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Collins JM, Keane JM, Deady C, Khashan AS, McCarthy FP, O'Keeffe GW, Clarke G, Cryan JF, Caputi V, O'Mahony SM. Prenatal stress impacts foetal neurodevelopment: Temporal windows of gestational vulnerability. Neurosci Biobehav Rev 2024; 164:105793. [PMID: 38971516 DOI: 10.1016/j.neubiorev.2024.105793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Prenatal maternal stressors ranging in severity from everyday occurrences/hassles to the experience of traumatic events negatively impact neurodevelopment, increasing the risk for the onset of psychopathology in the offspring. Notably, the timing of prenatal stress exposure plays a critical role in determining the nature and severity of subsequent neurodevelopmental outcomes. In this review, we evaluate the empirical evidence regarding temporal windows of heightened vulnerability to prenatal stress with respect to motor, cognitive, language, and behavioural development in both human and animal studies. We also explore potential temporal windows whereby several mechanisms may mediate prenatal stress-induced neurodevelopmental effects, namely, excessive hypothalamic-pituitary-adrenal axis activity, altered serotonin signalling and sympathetic-adrenal-medullary system, changes in placental function, immune system dysregulation, and alterations of the gut microbiota. While broadly defined developmental windows are apparent for specific psychopathological outcomes, inconsistencies arise when more complex cognitive and behavioural outcomes are considered. Novel approaches to track molecular markers reflective of the underlying aetiologies throughout gestation to identify tractable biomolecular signatures corresponding to critical vulnerability periods are urgently required.
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Affiliation(s)
- James M Collins
- APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - James M Keane
- APC Microbiome Ireland, University College Cork, Cork, Ireland.
| | - Clara Deady
- APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, Cork, Ireland.
| | - Fergus P McCarthy
- The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, Cork, Ireland.
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland.
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Valentina Caputi
- APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
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Del Pozo-Herce P, Miguel AGD, Gonzalez-Rosas L, Alejandro-Rubio O, Pascual-Lapuerta C, Porras-Segovia A. Grief as a Risk Factor for Psychosis: A Systematic Review. Curr Psychiatry Rep 2024; 26:379-393. [PMID: 38833148 DOI: 10.1007/s11920-024-01512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW The assessment of the risk of triggering psychosis upon exposure to grief is a challenge in clinical practice. Adequate diagnosis and early prevention are essential and may be helpful in the evolution of normal grief. We aimed to identify studies exploring grief as a risk factor for developing psychosis. RECENT FINDINGS A systematic review of 3 databases (PubMed, EMBASE, and Cochrane Library) was conducted. RESULTS In the first approach 618 studies were identified. After the selection process, 15 studies were included in the review. The association between grief and the risk of developing psychosis occurred at younger ages (before 18 years of age) in a first-degree relative and as a consequence of suicide or accidental death. We found that risk factors such as comorbidity, mental problems, unemployment, economic difficulties, and close ties with the deceased have a negative impact on health causing greater vulnerability to psychosis with a risk of developing complicated grief, with statistically significant results regarding the associations between early parental death and the probability of developing psychosis in adulthood.
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Affiliation(s)
- Pablo Del Pozo-Herce
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain.
