Schizophrenia and season of birth in a tropical region: relationship to rainfall

Systematic review and meta-analysis: Season of birth and schizophrenia risk

OBJECTIVE

Winter birth has been hypothesized to be associated with increased schizophrenia risk for nearly a century. Major hypotheses regarding the potential etiological risk factors for schizophrenia such as vitamin D deficiency and virus exposure in utero are predicated based on the observation that risk of schizophrenia is higher in children born in winter months.

METHODS

We conducted a systematic review and meta-analysis to examine the association between season and month of birth and risk of schizophrenia. We further investigated this relationship stratified by hemisphere.

RESULTS

Forty-three studies spanning 30 countries and territories and 440,039 individuals with schizophrenia were included in this meta-analysis. Winter births were associated with a small but statistically significant increased risk of schizophrenia (OR 1.05, 95 % CI 1.03-1.07, p < 0.0001) and summer births were associated with a small but statistically significant decreased risk of schizophrenia (OR 0.96, 95 % CI 0.94-0.98, p = 0.0001). Stratified subgroup analysis demonstrated no significant difference between hemispheres in the risk of schizophrenia for either winter or summer births.

CONCLUSIONS

Analysis using birth month data demonstrated a clear seasonal trend towards increased risk of schizophrenia being associated with winter birth months and decreased risk of schizophrenia in summer-to-fall months in the Northern but not Southern Hemisphere. These data suggest a small-but-substantial increased risk of schizophrenia in winter birth month. Further research needs to examine potential etiologic causes for this association.

Month of birth and mental disorders: A population-based study and validation using global meta-analysis

OBJECTIVE

Month of birth (MOB) is associated with specified mental disorders (MDs). However, whether these relationships extend to all MDs remains unclear. We investigate the association using a population-based cohort study and a meta-analysis.

METHODS

First, we examined patients with 34 DSM-5-classified MDs in the Taiwan national database. We estimated the relative risk ratios (RR) of each illness in each MOB relative to that in the general population and assessed the periodicity, with six further sensitivity analyses. Second, we searched PubMed, Embase, and Cochrane for related articles through 31 December 2020. We used a random-effects model, pooled RRs with 95% confidence intervals of each MOB from the identified studies, and transformed them from MOB to relative age in a year or season.

RESULTS

The cohort included 1,951,777 patients. Except for posttraumatic stress disorder, dissociative disorders, feeding/eating disorders, gender dysphoria, and paraphilic disorders, the other MDs had significant MOB periodicity. The meta-analysis included 51 studies investigating 10 MDs. The youngest age at the start of school owing to MOB was associated with the highest RRs of intellectual disability (1.13), autism (1.05), attention-deficit/hyperactivity disorder (1.13). Winter births had significant risks of schizophrenia (1.04), bipolar I disorder (1.02), and major depressive disorder (1.01), and autumn births had a significant risk of alcohol use disorder (1.02). No significant associations between season of birth and Alzheimer's disease, or eating disorders were found.

CONCLUSIONS

MOB is related to the risks of certain MDs. This finding provides a reference for future research on the etiology of MDs.

The effect of climate change on depression in urban areas of western Iran

Objective

Human is accustomed to climatic conditions of the environment where they are born and live throughout their lifetime. The aim of this study is to examine mood swings and depression caused by sudden climate changes that have not yet given the humans a chance to adapt.

Results

Our results showed that depression could be affected by climate change and as a result, the behavior of climatic elements and trends has damaged mental health in the western regions of Iran. By investigating the trends and changes of climatic time series and their relationship with the rate of depression in urban areas of western Iran, it can be said that climate change is probably a mental health challenge for urban populations. Climate change is an important and worrying issue that makes the life difficult. Rapid climate changes in western Iran including rising air temperature, changes in precipitation, its regime, changes cloudiness and the amount of sunlight have a negative effects on health. The results showed that type of increasing or decreasing trend, as well as different climatic elements in various seasons did not have the same effect on the rate of depression in the studied areas.

