Gender differences on the WAIS-IV in patients with schizophrenia

Juan Carlos Ruiz, Inmaculada Fuentes, Carmen Dasi, Marisa Navarro



Introduction. Results from studies that have investigated gender differences in neuropsychological functioning in schizophrenia have been inconsistent. Differences in the illness stage, in the demographic and clinical characteristics of the samples, and the instruments used to measure cognition may have contributed to the heterogeneity in the results.

Objective. Investigate the heterogeneity in the results comparing cognitive functioning in chronically ill male and female patients with schizophrenia.

Method. Twenty-five women and twenty-five men chronically ill patients with schizophrenia matched on age, age at illness onset, and years of education were evaluated in cognitive functioning using the WAIS-IV.

Results. Men showed higher scores than women on the two global measures, on the perceptual reasoning and working memory indices, and on the information, visual puzzles, digit span, and arithmetic subtests of the WAIS-IV. Cohen’s d effect sizes were high for the two global measures and the two indices (d > .68).

Discussion and conclusion. Overall, in chronically stable patients with diagnosis of schizophrenia, women’s performance on cognitive functioning was below men’s when assessed with the WAIS-IV, except in the case of processing speed. This pattern of gender differences is similar to the pattern observed in healthy populations. Our results can help to clarify the heterogeneity in the results from studies on gender differences in cognitive functioning in schizophrenia and may be valuable in designing cognitive-targeted interventions for schizophrenia.


Cognition; intelligence; confounding factors; schizophrenia; gender differences; WAIS-IV

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Albus, M., Hubmann, W., Mohr, F., Scherer, J., Sobizack, N., Franz, U., … Wahlheim, C. (1997). Are there gender differences in neuropsychological performance in patients with first-episode schizophrenia? Schizophrenia Research, 28(1), 39-50. doi: 10.1016/S0920-9964(97)00091-1

Ayesa-Arriola, R., Rodriguez-Sanchez, J. M., Gomez-Ruiz, E., Roiz-Santiáñez, R., Reeves, L. L., & Crespo-Facorro, B. (2014). No sex differences in neuropsychological performance in first episode psychosis patients. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 48, 149-154. doi: 10.1016/j.pnpbp.2013.09.009

Bilder, R. M., Lipschutz-Broch, L., Reiter, G., Geisler S. H., Mayerhoff, D. I., & Lieberman, J. A. (1992). Intellectual deficits in first-episode schizophrenia: Evidence for progressive deterioration. Schizophrenia Bulletin, 18(3), 437-448. doi: 10.1093/schbul/18.3.437

Bozikas, V. P., Kosmidis, M. H., Peltekis, A., Giannakou, M., Nimatoudis, I., Karavatos, A., … Garyfallos, G. (2010). Sex differences in neuropsychological functioning among schizophrenia patients. Australian and New Zealand Journal of Psychiatry, 44(4), 333-341. doi: 10.3109/00048670903489833

Daseking, M., Petermann, F., & Waldmann, H.-C. (2017). Sex differences in cognitive abilities: Analyses for the German WAIS-IV. Personality and Individual Differences, 114, 145-150. doi: 10.1016/j.paid.2017.04.003

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.

Fond, G., Boyer, L., Leboyer, M., Godin, O., Llorca, P. M., Andrianarisoa, M., … Bulzacka, E. (2018). Influence of Venus and Mars in the cognitive sky of schizophrenia. Results from the first-step national FACE-SZ cohort. Schizophrenia Research, 195, 357-365. doi: 10.1016/j.schres.2017.09.027

Fuentes-Durá, I., Ruiz, J. C., Dasí, C., Navarro, M., Blasco, P., & Tomás, P. (2019). WAIS-IV Performance in Patients with Schizophrenia. The Journal of Nervous and Mental Disease, 207(6), 467-473. doi: 10.1097/NMD.0000000000000997

Goldstein, J. M., Seidman, L. J., Goodman, J. M., Koren, D., Lee, H., Weintraub, S., & Tsuang, M. T. (1998). Are there sex differences in neuropsychological functions among patients with schizophrenia? The American Journal of Psychiatry, 155(10), 1358-1364. doi: 10.1176/ajp.155.10.1358

Hoff, A. L., Wieneke, M., Faustman, W. O., Horon, R., Sakuma, M., Blankfeld, H., … DeLisi, L. E. (1998). Sex differences in neuropsychological functioning of first-episode and chronically ill schizophrenic patients. The American Journal of Psychiatry, 155(10), 1437-1439. doi: 10.1176/ajp.155.10.1437

Ittig, S., Studerus, E., Papmeyer, M., Uttinger, M., Koranyi, S., Ramyead, A. & Riecher-Rössler, A. (2015). Sex differences in cognitive functioning in at-risk mental state for psychosis, first episode psychosis and healthy controls subjects. European Psychiatry, 30(2), 242-250. doi: 10.1016/j.eurpsy.2014.11.006

Leger, M., & Neill, J. C. (2016). A systematic review comparing sex differences in cognitive function in schizophrenia and in rodent models for schizophrenia, implications for improved therapeutic strategies. Neuroscience & Biobehavioral Reviews, 68, 979-1000. doi: 10.1016/j.neubiorev.2016.06.029

