
Cultures vary slightly in their expectations for men and women, leading to clear
gender and cultural differences in the presentation of symptoms. As a result,
different symptoms of psychosis have stronger effects on certain groups
due to the nature of their social standing. The examples here were discussed
in response to the following three questions:
Born Outside of U.S.
Demographic Icons
(See Quotes)
Introduction
Downstream Effects of Gender & Culture
Today, schizophrenia is widely believed to be caused by a genetic sensitivity to
environmental triggers that leads to a rise in psychotic symptoms. Because
gender and culture are a large part of this experience, minority groups often
present differently with psychotic symptoms and have vastly different
experiences before and after being diagnosed with a mental illness.
Our research seeks to understand the intricacies of these experiences, compiling
stories from patients of various genders and cultural backgrounds to answer a
looming question in psychosocial research: How can a person’s gender and
culture directly impact their experiences with mental illness?
Results
Triggers vs. Innate Symptoms
Gender Makeup of Abuse Victims
Gender Differences
While the prevalence of schizophrenia is equal for
men and women, the experience of the disorder is
different on several levels. The most notable of these
differences is the age of onset for the disorder, seen
here. The average age of onset for schizophrenia is
18 in men and 25 in women. (Sham 1994)
To understand how gender and culture
affect the onset of schizophrenia, it is
important to understand the course of
each participant’s illness in the context
of their experiences.
In our preliminary findings, male gender roles are more likely to be affected
by a man’s inability to work and support a family. In contrast, female
gender roles are more likely to be affected by social deficits, which lessen
women’s ability to socialize and sustain romantic relationships.
The graph here shows a breakdown of
abuse victims by gender. In this study,
women and gender minorities were
significantly more likely to be
victims of violence, either at the hands
of their families or romantic partners.
Conclusion
When discussing their initial
experiences with schizophrenia, two
distinct groups formed:
According to Yale University Medical School, earlier
diagnoses of psychotic disorders are directly linked
to better rates of recovery. As women show notably higher rates of diagnosis
after the age of 30, it must be called into question whether our insufficient
understanding of gender differences in the presentation of psychosis contributes
to poorer health outcomes for women and gender minorities.
v
Less than 170
170-185
185-200
200-215
215-230
230-245
245-260
260-275
275-290
290-305
305-320
More than 320
With respect to cultural differences, discrimination has been shown to increase
an individual’s risk of developing schizophrenia. With the current racial
tensions in the US alone, it is clear that adversity and persecution are a direct
cause of long-term stress, which has been shown to further the dysregulation of
dopamine in cases of psychosis. (Schizophrenia Research Forum 2009)
Research Methods
In this study, in-depth qualitative interviews were conducted with
20 participants diagnosed with either schizophrenia or
schizoaffective disorder.
During these interviews, information was collected on self-reported
demographics and basic life experiences, with a focus on the ways
these experiences interacted with the participant’s mental illness.
General topics discussed during these interviews include:
o
o
o
o
Course of Illness & Symptoms
History of Treatment
Gender Roles
Influence of Gender on Illness
o
o
o
o
Cultural Expectations
Religious Background
Familial Involvement
Social Relationships
All interviews were transcribed verbatim and are currently
undergoing a qualitative thematic analysis.
Gender and culture must be considered in the creation of culturallyrelevant psychosocial interventions to improve both the accessibility and
efficacy of care for schizophrenia. From trends we have seen in our data:
Women and cultural minorities may be more comfortable during
treatment if their doctor shares their gender or cultural background.
Schizophrenia has been observed in all cultures around the world, with a base
diagnostic prevalence of 1% worldwide. However, the incidence of schizophrenia
is notably higher in racial and ethnic minorities. In the US alone, AfricanAmericans are 2-3 times more likely to be diagnosed with schizophrenia.
(Bresnahan 2007)
The map pictured here shows
the global impact of schizophrenia.
This burden is measured in disability
adjusted life years (DALYs), as reported
in a 2004 WHO study. In low- and
middle-income countries, schizophrenia
is the 6th leading cause of years lived with disability. (WHO 2004)
Even in our preliminary analysis of this research, one point is clear: not all
cases of schizophrenia are created equal. As this disease is so heavily tied
to personal experiences, it is clear that sociocultural factors play a large
role in the development, presentation, and experience of psychosis.
Increased lifetime adversity for gender and cultural minorities
increases their risk of developing schizophrenia through trauma.
Cultural Differences
DALYs for schizophrenia per 100,000 inhabitants
Implications for Treatment
Traditional gender roles can be a source of stress for those with
psychosis, who often feel unable to fulfill these roles.
v
In our preliminary findings, it appears that gender and cultural minorities
are more likely to develop symptoms of psychosis following an adverse
life event, or “trigger”. Regarding the importance of this distinction, one
participant noted:
Psychiatrist Preference
Several participants mentioned
feeling more comfortable
around a certain psychiatrist
because they shared the same
race, gender, or cultural
background.
Psychiatrist preference may
relate directly to the
effectiveness of treatment, as
participants discussed ways in
which this comfort level
led to better psychiatric care.
However, Caucasian male
participants did not voice the
same preference, and several
reported feeling entirely
comfortable speaking to a
female psychiatrist.
All names discussed by participants were replaced with aliases to protect the participants’ confidentiality.
These are just some of the many sociocultural factors psychiatrists must
address to improve the quality of care for all demographic groups
diagnosed with schizophrenia.
Next Steps
As we continue our analysis of this information, we hope to elaborate on
these themes and provide further evidence of the sociocultural influences
at work in schizophrenia.
By giving a voice to minority groups living with mental illness, we can
learn from their experiences and improve psychiatric care for future
generations. We hope that this research will shed light on the various paths to
be taken towards more cohesive, patient-centered care. As the field of
psychiatry advances in future years, gender and culture must be accounted
for to treat underserved populations with the respect and responsiveness
that all patients deserve.
References
1. Bresnahan M, Begg MD, Brown A, Schaefer C, Sohler N, Insel B, Vella L, Susser
E. Race and risk of schizophrenia in a US birth cohort: another example of health
disparity? Int. J. Epidemiol. (2007); 36 (4): 751-758. doi:10.1093/ije/dym041
2. Early Diagnosis & Treatment is Important in Schizophrenia. Schizophrenia.com.
February 26, 2004. Retrieved March 11, 2016.
3. March D, Kirkbride J, Veling W. The Role of the Social Environment in
Psychiatric Research: Outstanding Challenges and Future Directions.
Schizophrenia Research Forum. March 5, 2009. Accessed February 1, 2006.
v
4. Sham PC, MacLean CJ, Kendler KS. A typological model of schizophrenia based
on age at onset, sex and familial morbidity. Acta Psychiatr Scand. 1994; 89:135–
41. doi: 10.1111/j.1600-0447.1994.tb01501.x.
5. World Health Organization (WHO). Age-standardized DALYs per 100,000 by
cause, and Member State, 2004; 2004. Retrieved March 11, 2016.