Investigating the effect of climatic parameters on mental disorder admissions

The main objective of this study was to evaluate the role of climatic parameters and phenomena including the monthly number of dusty/rainy/snowy/foggy days, cloudiness (Okta), horizontal visibility, and barometric pressure (millibar) on major depressive disorder, bipolar, schizophrenia, and schizoaffective admissions. The monthly data related to the number of admissions in Farshchian hospital and climatic parameters from March 2005 to March 2017 were extracted. Random forest regression and dynamic negative binomial regression were used to examine the relationship between variables; the statistical significance was considered as 0.05. The number of dusty/rainy/snowy/foggy days, cloudiness, and the number of days with vision less than 2 km had a significant positive relationship with admissions due to schizophrenia (p < 0.05). Barometric pressure had a negative effect on schizophrenia admissions (p < 0.001). The number of dusty/rainy/snowy/foggy days and cloudiness had a significant effect on schizoaffective admissions (p < 0.05). Bipolar admissions were negatively associated with rainy days and positively associated with dusty days and cloudiness (p < 0.05). The number of rainy/dusty/snowy days and cloudiness had a positive significant effect on major depressive disorder admissions. The results of the present study confirmed the importance of climatic parameter variability for major depressive disorder, bipolar, schizophrenia, and schizoaffective admissions.

Season of birth and population schizotypy: Results from a large sample of the adult general population

Although the last years have seen an increasing interest in schizotypy and its pathogenesis, there exist only a handful of studies examining the possible interaction between season of birth (SOB) and schizotypic personality structure. Available research used differing screening instruments, rendering comparisons between studies difficult, and sample sizes in adult populations may have been too small to detect a mild effect. The current study examined the association between SOB and psychometric schizotypy in the so far single-largest sample from the adult general population (N=8114), balanced for men and women, and utilizing a valid and reliable instrument for the assessment of schizotypy. Using the 12 most informative items of the Schizotypal Personality Questionnaire Brief, we obtained evidence of a small, but significant, effect of late winter and early spring births (February/March) on psychometric schizotypy. The effect was not constrained to women, but affected men and women alike. The observed association between SOB and schizotypy appears compatible with seasonal variations of temperature and influenza prevalence, and with recent evidence on seasonal variability in the activity of the human immune system. Our findings lend support to the continuum hypothesis of schizotypy and schizophrenia, for which SOB effects have been previously established.

Evidence for phenotypic plasticity in response to photic cues and the connection with genes of risk in schizophrenia

Numerous environmental factors have been identified as influential in the development of schizophrenia. Some are byproducts of modern life, yet others were present in our evolutionary past and persist to a lesser degree in the current era. The present study brings together published epidemiological data for schizophrenia and data on variables related to photic input for places of residence across geographical regions, using rainfall as an inverse, proxy measure for light levels. Data were gathered from the literature for two countries, the former Yugoslavia and Ireland, during a time in the early 20th century when mobility was relatively limited. The data for Yugoslavia showed a strong correlation between hospital census rates for schizophrenia (by place of birth) and annual rain (r = 0.96, p = 0.008). In Ireland, the hospital census rates and first admissions for schizophrenia (by place of permanent residence) showed a trend for correlation with annual rain, reaching significance for 1st admissions when the rainfall data was weighted by the underlying population distribution (r = 0.71, p = 0.047). In addition, across the years 1921-1945, birth-year variations in a spring quarter season-of-birth effect for schizophrenia in Ireland showed a trend for correlation with January-March rainfall (r = 0.80, p ≤ 0.10). The data are discussed in terms of the effect of photoperiod on the gestation and behavior of offspring in animals, and the premise is put forth that vestigial phenotypic plasticity for such photic cues still exists in humans. Moreover, genetic polymorphisms of risk identified for psychotic disorders include genes modulated by photoperiod and sunlight intensity. Such a relationship between phenotypic plasticity in response to a particular environmental regime and subsequent natural selection for fixed changes in the environmentally responsive genes, has been well studied in animals and should not be discounted when considering human disease.

