Thousands of women sterilised in Sweden without consent

Lifetime reproductive output over two generations in patients with psychosis and their unaffected siblings: the Uppsala 1915-1929 Birth Cohort Multigenerational Study

BACKGROUND

Schizophrenic patients have fewer offspring than the general population but it is unclear whether (i) this persists for more than one generation, (ii) the reduced fertility is compensated by increased fertility in unaffected relatives, (iii) sociodemographic factors confound or interact with the association, and (iv) patients with affective psychosis have a similar fertility disadvantage. This study measured biological fitness over two generations in patients with schizophrenia or affective psychosis, and their unaffected siblings.

METHOD

We conducted a historical cohort study using a Swedish birth cohort of 12 168 individuals born 1915-1929 and followed up until 2002. We compared biological fitness over two generations in patients with schizophrenia (n=58) or affective psychosis (n=153), and their unaffected siblings, with the population, adjusting for a range of sociodemographic variables from throughout the lifespan.

RESULTS

Patients with schizophrenia had fewer children [fertility ratio (FR) 0.42, 95% confidence interval (CI) 0.29-0.61] and grandchildren (FR 0.51, 95% CI 0.33-0.80) than the population. Some of this reduction was related to lower marriage rates in schizophrenic patients. The unaffected siblings of schizophrenic patients showed no evidence of any compensatory increase in fitness, but there was a trend towards enhanced fertility among the offspring of schizophrenia patients. Patients with affective psychosis and their relatives did not differ from the general population on any fertility measure.

CONCLUSIONS

Schizophrenia, but not affective psychosis, is associated with reduced biological fertility; this disadvantage is partly explained by marital status and persists into the second generation.

Legislating for the new predictive genetics

Many new genetic markers have become available for use in the diagnosis, prognosis or risk prediction of common multifactorial disease such as venous thrombo-embolism, coronary artery disease, dementias and some cancers. Regulation or legislation of their application in the fields of the family, employment, life assurance, confidentiality and property law is required. This is made difficult because of the rapid pace of genetic discoveries and their derived technologies, the diversity of opinions on the legitimate application of these new techniques, and the pluralistic and evolving social norms of society regarding the use of the new genetic methods. This paper examines some of the problems that can arise when regulation is attempted in each of the above fields. A variety of solutions such as referenda, moratoria, ethical codes of professional bodies or the drafting of scientifically accurate and appropriate legislation depending on particular circumstances are discussed as a means of achieving a flexible and responsive approach to the challenges posed by the use of the new genetic markers.

Nature, nurture and mental disorder: old concepts in the new millennium

BACKGROUND

Evidence from twin and adoption studies has highlighted the importance of gene-environment interaction in the aetiology of mental disorders, and advances in molecular genetics have raised hopes of more rapid progress in this field of investigation.

AIMS

To review epidemiological knowledge concerning genetic and environmental risk factors for a cross-section of psychiatric conditions, and evidence of interaction between the two types.

METHOD

Searches of the literature in genetic and psychiatric epidemiology, including contributions to this supplement.

RESULTS

Overall, firm knowledge on both genetic and environmental causal factors is still fragmentary, although progress has varied among diagnostic categories. Environmental aspects have been dealt with only perfunctorily in most genetic epidemiological research.

CONCLUSIONS

Better definition and classification of environmental hazards, and closer inter-disciplinary cooperation, will be necessary in future. Specific gene-environment interaction effects seem likely to prove most important in neuropsychiatric syndromes, and a less specific genetic influence on susceptibility to environmental stress among the common mental disorders.

Greek theories on eugenics

With the recent developments in the Human Genome Mapping Project and the new technologies that are developing from it there is a renewal of concern about eugenic applications. Francis Galton (b1822, d1911), who developed the subject of eugenics, suggested that the ancient Greeks had contributed very little to social theories of eugenics. In fact the Greeks had a profound interest in methods of supplying their city states with the finest possible progeny. This paper therefore reviews the works of Plato (The Republic and Politics) and Aristotle (The Politics and The Athenian Constitution) which have a direct bearing on eugenic techniques and relates them to methods used in the present century.