 |
|
Rates of Adult Schizophrenia Following Prenatal Exposure to the Chinese Famine of 1959-1961
David St Clair, MD, PhD;
Mingqing Xu, PhD;
Peng Wang, MD;
Yaqin Yu, MD;
Yourong Fang, MD;
Feng Zhang, MD;
Xiaoying Zheng, MD;
Niufan Gu, MD;
Guoyin Feng, MD;
Pak Sham, MD, PhD;
Lin He, PhD
JAMA. 2005;294:557-562.
Context Schizophrenia is a common major mental disorder. Intrauterine nutritional deficiency may increase the risk of schizophrenia. The main evidence comes from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited decline in food intake occurred. The most exposed cohort conceived during the famine showed a 2-fold increased risk of schizophrenia.
Objective To determine whether those who endured a massive 1959-1961 famine in China experienced similar results.
Design, Setting, and Participants The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. Wuhu and its surrounding 6 counties are served by a single psychiatric hospital. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers who were blinded to the nature of exposure. Data on number of births and deaths in the famine years were available, and cumulative mortality was estimated from later demographic surveys.
Main Outcome Measures Evidence of famine was verified, and unadjusted and mortality-adjusted relative risks of schizophrenia were calculated.
Results The birth rates (per 1000) in Anhui decreased approximately 80% during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the adjusted risk of developing schizophrenia in later life increased significantly, from 0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960 and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961.
Conclusion Our findings replicate the Dutch data for a separate racial group and show that prenatal exposure to famine increases risk of schizophrenia in later life.
Author Affiliations: Bio-X Center, Shanghai Jiao Tong University, Shanghai (Drs St Clair and Xu), Institute for Nutritional Sciences, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences (Drs Xu and He), Fourth People’s Hospital, Wuhu, Anhui (Drs Wang and Yu), Second People’s Hospital, Huang Shan, Anhui (Dr Fang), Institute of Population Research, Peking University (Dr Zheng), Shanghai Institute of Mental Health, Shanghai (Drs Gu and Feng), Department of Psychiatry, University of Hong Kong, Hong Kong (Dr Sham), and NHGG, Shanghai Jiao Tong University, Shanghai (Dr He), People’s Republic of China; Department of Mental Health, University of Aberdeen, Scotland (Drs St Clair and Zhang); and Division of Psychological Medicine, Institute of Psychiatry, London, England (Dr Sham).
RELATED LETTERS
Schizophrenia and the Chinese Famine of 1959-1961
Eric Lewin Altschuler
JAMA. 2005;294(23):2968.
EXTRACT
| FULL TEXT
Schizophrenia and the Chinese Famine of 1959-1961—Reply
Richard Neugebauer
JAMA. 2005;294(23):2968-2969.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Accumulating Evidence for Prenatal Nutritional Origins of Mental Disorders
Richard Neugebauer
JAMA. 2005;294(5):621-623.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Maternal Iron Deficiency and the Risk of Schizophrenia in Offspring
Insel et al.
Arch Gen Psychiatry 2008;65:1136-1144.
ABSTRACT
| FULL TEXT
What Is Spared by Fetal Brain-Sparing? Fetal Circulatory Redistribution and Behavioral Problems in the General Population
Roza et al.
Am J Epidemiol 2008;0:kwn233v1-kwn233.
ABSTRACT
| FULL TEXT
The Relationship Between Obstetric Complications and Temperament in Eating Disorders: A Mediation Hypothesis
Favaro et al.
Psychosom. Med. 2008;70:372-377.
ABSTRACT
| FULL TEXT
Better Outcome of Schizophrenia in India: A Natural Selection Against Severe Forms?
Thirthalli and Jain
Schizophr Bull 2008;0:sbn012v1-sbn012.
ABSTRACT
| FULL TEXT
Higher Risk of Offspring Schizophrenia Following Antenatal Maternal Exposure to Severe Adverse Life Events
Khashan et al.
Arch Gen Psychiatry 2008;65:146-152.
ABSTRACT
| FULL TEXT
Cohort Profile: The Dutch Hunger Winter Families Study
Lumey et al.
Int J Epidemiol 2007;36:1196-1204.
FULL TEXT
Parental Posttraumatic Stress Disorder as a Vulnerability Factor for Low Cortisol Trait in Offspring of Holocaust Survivors
Yehuda et al.
Arch Gen Psychiatry 2007;64:1040-1048.
ABSTRACT
| FULL TEXT
Schizophrenia and Neural Tube Defects: Comparisons From an Epidemiological Perspective
Zammit et al.
Schizophr Bull 2007;33:853-858.
ABSTRACT
| FULL TEXT
Schizophrenia: a common disease caused by multiple rare alleles
McClellan et al.
Br. J. Psychiatry 2007;190:194-199.
ABSTRACT
| FULL TEXT
The Surprisingly Rich Contours of Schizophrenia Epidemiology
McGrath
Arch Gen Psychiatry 2007;64:14-16.
FULL TEXT
Elevated Prenatal Homocysteine Levels as a Risk Factor for Schizophrenia
Brown et al.
Arch Gen Psychiatry 2007;64:31-39.
ABSTRACT
| FULL TEXT
Paternal age, size at birth, and size in young adulthood - risk factors for schizophrenia
Rasmussen
Eur J Endocrinol 2006;155:S65-S69.
ABSTRACT
| FULL TEXT
Maternal famine, de novo mutations, and schizophrenia.
McClellan et al.
JAMA 2006;296:582-584.
FULL TEXT
Epigenetics, Evolution, Endocrine Disruption, Health, and Disease
Crews and McLachlan
Endocrinology 2006;147:s4-s10.
ABSTRACT
| FULL TEXT
Invited Commentary: Taking the Search for Causes of Schizophrenia to a Different Level
March and Susser
Am J Epidemiol 2006;163:979-981.
ABSTRACT
| FULL TEXT
Schizophrenia, cancer and imprinting: early nutritional influences
Abel et al.
Br. J. Psychiatry 2006;188:394-394.
FULL TEXT
Reducing the Incidence of Low Birth Weight in Low-Income Countries Has Substantial Economic Benefits
Alderman and Behrman
WORLD BANK RES OBS 2006;21:25-48.
ABSTRACT
| FULL TEXT
The Role of Obstetric Events in Schizophrenia
Clarke et al.
Schizophr Bull 2006;32:3-8.
FULL TEXT
Emerging Empirical Evidence on the Ethics of Schizophrenia Research
Dunn et al.
Schizophr Bull 2006;32:47-68.
ABSTRACT
| FULL TEXT
Schizophrenia and the Chinese Famine of 1959-1961
Altschuler
JAMA 2005;294:2968-2968.
FULL TEXT
What's new in the other general journals
Martyn
BMJ 2005;331:369-370.
FULL TEXT
Accumulating Evidence for Prenatal Nutritional Origins of Mental Disorders
Neugebauer
JAMA 2005;294:621-623.
FULL TEXT
|