Viral infection, inflammation and schizophrenia

Schizophrenia is a severe neurodevelopmental disorder with genetic and environmental etiologies. Prenatal viral/bacterial infections and inflammation play major roles in the genesis of schizophrenia. In this review, we describe a viral model of schizophrenia tested in mice whereby the offspring of mice prenatally infected with influenza at E7, E9, E16, and E18 show significant gene, protein, and brain structural abnormalities postnatally. Similarly, we describe data on rodents exposed to bacterial infection or injected with a synthetic viral mimic (PolyI:C) also demonstrating brain structural and behavioral abnormalities. Moreover, human serologic data has been indispensible in supporting the viral theory of schizophrenia. Individuals born seropositive for bacterial and viral agents are at a significantly elevated risk of developing schizophrenia. While the specific mechanisms of prenatal viral/bacterial infections and brain disorder are unclear, recent findings suggest that the maternal inflammatory response may be associated with fetal brain injury. Preventive and therapeutic treatment options are also proposed. This review presents data related to epidemiology, human serology, and experimental animal models which support the viral model of schizophrenia.

[Seasonality of Schizophrenia: Findings of a Descriptive Study in Santa Marta, Colombia]

Introduction

Multiple studies carried out around the globe have concluded that there is a seasonal effect on the births of patients that will go on to develop schizophrenia later on. A relationship between being exposed to certain infectious agents during the prenatal period and possible direct effects on the developing brain that will later be expressed by the classical clinical picture has been suggested.

Objective

To analyze the behavior of births in a sample of individuals with schizophrenia from Santa Marta, Colombia.

Methods

Descriptive study based on the review of clinical histories of the patients seen in a psychiatric institute.

Discussion

A larger number of births took place during the rainiest months of the year suggesting a possible seasonal effect. However, the lack of data on births in Santa Marta during the years of the study did not allow a comparison between the results of the study and the birth rates of the general population. Even so, these findings have implications for future research regarding seasonality of schizophrenia in Colombia. They do not reflect an individual risk of developing the illness but they do document the characteristics of the temporal behavior of the births in the sample studied. Further studies that overcome the limitations of the present one are needed.

Birth characteristics and schizotypy: evidence of a potential "second hit"

Schizophrenia is associated with a modest increase in winter births as well as increased odds of being born in more densely populated and midrange latitude regions. It is unclear the degree to which these findings hold for individuals with schizotypy, defined in terms of the personality organization that is a potential precursor to schizophrenia-spectrum disorders. This issue is important for understanding whether birth factors contribute to general schizophrenia vulnerability or whether they reflect a secondary "hit" that increases the likelihood of psychosis onset in vulnerable individuals. The present project examined season of birth, birthplace population and birth location in a large group of young adults from the southeastern United States. Individuals with extreme schizotypy scores did not differ from those without schizotypy in season of birth, birthplace latitude or population. However, 60% of individuals within the schizotypy group who reported a diagnosis of schizophrenia or prior hospitalization were born during winter months; a dramatic difference from other individuals within the schizotypy group. We also found that individuals with negative/schizoid traits showed a birthplace population less than half that of other individuals with schizotypy. Season of birth appears to be a "second hit" that is related to expression of psychopathology onset in vulnerable individuals. This finding, and the unexpected inverse relationship between birthplace population and negative/schizoid traits, is discussed.

Correlation between schizophrenia and seasonality of birth in a tropical region

OBJECTIVE: To investigate the statistical relationship between season of birth and schizophrenia in 461 patients hospitalized in three psychiatric facilities in the towns of Araras, Itapira, and Espírito Santo do Pinhal, interior of São Paulo State, southeastern Brazil. METHODS: Date and place of birth of the patients were collected and used to determine the season of birth. Results were analyzed by the chi-square test. Data regarding temperature and rainfall between 1952 and 1986, corresponding to the years of birth of the patients studied, were also obtained. RESULTS: The results showed a higher prevalence of births in the winter months (p = 0.0044), a period characterized in this region by a decline in temperature and rainfall. CONCLUSION: These findings indicate a possible influence of seasonality on the pathogenesis of schizophrenia and suggest that the winter in this region, together with other factors, may contribute to the late development of the disease.

