Sociodemographic and clinical predictors of response in early psychosis: a focus on gender and migration

Background

Early Psychosis Intervention Programs aim to reduce the Duration of Untreated Psychosis (DUP), improve symptom trajectories, and enhance functional recovery. However, gender and migration remain underexplored determinants of outcome. Women may face unique vulnerabilities, including caregiving burden, exposure to gender-based violence, and under-recognition of their symptoms, while migrants experience additional structural barriers, stress, and reduced access to culturally adapted care. Understanding how these factors influence treatment response is essential to tailoring early intervention strategies(1).

Methods

A retrospective cohort study was conducted including 88 patients with first-episode psychosis who were treated by the Early Intervention in Psychosis Team at Mutua Terrassa (2024). Sociodemographic, diagnostic, and clinical variables were collected at baseline and after 12 months. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS) and functioning using the Global Assessment of Functioning (GAF). Statistical analyses included Mann–Whitney U and chi-square tests. The study was approved by the Ethical Committee of the institution.

Results

The sample had a mean age of 27.8 years, with 35.2% (n=31) women and 30.7% (n=27) migrants. Among the migrants, the most common region of origin was Africa (48.1%), followed by Latin America (40.7%), Asia (7.4%), and Oceania (3.7%). Schizophrenia was the most frequent diagnosis (42%), consistent with the typical clinical profile observed in early intervention services for first-episode psychosis.

At 12 months, patients showed significant clinical and functional improvement. PANSS total scores decreased from 88.0 to 54.3 (−38.3%), while the median GAF improved from 25 to 60 (p<0.001), indicating substantial recovery in symptom severity and overall functioning.

Gender differences:

Women were significantly more likely to receive psychotherapy during follow-up compared with men (100% vs. 87.7%, p=0.042), suggesting greater engagement in psychological interventions within the program. Substance use was notably less prevalent among women (19.4% vs. 47.4%, p=0.010). In addition, affective disorders were substantially more frequent in women than in men (75% vs. 25.5%, p<0.001), supporting previous evidence of sex-related diagnostic differences in first-episode psychosis. However, no significant gender differences were observed in clinical or functional improvement, as measured by changes in PANSS and GAF scores over 12 months.

Migration differences:

• Migrants presented with greater baseline severity (PANSS median 96 vs. 80; p=0.000). • DUP was longer among migrants (3.5 vs. 2 weeks; p=0.034). • The use of long-acting injectable antipsychotics was higher among the migrants (44.4% vs. 13.1%; p=0.001).

• Psychotherapy rates were lower (77.8% vs. 98.4%; p=0.001).

Discussion

Patients demonstrated substantial clinical and functional improvement after one year, which is consistent with the expected outcomes of specialized early intervention services. Gender patterns reflect known differences in clinical presentation, comorbidities, and help-seeking behavior. In contrast, migrant patients showed greater baseline severity, a longer DUP, and reduced access to psychotherapy, which suggests structural and cultural barriers. These findings emphasize the importance of implementing gender-sensitive and culturally responsive care pathways to optimize outcomes and reduce disparities in early psychosis.

References

1 González-Rodríguez, A., Natividad, M., Paolini, J. P., Balagué, A., Román, E., Bagué, N., Izquierdo, E., Salvador, M., Vallet, A., Pérez, A., & Monreal, J. A. (2023). Incorporating evidence of migrant women with schizophrenia into a women's clinic. Women, 3(4), 32. https://doi.org/10.3390/women4040032