Schizophrenia Bulletin Advance Access originally published online on January 20, 2009
Schizophrenia Bulletin 2009 35(3):568-576; doi:10.1093/schbul/sbn168
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Prenatal Malnutrition and Adult Schizophrenia: Further Evidence From the 1959-1961 Chinese Famine
2 Bio-X Life Science Research Center, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, PR China
3 Longquan Mountain Hospital of Guangxi Province, 1 Jila Road, Liuzhou 545005, PR China
4 Shanghai Institute of Mental Health, 600 South Wan Ping Road, Shanghai 200030, PR China
5 Institute for Nutritional Sciences, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, PR China
6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
7 New York State Psychiatric Institute, New York, NY
8 Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen AB252ZD,UK
9 HKU Department of Psychiatry and Genome Research Centre, University of Hong Kong, Pokfulam Road
1 To whom correspondence should be addressed; Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen AB252ZD, UK; tel: 44-0-1224553879, fax: 44-0-1224-557400, e-mail: d.stclair{at}abdn.ac.uk
Objective: Evidence from the 1944–1995 Dutch Hunger Winter and the 1959–1961 Chinese famines suggests that those conceived or in early gestation during famines, have a 2-fold increased risk of developing schizophrenia in adult life. We tested the hypothesis in a second Chinese population and also determined whether risk differed between urban and rural areas. Method: The risk of schizophrenia was examined in Liuzhou prefecture of Guangxi autonomous region. Rates were compared among those conceived before, during, and after the famine years. Based on the decline in birth rates, we predicted that those born in 1960 and 1961 would have been exposed to the famine during conception or early gestation. All psychiatric case records in Liuzhou psychiatric hospital for the years 1971 through 2001 were examined and clinical/sociodemographic data extracted by psychiatrists blind to exposure status. Data on births and deaths in the famine years were also available, and cumulative mortality was estimated from later demographic surveys. Evidence of famine was verified, and results were adjusted for mortality. Relative risks (RRs) for schizophrenia were calculated for the region as a whole and for urban and rural areas separately. Results: Mortality-adjusted RR for schizophrenia was 1.5 (1960) and 2.05 (1961), respectively. However, the effect was exclusively from the rural areas RR = 1.68 (1960) and RR = 2.25 (1961). Conclusions: We observe a 2-fold increased risk of schizophrenia among those conceived or in early gestation at the height of famine with risk related to severity of famine conditions.
Keywords: prenatal / famine / china / schizophrenia
* Ming-Qing Xu and Wen-Sheng Sun Equality contributed to this work.
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