| | | | - Luis Gonzalez-Rosas
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Rey Juan Carlos, Madrid, Spain
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Hope H, Pierce M, Gabr H, Radojčić MR, Swift E, Taxiarchi VP, Abel KM. The causal association between maternal depression, anxiety, and infection in pregnancy and neurodevelopmental disorders among 410 461 children: a population study using quasi-negative control cohorts and sibling analysis. Psychol Med 2024; 54:1693-1701. [PMID: 38205522 DOI: 10.1017/s0033291723003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND To address if the long-standing association between maternal infection, depression/anxiety in pregnancy, and offspring neurodevelopmental disorder (NDD) is causal, we conducted two negative-control studies. METHODS Four primary care cohorts of UK children (pregnancy, 1 and 2 years prior to pregnancy, and siblings) born between 1 January 1990 and 31 December 2017 were constructed. NDD included autism/autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability, cerebral palsy, and epilepsy. Maternal exposures included depression/anxiety and/or infection. Maternal (age, smoking status, comorbidities, body mass index, NDD); child (gender, ethnicity, birth year); and area-level (region and level of deprivation) confounders were captured. The NDD incidence rate among (1) children exposed during or outside of pregnancy and (2) siblings discordant for exposure in pregnancy was compared using Cox-regression models, unadjusted and adjusted for confounders. RESULTS The analysis included 410 461 children of 297 426 mothers and 2 793 018 person-years of follow-up with 8900 NDD cases (incidence rate = 3.2/1000 person years). After adjustments, depression and anxiety consistently associated with NDD (pregnancy-adjusted HR = 1.58, 95% CI 1.46-1.72; 1-year adj. HR = 1.49, 95% CI 1.39-1.60; 2-year adj. HR = 1.62, 95% CI 1.50-1.74); and to a lesser extent, of infection (pregnancy adj. HR = 1.16, 95% CI 1.10-1.22; 1-year adj. HR = 1.20, 95% CI 1.14-1.27; 2-year adj. HR = 1.19, 95% CI 1.12-1.25). NDD risk did not differ among siblings discordant for pregnancy exposure to mental illness HR = 0.97, 95% CI 0.77-1.21 or infection HR = 0.99, 95% CI 0.90-1.08. CONCLUSIONS Maternal risk appears to be unspecific to pregnancy: our study provided no evidence of a specific, and therefore causal, link between in-utero exposure to infection, common mental illness, and later development of NDD.
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Affiliation(s)
- Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hend Gabr
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Mathematics, Insurance, and Statistics, Faculty of Commerce, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Maja R Radojčić
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleanor Swift
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Mawson ER, Morris BJ. A consideration of the increased risk of schizophrenia due to prenatal maternal stress, and the possible role of microglia. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110773. [PMID: 37116354 DOI: 10.1016/j.pnpbp.2023.110773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
Schizophrenia is caused by interaction of a combination of genetic and environmental factors. Of the latter, prenatal exposure to maternal stress is reportedly associated with elevated disease risk. The main orchestrators of inflammatory processes within the brain are microglia, and aberrant microglial activation/function has been proposed to contribute to the aetiology of schizophrenia. Here, we evaluate the epidemiological and preclinical evidence connecting prenatal stress to schizophrenia risk, and consider the possible mediating role of microglia in the prenatal stress-schizophrenia relationship. Epidemiological findings are rather consistent in supporting the association, albeit they are mitigated by effects of sex and gestational timing, while the evidence for microglial activation is more variable. Rodent models of prenatal stress generally report lasting effects on offspring neurobiology. However, many uncertainties remain as to the mechanisms underlying the influence of maternal stress on the developing foetal brain. Future studies should aim to characterise the exact processes mediating this aspect of schizophrenia risk, as well as focussing on how prenatal stress may interact with other risk factors.
