Goldstein (1988)

To see if there is any significant different in the age of onset of schizophrenia between the two sexes, and to see if women have a less severe course of the disorder than men.

• 199 women and men.
• In the 1970s they had all been diagnosed with schizophrenia on admittance and on discharge from psychioatric hospticals, where they had stayed for less than 6 months.
• All were aged between 18 and 45 years.
• None of them had any organic brain disorder such as epilepsy, and none had any drug problem, including alcohol abuse.
• They were re-diagnosed 10 years later using the revised version of DSM.
• Of the original 199 patients, 169 were re-diagnosed with schizophrenia using he revised version.
• 30 were deemed not to be schizophrenic according to therevised version of DSM 9i.e. they had been misdiagnosed).
• Of the 169 who were re-diagnosed, 52 were first-time admissions and 38 had had only one previous hospitalisation in the 1970s.
• The remainder were the patients studied by Goldstein.
• How well the patients could fundtion in everyday life was measured by looking at marital status, occupational status, peer relationships, isolation and interests.
• The course and severity of the illness was measured by looking at the number of times the patients had been in hospital, and how long the hospital stays had been over a 10-year period.

• The researchers found that schizophrenic women had a significantly lower number of re-hospitalisations, and that they had shorter stays in hospital over the 10-year period.
• The difference in gender was even stronger when looking at a five-year period, possibly because the severity of schizophrenia doesn't worsen after five-years.
• Differences in premorbid functioning, such as isolation, peer relationships and interests, affected re-hospitalisations.
• Social functioning, such as marital and occupational status, affected the length of stays.

Gender differences in the course of schizophrenia are present in the early stages of the disorder, with poorer premorbid funstioning in men being responsible for a poorer outcome.

Whilst this was a longitudinal study, it didn't suffer from the problem of participats dropping out, as data on their functioning was collected at the start of the stay, and data about their hospitalisation was obtained from the New York State Department of Mental Health.

The men and women were well matched terms of marital status, age, education, religion and socio-economic status.

Two experts who didn't know the aim of the study tested the reliability of the re-diagnosis; there was an inter-rater reliability rate of 80%, showing that there was good reliability.

The sample size was 169, as they added people who had previously had one hospital stay before the start of the study to increase the sample so that it was more generalisable to all schizophrenics.

Other studies support the findings of this study. Gitterlman-Klein and Klein (1969) found that men tend to have poorer premorbid histories than women, and Huber et al. (1980) found that those with a poorer premorbid history had a poorer outcome when it came to schizophrenia. Angermeyer et al. (1987) carried put a larger replication of this study and found the same results. This increases the reliability of Goldstein's study.

The data is objective and unbiased in terms of the number of hospital stays and length of the stays, as it came from an outside agency that accurately recorded these details.

Whilst the men and women were matched for employment status, the type of employment varied. The women mostely had clerical or sales jobs or were housewives, whilst the ment had more blue collar jobs.

There are problems with generalising the results, as all the participants returned to their families after hospitalisation. The same results may not be true for schizophrenics who don't return to their families. However, all these patients were in the early stages, and it has been found that most early-stage schizophrenics do rely on family help after hospitalisation, so this may in fact be representative.

Another problem with the sample is that the age limit was 45 years. 9% of schizophrenic women have their first schizophrenic episode after 45 and have more paranoia, whilst very few men do, so this may have biased the sample in favour of finding the gender differences. However, in the current version of DSM, people must be under 45 to be diagnosed with schizophrenia, as those over 45 would be diagnosed with a different disorder.

If you argue that DSM is not a valid measurement of mental illness, this brings into question the validity of the diagnosis of schizophrenia.