Impact of Biological Sex on Emotional Perception Among Adults With Schizophrenia Spectrum Disorders: Protocol for a Systematic Review

Background: It is well established that individuals with schizophrenia experience deficits in emotional perception that can impact long-term social and occupational functioning. Understanding the factors that impact these impairments is important for targeting interventions to improve recovery. In the general population, compared with males, females tend to show greater perception of emotions. Whether this sex difference persists in schizophrenia is less clear. In contrast to males, females diagnosed with schizophrenia tend to have a higher age of disease onset and better premorbid functioning but do not necessarily have better outcomes. Effective treatments for social cognitive impairments are highly relevant to long-term functional rehabilitation. A greater understanding of the cognitive deficits in emotional perception within females and males living with schizophrenia may assist interventions to be better tailored to individuals. Objective: This systematic review aims to collate, synthesize, and critically appraise evidence considering the influence of biological sex (female and male) on the emotional perception of individuals with schizophrenia. Methods: This is a systematic review protocol based on the PRISMA-P (Preferred Reporting Items for Systematic Reviewsand Meta-Analyses Protocols) guidelines. The electronic databases MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFOwill be systematically searched. To be included in this review, studies must compare the emotional perceptions of male and femaleparticipants older than 18 years who have a primary diagnosis of a schizophrenia spectrum disorder. Qualitative studies, case reports, case series, unpublished manuscripts, and studies not reported in English will be excluded. Key search strategies will include combinations of the following terms: "men," "male," "man," "female," "women," "woman," "sex," "gender," "emotionalperception," "emotional processing," "schizophrenia," "schizophren," "psychotic disorders," "psychosis," "psychoses," "psychotic,""schizoaffective," "schizotypal personality disorder," and "schizotyp." Identified studies will be uploaded to the web-basedCovidence systematic review management software. The risk of bias for individual studies will be assessed using the relevantJoanna Briggs Institute checklist tools. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation)system will also be used to evaluate the strength of the evidence base. Findings will be synthesized to provide a systematicsummary of the existing literature. If sufficiently comparable data to permit meta-analysis emerges, a random-effects meta-analysis will be performed. Results: This systematic review was registered with the PROSPERO (International Prospective Register of Systematic Reviews)in October 2023. The search and screening of study titles and abstracts are currently underway. Data are expected to be extracted and analyzed in July 2024. Conclusions: Results will contribute to an improved understanding of the social cognitive profiles of males and females with schizophrenia. This knowledge is expected to inform the adaptation of interventions to improve functional outcomes Trial Registration: PROSPERO CRD42023463561; https://tinyurl.com/34sr3rnfInternational Registered Report Identifier (IRRID): DERR1-10.2196/56977