Season of birth and schizophrenia in Northeast Brazil: relationship to rainfall

Although the association of schizophrenia and winter birth has been replicated many times in the Northern hemisphere, studies in the Southern hemisphere have been less consistent in their findings. A study from NE Brazil indicated the period between May and July, 3 months after the peak in rainfall, as a risk period for schizophrenia birth. We report findings from a random selection of charts (N = 1789) from the only public inpatient psychiatric facility in Ceará, Brazil (2 degrees to 5 degrees S). We compared the seasonality of birth in the schizophrenia group (N = 406) to multiple control groups: (1) psychosis not otherwise specified (N = 868), (2) other psychiatric diagnoses (N = 515), and (3) the average monthly birth rate in the general population. Patients with schizophrenia had a significantly greater risk of being born in the risk period compared with any of the control groups. There is a significant association between rainfall in a month and schizophrenia births 3 (p = 0.03) and 4 months (p = 0.01) later. This study corroborates findings of a significant seasonality in schizophrenia births in northeast Brazil.

Excess in the spring and deficit in the autumn in birth rates of male schizophrenic patients in Italy: potential role of perinatal risk factors

OBJECTIVE

The aim of this study was to evaluate whether there were different seasonal variations of births in an Italian population of patients with schizophrenia, with other psychotic disorders, and with personality disorders than in the general population.

METHODS

Birth dates of 1270 patients admitted to one university psychiatric unit in Rome between 1990 and 2003, with a diagnosis of schizophrenia, other psychotic disorder (OPD) and personality disorder/cluster A (PD) were analyzed according to seasonal variation.

RESULTS

A significant excess of births in spring (with a peak in May) and a deficit in autumn (with a trough in October) was found in the sample of male schizophrenics (n = 506). No statistically significant variations were found in either the sample of female schizophrenics (n = 88) or in the combined sample with OPD and PD (n = 676).

CONCLUSIONS

The findings serve to strengthen the existing hypotheses that schizophrenia is related to environmental factors acting on the development of the central nervous system intrauterinely.

Seasonality effects on schizophrenic births in multiplex families in a tropical island

Many studies have found that individuals with schizophrenia have been born in winter months in disproportionately high numbers. Temperature and weather effects, such as hot summers or cold winters, have been among the suggested explanations for this seasonality effect. We studied the relationship between schizophrenia and season of birth in Puerto Rico, a tropical island with mild seasonal variation of temperature and virtually no cold periods. Our sample consisted of 132 subjects (57 with schizophrenia, 75 without) from 24 multiplex families. Schizophrenic family members were significantly more likely to be born during the winter months (21/57; 36.8%) than their unaffected relatives (16/75; 21.3%). These results suggest that extreme temperatures are not a sufficient explanation for the seasonality effect and that other factors associated with seasonality may have an effect on the later development of schizophrenia. The fact that a seasonality effect was found in a group likely to have an increased genetic loading for schizophrenia suggests that seasonality may be associated with a second, environmental "hit" in a "two-hit hypothesis" of schizophrenia.

Maternal exposure to first-trimester sunshine is associated with increased birth weight in human infants

Two alternative hypotheses have been generated to account for seasonal variation in the birth weight of human infants born in industrialized countries. First, it has been hypothesized that low ambient temperature during the second trimester of gestation decreases birth weight. Second, it has been hypothesized that exposure to bright sunshine during the first trimester increases birth weight. We tested these two hypotheses to determine which, if either, accounted for seasonal variation in birth weight of full-term infants. Birth weight data, collected over a 5-year period, were analyzed as a function of peak and trough sunshine and ambient temperature. Although there was no effect of ambient temperature during any trimester on birth weight, infants whose mothers were exposed to peak sunshine during their first trimester were born significantly heavier than infants whose mothers experienced trough levels of sunshine during the same trimester. Furthermore, infants whose mothers were exposed to trough levels of sunshine during their second and third trimesters were born significantly heavier than infants whose mothers were exposed to peak levels of sunshine during the same trimesters. We hypothesize that high levels of sunshine during early gestation may increase the level of insulin-like growth factor (IGF)-1, facilitating prenatal growth.

