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

Sex differences have been identified in young adults along the psychosis continuum, but studies in children and adolescents are scarce. This study aimed to evaluate possible sex differences in clinical characteristics and outcomes in children and adolescents with clinical high risk for psychosis (CHR).

A naturalistic longitudinal cohort study assessed sociodemographics, CHR symptoms, functioning, and mood at baseline and at 18 months' follow-up in 221 CHR participants (154 females and 67 males) and 159 controls (93 females and 66 males). Regression analyses were performed to test baseline differences, and multinominal regression was used to test the implication of sex in outcome.

Despite initial pairwise differences in attenuated positive symptoms, regression analyses failed to show sex differences in CHR symptoms when control group was added to the analyses. The interaction between sex and group significantly predicted depressive symptoms (B = -2.907, p = .040, 95% CI: [-5.681, -0.133]) and caffeine use lifetime (OR = 0.36, 95% CI: [0.138, 0.924], p = .034). A significant interaction between age and sex showed that the older the age in females, the greater the probability of non-remission of CHR at follow-up, as compared to males (B = 0.338, IC 95%: [0.123, 0.933], p = .036), but no relevant associations with sex were found in psychosis outcome.

No sex-related differences in CHR symptoms were observed in a CHR children and adolescent population. Outcomes related to non-remission of CHR state in older females could reflect the greater prevalence of psychosis-like experiences in adolescent females. These results invite us to reconsider the usefulness of the current CHR criteria in young populations, especially if we do not take into account a gender perspective and how age might affect it.