Sex differences and implications in outcome in children and adolescents at clinical high risk for psychosis

A study led by the Research in Child and Adolescent Mental Health Group of Institut de Recerca Sant Joan de Déu (IRSJD) and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) analyzes sex differences in adolescents at clinical high risk of developing psychosis. This research is part of a preventive paradigm regarding psychotic spectrum disorders, which over the past 30 years has focused on the early detection of at-risk populations.

The study included a sample of 221 adolescents at Clinical High Risk (CHR) for psychosis and 159 healthy controls, with follow-up over an 18-month period. The objective was to explore whether sex influences risk symptoms, social and occupational functioning, and substance use.

Key Findings of the Study

• No differences in psychotic symptoms: Initially, girls showed higher scores on symptoms such as suspiciousness. However, these differences disappeared when compared to the control population, suggesting these traits are common among healthy adolescents and not specific to psychosis risk.
• No differences in transition to psychosis: Although the initial at-risk sample was predominantly female (70%), there were no differences in the proportion of boys and girls who developed psychosis after 18 months.
• Higher depressive symptoms in girls: While girls exhibited higher levels of depressive symptoms, no significant differences were found in the prevalence of depressive disorders between boys and girls.
• Symptom persistence in older adolescent girls: Older girls showed a greater tendency to maintain a high-risk status over time.
• Substance use: Unlike studies in adults, boys at risk did not show higher overall substance use. However, CHR girls reported lower caffeine consumption compared to CHR boys.

As Dr. Jordina Tor, lead author of the article, researcher at the Research in Child and Adolescent Mental Health Group of the Institut de Recerca Sant Joan de Déu (IRSJD), and psychologist at the SJD Barcelona Children's Hospital (HSJD), explains:

"This study helps us better understand how sex and age may influence the evolution of risk symptoms in adolescents. It is crucial to adapt detection and intervention strategies to ensure a more precise and effective approach, avoiding both over-intervention and under-detection."

Clinical Implications

These findings highlight the importance of revising diagnostic criteria for clinical high risk of psychosis in adolescents, integrating factors such as sex and age. Professionals are advised to:

• Monitor depressive symptoms specifically in at-risk adolescent girls.
• Consider that the persistence of risk status in older girls is not always indicative of psychosis development.
• Apply gender- and sex-sensitive approaches in early intervention programs.

Why Is This Research Important?

Understanding sex-specific patterns in populations at risk for psychosis can enhance early detection, allow for more tailored support, and help prevent stigmatization or unnecessary interventions in adolescents with transient symptoms.

Read the full study in the Journal of Child Psychology and Psychiatry (JCPP)

This research was made possible thanks to the collaboration of the Carlos III Health Institute, Torrons Vicens, and the Alicia Koplowitz Foundation.