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Affiliation(s)
- Eleanor R Mawson
- School of Psychology and Neuroscience, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Brian J Morris
- School of Psychology and Neuroscience, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
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Allardyce J, Hollander AC, Rahman S, Dalman C, Zammit S. Association of trauma, post-traumatic stress disorder and non-affective psychosis across the life course: a nationwide prospective cohort study. Psychol Med 2023; 53:1620-1628. [PMID: 34412716 PMCID: PMC10009379 DOI: 10.1017/s0033291721003287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to examine the temporal relationships between traumatic events (TE), post-traumatic stress disorder (PTSD) and non-affective psychotic disorders (NAPD). METHODS A prospective cohort study of 1 965 214 individuals born in Sweden between 1971 and 1990 examining the independent effects of interpersonal and non-interpersonal TE on incidence of PTSD and NAPD using data from linked register data (Psychiatry-Sweden). Mediation analyses tested the hypothesis that PTSD lies on a causal pathway between interpersonal trauma and NAPD. RESULTS Increasing doses of interpersonal and non-interpersonal TE were independently associated with increased risk of NAPD [linear-trend incidence rate ratios (IRR)adjusted = 2.17 [95% confidence interval (CI) 2.02-2.33] and IRRadjusted = 1.27 (95% CI 1.23-1.31), respectively]. These attenuated to a relatively small degree in 5-year time-lagged models. A similar pattern of results was observed for PTSD [linear-trend IRRadjusted = 3.43 (95% CI 3.21-3.66) and IRRadjusted = 1.45 (95% CI 1.39-1.50)]. PTSD was associated with increased risk of NAPD [IRRadjusted = 8.06 (95% CI 7.23-8.99)], which was substantially attenuated in 5-year time-lagged analyses [IRRadjusted = 4.62 (95% CI 3.65-5.87)]. There was little evidence that PTSD diagnosis mediated the relationship between interpersonal TE and NAPD [IRRadjusted = 0.92 (percentile CI 0.80-1.07)]. CONCLUSION Despite the limitations to causal inference inherent in observational designs, the large effect-sizes observed between trauma, PTSD and NAPD in this study, consistent across sensitivity analyses, suggest that trauma may be a component cause of psychotic disorders. However, PTSD diagnosis might not be a good proxy for the likely complex psychological mechanisms mediating this association.
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Affiliation(s)
- Judith Allardyce
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales
- Centre for Clinical Brain Sciences (Division of Psychiatry), University of Edinburgh, Edinburgh, Scotland
| | | | - Syed Rahman
- Dept of Global Public Health, Karolinksa Institutet, Solna, Sweden
| | - Christina Dalman
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Psykisk Hälsa, Centrum för epidemiologi och samhällsmedicin, Stockholm, Sweden
| | - Stan Zammit
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, England
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Lu WT, Zhao XC, Wang R, Li N, Song M, Wang L, Yu LL, Gao YY, Wang YM, An CX, Wang XY. Long-term effects of early stress due to earthquake exposure on depression symptoms in adulthood: a cross-sectional study. Injury 2023; 54:207-213. [PMID: 35989117 DOI: 10.1016/j.injury.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to investigate the long-term effects of early stress by Tangshan earthquake on symptoms of depression in adulthood. METHOD A total of 1534 volunteers born and raised in Tangshan were investigated; finally, 1328 subjects were enrolled in the study. They were divided into three groups according to their birth dates: infant exposure, prenatal exposure, and non-exposure. The questionnaires and psychological evaluation of all subjects were completed using a one-on-one psychological test. RESULTS The rate of depressive symptoms in the prenatal exposure group was the highest, and the lowest in the non-exposure group, with statistical differences among the three groups (P = 0.002). Moreover, the incidences of depressed mood, suicide ideation and work and loss of interest in the prenatal exposure group were significantly higher than those in the infant exposure group and the non-exposure group (P = 0.008, P = 0.001, P = 0.038, respectively). Multiple logistic regression analysis showed that male could be a protective factor for symptoms of depression in adulthood, and earthquake exposure was an important predictor of the incidence of depression symptoms. CONCLUSIONS Fetal or infancy exposure to earthquake might correlate to depression symptoms in adulthood.
