Schizophrenia Bulletin Advance Access published online on April 8, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp023
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Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections?
2 Genetics Laboratory, McLean Hospital, Belmont, MA
3 Department of Psychiatry, Harvard Medical School, Boston, MA
4 Wellesley College, Wellesley, MA
1 To whom correspondence should be addressed; Genetics Laboratory, McLean Hospital, NB-G-28 115 Mill Street, Belmont, MA 02478; tel: 617-855-3439, fax: 617-855-2348, e-mail: dkinney{at}mclean.harvard.edu.
Previous surveys found a large (>10-fold) variation in schizophrenia prevalence at different geographic sites and a tendency for prevalence to increase with latitude. We conducted meta-analyses of prevalence studies to investigate whether these findings pointed to underlying etiologic factors in schizophrenia or were the result of methodological artifacts or the confounding of sites' latitude with level of healthcare at those sites. We found that these patterns were still present after controlling for an index of healthcare—infant mortality—and focusing on 49 studies that used similar diagnostic and ascertainment methods. The tendencies for schizophrenia prevalence to increase with both latitude and colder climate were still large and significant and present on several continents. The increase in prevalence with latitude was greater for groups with low fish consumption, darker skin, and higher infant mortality—consistent with a role of prenatal vitamin D deficiency in schizophrenia. Previous research indicates that poor prenatal healthcare and nutrition increase risk for schizophrenia within the same region. These adverse conditions are more prevalent in developing countries concentrated near the equator, but schizophrenia prevalence is lowest at sites near the equator. This suggests that schizophrenia-producing environmental factors associated with higher latitude may be so powerful they overwhelm protective effects of better healthcare in industrialized countries. The observed patterns of correlations of risk factors with prevalence are consistent with an etiologic role for prenatal vitamin D deficiency and exposure to certain infectious diseases. Research to elucidate environmental factors that underlie variations in schizophrenia prevalence deserves high priority.
Keywords: epidemiology / etiology / immune function / prenatal / geography / risk factor