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Sex Differences in Emotional Reactivity to Daily Life Stress in Psychosis

J Clin Psychiatry 2004;65(6):805-809

Background: The expression of schizophrenia has been reported to differ between the sexes. The current study investigates whether these sex differences in clinical expression are reflected in one underlying mechanism that may be causally related to psychosis, namely increases in stress sensitivity in daily life.

Method: Forty-two participants (22 men, 20 women) with Research Diagnostic Criteria-defined psychotic disorder in a state of clinical remission were studied with the Experience Sampling Method (a structured diary technique assessing current context and mood in daily life) to assess (1) appraised subjective stress related to daily events and activities and (2) emotional reactivity conceptualized as changes in both negative affect and positive affect in relation to the subjective stress. Data were collected from January 1997 to May 1999.

Results: Multilevel regression analyses revealed that women reported a significantly (p < .05) increased emotional reactivity to daily life stress compared with men, reflected in both an increase in negative affect and a decrease in positive affect.

Conclusion: These results suggest that gender differences may not be limited to the characteristics of psychosis but may also be reflected in underlying etiologic mechanisms. Furthermore, these results might strengthen the hypothesis that women are more susceptible than men to a schizoaffective expression of schizophrenia.