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Affiliation(s)
- Wen-Ting Lu
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Chuan Zhao
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ran Wang
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Na Li
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mei Song
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lan Wang
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lu-Lu Yu
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuan-Yuan Gao
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yu-Mei Wang
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cui-Xia An
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xue-Yi Wang
- Institute of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Vargas TG, Mittal VA. The Critical Roles of Early Development, Stress, and Environment in the Course of Psychosis. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:423-445. [PMID: 36712999 PMCID: PMC9879333 DOI: 10.1146/annurev-devpsych-121020-032354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Psychotic disorders are highly debilitating with poor prognoses and courses of chronic illness. In recent decades, conceptual models have shaped understanding, informed treatment, and guided research questions. However, these models have classically focused on the adolescent and early adulthood stages immediately preceding onset while conceptualizing early infancy through all of childhood as a unitary premorbid period. In addition, models have paid limited attention to differential effects of types of stress; contextual factors such as local, regional, and country-level characteristics or sociocultural contexts; and the timing of the stressor or environmental risk. This review discusses emerging research suggesting that (a) considering effects specific to neurodevelopmental stages prior to adolescence is highly informative, (b) understanding specific stressors and levels of environmental exposures (i.e., systemic or contextual features) is necessary, and (c) exploring the dynamic interplay between development, levels and types of stressors, and environments can shed new light, informing a specified neurodevelopmental and multifaceted diathesis-stress model.
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Affiliation(s)
- T G Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - V A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Departments of Psychiatry and Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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Schneider M, Müller CP, Knies AK. Low income and schizophrenia risk: a narrative review. Behav Brain Res 2022; 435:114047. [PMID: 35933046 DOI: 10.1016/j.bbr.2022.114047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.
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Affiliation(s)
- Miriam Schneider
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria.
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Andrea K Knies
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria
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Selvendra A, Toh WL, Neill E, Tan EJ, Rossell SL, Morgan VA, Castle DJ. Age of onset by sex in schizophrenia: Proximal and distal characteristics. J Psychiatr Res 2022; 151:454-460. [PMID: 35605342 DOI: 10.1016/j.jpsychires.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Earlier schizophrenia onset in men relative to women has been a consistent finding in the literature, but a nuanced understanding of underlying reasons remains elusive. Further consideration should be given to factors associated with sex differences in age of onset. METHOD Participants with schizophrenia were derived from the 2010 Australian Survey of High Impact Psychosis (n = 857). The SHIP survey constituted a representative, population-based study of almost 1.5 million Australian adults seen at various mental health services, and assessed personal health information, psychiatric comorbidities as well as psychosis illness and treatment. Hierarchical clustering was employed to identify age of onset by sex. Within-sex comparisons on distal and proximal factors affecting age of onset were conducted. RESULTS Using modal age, two and three clusters were respectively found in men (early versus late onset) and women (early versus mid versus late onset). Early onset groups in both sexes had an increased family history of psychosis compared to older onset, but other risk factors were not consistent across the sexes. Less premorbid impairment was noted in females with middle to later onset schizophrenia. CONCLUSION These findings further inform our understanding of the pathogenesis of schizophrenia. Added explorations of trends in older onset schizophrenia cohorts is especially important.
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Affiliation(s)
- Ajit Selvendra
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | - Wei Lin Toh
- Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Erica Neill
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eric J Tan
