Gender, Psychiatric Comorbidities Affect Psychotic Depression Outcomes

Associated outcomes include higher rates of psychiatric hospitalization and mortality.

A recent study on gender and psychiatric comorbidities in individuals with psychotic depression (PD) found that comorbidities have significant implications for PD age of onset and outcomes.

Using the Northern Finland Birth Cohort 1966 and national registers, Miika Nietola, Psychiatric Department, University of Turku, Finland, and colleagues analyzed 12,058 individuals who had been followed since mid-pregnancy for lifetime psychiatric diagnoses, age of illness onset, hospitalizations, disability pension rate, and mortality. Fifty-eight individuals in the sample had a lifetime diagnosis of PD (male, n = 23; female, n = 35); the lifetime prevalence of PD in the participants was 0.5%; and the median age for participants with PD was 40.2 years.1

In comparing outcome variables in subgroups for gender and comorbid PD or alcohol use disorder (AUD), the researchers identified the prevalence of comorbid personality disorders at 38% and comorbid AUDs at 41%. Results showed that psychiatric hospitalization was more strongly associated with male gender (p=0.03), personality disorder (p<0.01), and comorbid AUD (p<0.01). Comorbid PD was also associated with both earlier onset (p<0.01) and higher mortality (p=0.03) and was more common in men than women at 61% and 29%(p=0.03), respectively. However, Nietola et al found no statistical difference related to gender in the disability pension rate for individuals with PD.1

Since little is known about the effects of gender and comorbid psychopathologies on PD prognoses, the researchers stated that this study’s findings highlight a need for further research on these effects in individuals with PD and on PD in general—especially since comorbid personality disorders have been associated with poorer outcomes in individuals with non-psychotic depression. They also suggested that clinicians to control the effects of gender and comorbidity as confounding factors in PD trajectories.1

“Clinical implications of high alcohol use and personality disorder comorbidity in PD include rigorous assessment of these disorders in everyday practice and active implementation of effective treatments,” Nietola and colleagues wrote. “There are potential possibilities to improve outcomes of PD by focusing more on those detrimental comorbidities that appear to associate with a malign course of illness.”


1. Nietola M, Nordström T, Miettunen J, et al. Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression—a birth cohort study. J Affect Disord. 2022;296:587-592.