Wild-type and attenuated influenza virus infection of the neonatal rat brain

Although influenza virus infection of humans has been associated with a wide spectrum of clinical neurological syndromes, the pathogenesis of influenza virus associated central nervous system (CNS) disease in humans remains controversial. To better study influenza virus neuropathogenesis, an animal model of influenza-associated CNS disease using human virus isolates without adaptation to an animal host was developed. This neonatal rat model of influenza virus CNS infection was developed using low-passage human isolates and shows outcomes in specific brain regions, cell types infected, and neuropathological outcomes that parallel the available literature on cases of human CNS infection. The degree of virus replication and spread in the rat brain correlated with the strains' neurotoxicity potential for humans. In addition, using sensitive neurobehavioral test paradigms, changes in brain function were found to be associated with areas of virus replication in neurons. These data suggest that further evaluation of this pathogenesis model may provide important information regarding influenza virus neuropathogenesis, and that this model may have possible utility as a preclinical assay for evaluating the neurological safety of new live attenuated influenza virus vaccine strains.

What causes seasonality of birth in schizophrenia?

An excess of winter-spring births (and/or a decrease of summer births) has consistently been observed in schizophrenia (SCZ). This observation may provide a significant clue about the causes of the disease if specific factors which cause the phenomenon can be determined. This paper reviews several studies which investigated factors correlated with this observation in SCZ, in an attempt to determine which factors more likely cause the seasonality. Among the candidates of the factors are meteorological variables (such as ambient temperature), several infections, maternal hormones, sperm quality, nutrition and external toxins. A variation of procreation might also have an effect. Among the factors, the most extensively studied are temperature and viral infections. Some of them have appeared promising, but further studies are definitely required. Several challenges, including complicated correlations of the factors and determination of the susceptible period during pregnancy, need to be overcome. Comparisons of the data from areas and cohorts with different patterns of the candidate factors may be helpful. Animal studies may also help investigate the molecular and physiological mechanisms of the phenomenon.

Schizophrenia and season of birth: relationship to geomagnetic storms

An excess pattern of winter and spring birth, of those later diagnosed as schizophrenic, has been clearly identified in most Northern Hemisphere samples with none or lesser variation in Equatorial or Southern Hemisphere samples. Pregnancy and birth complications, seasonal variations in light, weather, temperature, nutrition, toxins, body chemistry and gene expression have all been hypothesized as possible causes. In this study, the hypothesis was tested that seasonal variation in the geomagnetic field of the earth primarily as a result of geomagnetic storms (GMS) at crucial periods in intrauterine brain development, during months 2 to 7 of gestation could affect the later rate of development of schizophrenia. The biological plausibility of this hypothesis is also briefly reviewed. A sample of eight representative published studies of schizophrenic monthly birth variation were compared with averaged geomagnetic disturbance using two global indices (AA*) and (aa). Three samples showed a significant negative correlation to both geomagnetic indices, a further three a significant negative correlation to one of the geomagnetic indices, one showed no significant correlation to either index and one showed a significant positive correlation to one index. It is suggested that these findings are all consistent with the hypothesis and that geomagnetic disturbance or factors associated with this disturbance should be further investigated in birth seasonality studies.