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health (CMH), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, WA, Australia; Centre for Clinical Research in Neuropsychiatry, Medical School, University of Western Australia, Perth, WA, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Huang Z, Zhang B, Liao L, Chen J, Zheng R, Cai D, Huang J. Probiotics improves abnormal behavior and hippocampal injury in pregnant-stressed offspring rats. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:443-452. [PMID: 35545339 PMCID: PMC10930160 DOI: 10.11817/j.issn.1672-7347.2022.210231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES During pregnancy, pregnant women are prone to stress reactions due to external stimuli, affecting their own health and fetal development. At present, there is no good treatment for the stress reactions from pregnant women during pregnancy. This study aims to explore the effect of probiotics on abnormal behavior and hippocampal injury in pregnant stressed offspring. METHODS SD pregnant rats were divided into a control group, a stress group, and a probiotics group, with 6 rats in each group. The control group was untreated; the stress group was given restraint stress on the 15th-20th day of pregnancy; the probiotics group was given both bifidobacterium trisporus capsules and restraint stress on the 15th-20th day of pregnancy, and the offspring continued to be fed with probiotics until 60 days after birth (P60). The offspring rats completed behavioral tests such as the open field test, the elevated plus maze test, the new object recognition test, and the barnes maze test at 60-70 d postnatally. Nissl's staining was used to reflect the injury of hippocampal neurons; immunohistochemical staining was used to detect the expression of microglia marker ionized calcium binding adapter molecule 1 (IBA-1) which can reflect microglia activation; ELISA was used to detect the content of plasma TNF-α and IL-1β; Western blotting was used to detect the expression of Bax, Bcl-2, and caspase-3. RESULTS The retention time of offspring rats in the stress group in the central area of the open field was significantly less than that in the control group (P<0.01), and the retention time of offspring rats in the probiotic group in the central area of the open field was significantly more than that in the stress group (P<0.05). The offspring rats in the stress group stayed in the open arm for a shorter time than the control group (P<0.05) and entered the open arm less often than the control group (P<0.01); the offspring rats in the probiotic group stayed in the open arm for a longer time than the stress group and entered the open arm more often than the stress group (both P<0.05). The discrimination ratio for new to old objects in the offspring rats of the stress group was significantly lower than that of the control group (P<0.01), and the discrimination ratio for new to old objects in the offspring rats of the probiotic group was significantly higher than that of the stress group (P<0.05). The offspring rats in the stress group made significantly more mistakes than the control group (P<0.05), and the offspring rats in the probiotic group made significantly fewer mistakes than the stress group (P<0.05). Compared with the control group, the numbers of Nissl bodies in CA1, CA3, and DG area were significantly reduced in the offspring rats of the stress group (all P<0.001), the number of activated microglia in DG area of hippocampus was significantly increased (P<0.01), the contents of TNF-α and IL-1β in peripheral blood were significantly increased (P<0.05 or P<0.01), the protein expression level of Bcl-2 was significantly down-regulated, and the protein expression levels of Bax and caspase-3 were significantly up-regulated (all P<0.001). Compared with the stress group, the numbers of Nissl bodies in CA1, CA3, and DG area were significantly increased in the probiotic group offspring rats (P<0.001, P<0.01, P<0.05), the number of activated microglia in the DG area of hippocampus was significantly reduced (P<0.05), and the TNF-α and IL-1β levels in peripheral blood were significantly decreased (both P<0.05), the protein expression level of Bcl-2 was significantly up-regulated, and the protein expression levels of Bax and caspase-3 were significantly down-regulated (all P<0.001). CONCLUSIONS Probiotic intervention partially ameliorated anxiety and cognitive impairment in rats offspring of pregnancy stress, and the mechanism may be related to increasing the number of neurons, inhibiting the activation of hippocampal microglia, and reducing inflammation and apoptosis.
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Affiliation(s)
- Zhongjun Huang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013.
| | - Bin Zhang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013
- Shanghai Pharmaceutical Clinical Research Center Co., Ltd., Shanghai 200032
| | - Libin Liao
- Department of Histology and Embryology, Basic Medical College of Xinjiang Medical University, Urumqi 830011, China
| | - Jie Chen
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013
| | - Ruping Zheng
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013
| | - Deyang Cai
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013
| | - Jufang Huang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha 410013.