Leucht, S., Samara, M., Heres, S., & Davis, J. M. (2016). Dose Equivalents for Antipsychotic Drugs: The DDD Method. Schizophrenia. Bulleting, 42(Suppl 1), S90-S94. doi: 10.1093/schbul/sbv167

Leung, A. & Chue, P. (2000). Sex differences in schizophrenia, a review of the literature. Acta Psychiatrica Scandinavica, 101(401), 3-38. doi: 10.1111/j.0065-1591.2000.0ap25.x

Lewine, R., Haden, C., Caudle, J., & Shurett, R. (1997). Sex-onset effects on neuropsychological function in schizophrenia. Schizophrenia Bulletin, 23(1), 51-61. doi: 10.1093/schbul/23.1.51

Li, A. W. Y., Hui, C. L. M., Lee, E. H. M., Chang, W. C., Chan, S. K. W., & Chen, E. Y. H. (2019). Gender differences in correlates of cognition in first-episode psychosis. Psychiatry Research, 271, 412-420. doi: 10.1016/j.psychres.2018.12.011

Longenecker, J., Dickinson, D., Weinberger, D. R., & Elvevåg, B. (2010). Cognitive differences between men and women: A comparison of patients with schizophrenia and healthy volunteers. Schizophrenia Research, 120(1-3), 234-235. doi: 10.1016/j.schres.2009.12.009

Lynn, R. (1998). Sex differences in intelligence: Data from a Scottish standardisation of the WAIS-R. Personality and Individual Differences, 24(2), 289-290. doi: 10.1016/S0191-8869(97)00165-7

Mendrek, A., & Mancini-Marïe, A. (2016). Sex/gender differences in the brain and cognition in schizophrenia. Neuroscience & Biobehavioral Reviews, 67, 57-78. doi: 10.1016/j.neubiorev.2015.10.013

Mesholam-Gately, R. I., Giuliano, A. J., Goff, K. P., Faraone, S. V., & Seidman, L. J. (2009). Neurocognition in first-episode schizophrenia: A meta-analytic review. Neuropsychology, 23(3), 315-336. doi: 10.1037/a0014708

Ochoa, S., Usall, J., Cobo, J., Labad, X., & Kulkarni, J. (2012). Gender differences in schizophrenia and first-episode psychosis: A comprehensive literature review. Schizophrenia Research and Treatment, Article ID 916198, 1-9. doi: 10.1155/2012/916198

Roder, V., & Müller, D. R. (2015). INT-Integrated Neurocognitive Therapy for Schizophrenia Patients. Springer International Publishing Switzerland.

Rodriguez-Jimenez, R., Dompablo, M., Bagney, A., Santabárbara, J., Aparicio, A. I., Torio, I., … Palomo, T. (2015). The MCCB impairment profile in a Spanish sample of patients with schizophrenia: Effects of diagnosis, age, and gender on cognitive functioning. Schizophrenia Research, 169(1-3), 116-120. doi: 10.1016/j.schres.2015.09.013

Savadjiev, P., Whitford, T. J., Hough, M. E., Clemm von Hohenberg, C., Bouix, S., Westin, C.-F., ... Kubicki, M. (2014). Sexually dimorphic white matter geometry abnormalities in adolescent onset schizophrenia. Cerebral Cortex, 24(5), 1389-1396. doi: 10.1093/cercor/bhs422

Seidman, L. J., Goldstein, J. M., Goodman, J. M., Koren, D., Turner, W. M., Faraone, S. V., & Tsuang, M. T. (1997). Sex differences in olfactory identification and Wisconsin card sorting performance in schizophrenia: Relationship to attention and verbal ability. Biological Psychiatry, 42(2), 104-115. doi: 10.1016/S0006-3223(96)00300-9

Torniainen, M., Suvisaari, J., Partonen, T., Castaneda, A. E., Kuha, A., Perälä, J., … Tuulio-Henriksson, A. (2011). Sex differences in cognition among persons with schizophrenia and healthy first-degree relatives. Psychiatry Research, 188(1), 7-12. doi: 10.1016/j.psychres.2010.11.009

van der Sluis, S., Posthuma, D., Dolan, C. V., de Geus, E. J. C., Colom, R., & Boomsma, D. I. (2006). Sex differences on the Dutch WAIS-III. Intelligence, 34(3), 273-289. doi: 10.1016/j.intell.2005.08.002

Vaskinn, A., Sundet, K., Simonsen, C., Hellvin, T., Melle, I., & Andreasen, O. A. (2011). Sex differences in neuropsychological performance and social functioning in schizophrenia and bipolar disorder. Neuropsychology, 25(4), 499-510. doi: 10.1037/a0022677

Ventura, J., Green, M. F., Shaner, A., & Liberman, R. P. (1993). Training and quality assurance with the Brief Psychiatric Rating Scale: “the drift busters”. International Journal of Methods in Psychiatric Research, 3(4), 221-244.

Wechsler, D. (2012). Escala de Inteligencia de Wechsler para Adultos-Cuarta Edición: Manual técnico y de interpretación. Madrid: Pearson.

Zanelli, J., Morgan, K., Dazzan, P., Morgan, C., Russo, M., Pilecka, I., … Reichenberg, A. (2013). Gender differences in neuropsychological performance across psychotic disorders–a multi-centre population basedcase-control study. PLoS ONE, 8(10), e77318. doi: 10.1371/journal.pone.0077318