Influenza Aviária: Uma Revisão dos Últimos Dez Anos

A influenza aviária é doença exótica no Brasil. O sistema de vigilância implementado pelo Programa Nacional de Sanidade Avícola (PNSA) mantém monitoração permanente das aves das principais espécies domésticas, tanto do material genético importado para a indústria avícola, por exemplo, da espécie das galinhas (Gallus gallus formadomestica), perus (Meleagris gallopavo formadomestica), codornas (Coturnix coturnix japonica), patos (Anas), primários (elite), bisavós e avós para postura ou corte, como aves de espécies de exploração mais recente, exóticas, por exemplo avestruzes (Struthio camelus) ou nativas, por exemplo emas (Rhea americana). Os plantéis de reprodutores em produção são também acompanhados por amostragens periódicas, conforme previsto no PNSA, além da monitoração das respostas aos programas de vacinação, por exemplo, contra bronquite infecciosa e doença infecciosa bursal. O PNSA estabelece as normas de atuação para o controle e erradicação da doença de Newcastle (ND) e Influenza Aviária (AI) (Projeto de Vigilância, 2001), a saber: I - Notificação de focos da doença (e confirmação laboratorial no LARA-Campinas); II - Assistência a focos; III - Medidas de desinfecção; IV - Sacrifício sanitário; V - Vazio sanitário; VI - Vacinação dos plantéis ou esquemas emergenciais; VII - Controle e fiscalização dos animais susceptíveis; VIII - Outras medidas sanitárias; A vigilância e atenção ao foco exige o diagnóstico laboratorial e diferencial de AI e ND, que segue as normas do PNSA, conforme o sumário abaixo: 1- Interdição e coleta de materiais para exame laboratorial oficial; 2- Registro das aves: espécie(s), categoria(s), número(s), manutenção de aves; utensílios e produtos no local; proibição de trânsito de e para a(s) propriedade(s) em um raio de 10 km; controle de todos os animais e materiais possíveis fontes de propagação; desinfecção de vias de entradas e saídas à(s) propriedade(s); inquérito epidemiológico. 3- Confirmação laboratorial: isolamento de agente letal hemaglutinante em ovos embrionados de galinhas SPF, não inibido (inibição da hemaglutinação) ou não neutralizado (soroneutralização) por soro específico para o vírus da doença de Newcastle; caracterização do agente como vírus da influenza aviária (AIV) por detecção de antígenos da nucleoproteína e/ou matriciais de AIV e de seu subtipo por ensaios específicos para a caracterização da hemaglutinina e neuraminidase (imunodifusão, imunoenzimáticos ou moleculares). 4- Abate e destruição imediata (cremação) de todas as aves, resíduos, carnes e ovos da(s) propriedade(s) atingida(s) e vizinhas (raio de 3 km); limpeza e desinfecção das instalações; vazio sanitário (mínimo 21 dias); 5- Permitir o transporte para o abate ou incubação dentro da zona de vigilância (raio de 10 km). 6- Proibir feiras, exposições, mercados na zona de vigilância (10 km). 7- Aplicar estas medidas por mínimo de 21 dias após a destruição das fontes de propagação e desinfecção das instalações, proibir a retirada de aves e produtos na zona de proteção (3 km) por 21 dias e 15 dias na zona de vigilância (10 km). A certificação de área livre segue as normas da OIE e PNSA, considerando AI exótica no Brasil (país livre), e exige: 1- AI de alta patogenicidade não diagnosticada pelo sistema de vigilância pelos últimos 3 anos; 2- Um período de 6 meses após o abate, destruição das aves e resíduos e desinfecção após surto; O sistema de criação da avicultura predominante no Brasil (galinhas e perus) emprega a mais atual tecnologia e conhecimento científico na produção, no qual os plantéis são gerenciados com biossegurança, avaliação permanente dos pontos críticos, sistema de qualidade total e programas de vacinações que garantem a prevenção de inúmeros problemas sanitários. A prevenção de influenza aviária é especialmente favorecida por essas características. O sistema e tipo de construção (galpões) para o alojamento dos plantéis dessas espécies dificultam também o desafio eventualmente imposto pelas aves de vida livre. A localização geográfica da avicultura nacional, localizada fora das rotas migratórias das aves-reservatório, pode também exercer papel importante na ausência de focos de influenza no Brasil. Além disso, o baixo índice de replicação dos AIV nas aves migratórias durante a estada na região subtropical também influi para a menor ocorrência. As espécies de aves domésticas de importância comercial mais sensíveis à infecção e potencialmente envolvidas no papel de fonte de infecção, conforme citadas na literatura internacional, perus e patos, são mantidas em galpões industriais com sistema de biossegurança e de distribuição geográfica bastante restrita, em contraste com as criações dos países com relatos permanentes de surtos, em que se associam as condições de desafio naturais geográficas ditadas pelas rotas migratórias, mais alta replicação na ave na estação (países temperados) e a criação em campo aberto.