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Su X, Yu Y, Meng L, Duan T, Zhao Y, László KD, Valdimarsdóttir UA, Hua J, Li J. Prenatal Maternal Bereavement and Its Association With Intellectual Disability in the Offspring. Psychosom Med 2021; 83:887-893. [PMID: 34334730 PMCID: PMC8505139 DOI: 10.1097/psy.0000000000000990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to examine the association of a mother's loss of a close relative before or during pregnancy with intellectual disability (ID) in the offspring. METHODS We performed a nationwide population-based cohort study based on Danish national registries. All live-born singletons born in Denmark during the 1978-2016 period (n = 2,216,601) were followed up starting from birth to 38 years of age. Log-linear Poisson regression was used to estimate the association between maternal bereavement (the death of an older child, a partner, or a parent 1 year before or during pregnancy) and the risk of ID in the offspring. RESULTS Maternal bereavement during or before pregnancy was associated with an increased risk of ID (incidence rate ratio [IRR] = 1.15; 95% confidence interval [CI] = 1.04-1.28). The risk of ID was increased by 27% when maternal bereavement occurred during pregnancy (IRR = 1.27; 95% CI = 1.08-1.49). When stratifying on the child's sex, we also observed an increased risk of ID associated with maternal bereavement during pregnancy both for male (IRR = 1.25; 95% CI = 1.02-1.53) and for female (IRR = 1.31; 95% CI = 1.02-1.69), respectively. The IRRs for unnatural death of a relative were also elevated (IRR = 1.22; 95% CI = 0.91-1.64) in general, although the difference was not statistically significant. CONCLUSIONS Our findings suggest that prenatal stress due to maternal loss of a close relative may increase the risk of offspring's ID of both sexes, in particular when the loss happened during pregnancy.
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12
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Early magnetic resonance imaging biomarkers of schizophrenia spectrum disorders: Toward a fetal imaging perspective. Dev Psychopathol 2021; 33:899-913. [PMID: 32489161 DOI: 10.1017/s0954579420000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is mounting evidence to implicate the intrauterine environment as the initial pathogenic stage for neuropsychiatric disease. Recent developments in magnetic resonance imaging technology are making a multimodal analysis of the fetal central nervous system a reality, allowing analysis of structural and functional parameters. Exposures to a range of pertinent risk factors whether preconception or in utero can now be indexed using imaging techniques within the fetus' physiological environment. This approach may determine the first "hit" required for diseases that do not become clinically manifest until adulthood, and which only have subtle clinical markers during childhood and adolescence. A robust characterization of a "multi-hit" hypothesis may necessitate a longitudinal birth cohort; within this investigative paradigm, the full range of genetic and environmental risk factors can be assessed for their impact on the early developing brain. This will lay the foundation for the identification of novel biomarkers and the ability to devise methods for early risk stratification and disease prevention. However, these early markers must be followed over time: first, to account for neural plasticity, and second, to assess the effects of postnatal exposures that continue to drive the individual toward disease. We explore these issues using the schizophrenia spectrum disorders as an illustrative paradigm. However, given the potential richness of fetal magnetic resonance imaging, and the likely overlap of biomarkers, these concepts may extend to a range of neuropsychiatric conditions.
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13
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Robinson N, Bergen SE. Environmental Risk Factors for Schizophrenia and Bipolar Disorder and Their Relationship to Genetic Risk: Current Knowledge and Future Directions. Front Genet 2021; 12:686666. [PMID: 34262598 PMCID: PMC8273311 DOI: 10.3389/fgene.2021.686666] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
Schizophrenia (SZ) and bipolar disorder (BD) are severe psychiatric disorders which result from complex interplay between genetic and environmental factors. It is well-established that they are highly heritable disorders, and considerable progress has been made identifying their shared and distinct genetic risk factors. However, the 15-40% of risk that is derived from environmental sources is less definitively known. Environmental factors that have been repeatedly investigated and often associated with SZ include: obstetric complications, infections, winter or spring birth, migration, urban living, childhood adversity, and cannabis use. There is evidence that childhood adversity and some types of infections are also associated with BD. Evidence for other risk factors in BD is weaker due to fewer studies and often smaller sample sizes. Relatively few environmental exposures have ever been examined for SZ or BD, and additional ones likely remain to be discovered. A complete picture of how genetic and environmental risk factors confer risk for these disorders requires an understanding of how they interact. Early gene-by-environment interaction studies for both SZ and BD often involved candidate genes and were underpowered. Larger samples with genome-wide data and polygenic risk scores now offer enhanced prospects to reveal genetic interactions with environmental exposures that contribute to risk for these disorders. Overall, although some environmental risk factors have been identified for SZ, few have been for BD, and the extent to which these account for the total risk from environmental sources remains unknown. For both disorders, interactions between genetic and environmental risk factors are also not well understood and merit further investigation. Questions remain regarding the mechanisms by which risk factors exert their effects, and the ways in which environmental factors differ by sex. Concurrent investigations of environmental and genetic risk factors in SZ and BD are needed as we work toward a more comprehensive understanding of the ways in which these disorders arise.
