LAUSR

Abstract Background The need for mental health care services is particularly high in low and middle income countries (LMICs) where socio-economic factors have a deep impact on treatment and management of psychosis. Lack of funds and qualified professional represent the main challenge to treatment gap leaving between 36% and 45% of people with psychosis without care for their condition thus having a huge impact at individual and societal level. Although data from epidemiological research show that prevalence of psychosis is equal between sexes, some differences in terms of needs for care might be relevant, particularly in a context that has been affected by dramatic socio-economic and cultural changes. In this study we explore in a representative sample of people with psychosis from Kosovo*, as part of a large multi-country study (EU-funded IMPULSE project), whether demographic, socio-economic and clinical differences exist between male and female patients. Methods Data on demographic, socio-economic characteristics, use of psychosocial treatment and medication was collected; general level of psychopathology and negative symptoms were assessed through the Brief Psychiatric Rating Scale, Brief Symptom Inventory and Clinical Assessment Interview for Negative Symptoms. Male and female patients were compared in terms of demographic, socio-economic and clinical characteristics using Chi-square and independent sample t- test as appropriate. Results The sample (n=103) was composed by 33 female and 70 male patients with psychosis. The two groups did not show any statistically significant difference in age, employment, level of education; however, marital status seems to differ with higher proportion of women being separated (p=0.009). No differences emerged in monthly income, while a trend of significance (p=0.079) suggested that female patients had slightly higher financial benefits than their male counterpart. While there was no difference in terms of psychiatric diagnosis, higher depressive (p=0.017) and paranoid symptoms (at trend level, p=0.054) were reported by females patients. There were no differences on antipsychotic medication. Attendance of a psychosocial treatment was higher in male than in female patients (80% vs 57.6%; p=0.017) without any difference though in the type of approach. Overall, patients who attended a psychosocial treatment had lower negative symptoms (p<0.001) compared to those who did not. Discussion Female patients with psychosis were found to have a worse clinical presentation compared to male patients, and to have a lower attendance to psychosocial treatment. Regardless of sex, psychosocial treatment seems to be associated to less negative symptomatology. More research is needed to better characterise clinical presentation of people with psychosis in LMICs and to understand whether access to mental health service, particularly psychosocial intervention, is accountable to clinical characteristics or to contextual factors, social and/or economic in nature. Offering psychosocial intervention to this clinical population could alleviate burden of the illness in this clinical population.