Schizophrenia
and Early Parental Loss
Environment and
vulnerability to major psychiatric illness: a case
control study of early parental loss in major
depression, bipolar disorder and schizophrenia.
Mol Psychiatry 1999 Mar;4(2):163-72
Comment in: Mol Psychiatry. 1999 Mar;4(2):106-8.
Agid O, Shapira B, Zislin J,
Ritsner M, Hanin B, Murad H, Troudart T, Bloch M,
Heresco-Levy U, Lerer B.
Dept of Psychiatry, Hadassah-Hebrew University Medical
Center, Jerusalem, Israel.
The current focus on identifying genes which
predispose to psychiatric illness sharpens the need to
identify environmental factors which interact with
genetic predisposition and thus contribute to the
multifactorial causation of these disorders. One such
factor may be early parental loss (EPL). The putative
relationship between early environmental stressors
such as parental loss and psychopathology in adult
life has intrigued psychiatrists for most of this
century. We report a case control study in which rates
of EPL, due to parental death or permanent separation
before the age of 17 years were evaluated in patients
with major depression (MD), bipolar disorder (BPD) and
schizophrenia (SCZ), compared to individually matched,
healthy control subjects (MD-Control, 79 pairs;
BPD-Control, 79 pairs; SCZ-Control, 76 pairs). Loss of
parent during childhood significantly increased the
likelihood of developing MD during adult life (OR=3.8,
P=0.001). The effect of loss due to permanent
separation (P=0.008) was more striking than loss due
to death, as was loss before the age of 9 years
(OR=11.0, P=0.003) compared to later childhood and
adolescence. The overall rate of EPL was also
increased in BPD (OR=2.6, P=0.048) but there were no
significant findings in any of the subcategories of
loss. A significantly increased rate of EPL was
observed in schizophrenia patients (OR=3.8, P=0.01),
particularly before the age of 9 years (OR=4.3,
P=0.01). Comparison of psychosocial, medical and
clinical characteristics of subjects with and without
a history of EPL, within the larger patient groups
from which the matched samples were drawn (MD, n=136;
BPD, n=107; SCZ, n=160), yielded few significant
findings. Among the controls (n=170), however,
subjects who had experienced EPL, reported lower
incomes, had been divorced more frequently, were more
likely to be living alone, were more likely to smoke
or have smoked cigarettes and reported more physical
illness (P=0.03-0.001). Long term neurobiological
consequences of early environmental stressors such as
maternal deprivation have been extensively studied in
many animal species. Recently, enduring changes in
hypothalamic-pituitary-adrenal axis function,
including corticotrophin releasing factor gene
expression, have received particular attention.
Analogous processes may be implicated in the effect of
EPL on human vulnerability to psychopathology, via
alterations in responsiveness to stress. Genetic
predisposition may influence the degree of
susceptibility of the individual to the effects of
early environmental stress and may also determine the
psychopathological entity to which the individual is
rendered vulnerable as a consequence of the stress.
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this article. The more exposure I feel this abstract
receives,, the less people with the BP will suffer.
Clinicians need this training. Consumers and families
desperately need to be educated. I am deeply grateful
to the researchers that provide us with valuable
information in assisting us with treatment and
etiology.
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