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Affiliation(s)
| | - Sarah E. Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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14
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St Clair D, Lang B. Schizophrenia: a classic battle ground of nature versus nurture debate. Sci Bull (Beijing) 2021; 66:1037-1046. [PMID: 36654248 DOI: 10.1016/j.scib.2021.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/29/2020] [Accepted: 10/13/2020] [Indexed: 01/20/2023]
Abstract
Much has been learned about the etiology and pathogenesis of schizophrenia since the term was first used by Eugene Bleuler over a century ago to describe one of the most important forms of major mental illness to affect mankind. Both nature and nurture feature prominently in our understanding of the genesis of the overall risk of developing schizophrenia. We now have a firm grasp of the broad structure of the genetic architecture and several key environmental risk factors have been identified and delineated. However, much of the heritability of schizophrenia remains unexplained and the reported environmental risk factors do not explain all the variances not attributable to genetic risk factors. The biggest problem at present is that our understanding of the causal mechanisms involved is still in its infancy. In this review, we describe the extent and limits of our knowledge of the specific genetic/constitutional and non-genetic/environmental factors that contribute to the overall risk of schizophrenia. We suggest novel methods may be required to understand the almost certainly immensely complex multi-level causal mechanisms that contribute to the generation of the schizophrenia phenotype.
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Affiliation(s)
- David St Clair
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, National Clinical Research Center for Mental Disorders, Changsha 410011, China; Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; Bio-X Life Science Research Center, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Bing Lang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, National Clinical Research Center for Mental Disorders, Changsha 410011, China; Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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15
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Demaria F, Vicari S. COVID-19 quarantine: Psychological impact and support for children and parents. Ital J Pediatr 2021; 47:58. [PMID: 33750452 PMCID: PMC7941406 DOI: 10.1186/s13052-021-01005-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 01/25/2023] Open
Abstract
In response to the coronavirus (COVID-19) pandemic, national governments have imposed urgent sanitary and social measures to control the spread of the virus. One such measure is quarantine, which involves restricting people’s movement through the isolation of infected or suspected infected individuals in order to reduce the risk of new infections. Research has shown that quarantine is a psychologically stressful experience. With respect to children, lack of school and interruptions to daily routines could have a negative impact on their physical and mental health. Parents may also pass their psychological distress to children and practice inappropriate parenting behaviors, which could contribute to the development of post-traumatic stress symptoms in children. In order to prevent these negative outcomes, governments must carefully consider any their decision to impose quarantine and family social care services must work together with children’s mental health services to ensure that the experience is as tolerable and safe as possible.
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Affiliation(s)
- Francesco Demaria
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli, 41, 00146, Rome, Italy.
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli, 41, 00146, Rome, Italy.,Department of Life Sciences and Public Health, Catholic University, 00168, Rome, Italy
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16
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Paquin V, Lapierre M, Veru F, King S. Early Environmental Upheaval and the Risk for Schizophrenia. Annu Rev Clin Psychol 2021; 17:285-311. [PMID: 33544627 DOI: 10.1146/annurev-clinpsy-081219-103805] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Why does prenatal exposure to wars, natural disasters, urbanicity, or winter increase the risk for schizophrenia? Research from the last two decades has provided rich insight about the underlying chains of causation at play during environmental upheaval, from conception to early infancy. In this review, we appraise the evidence linking schizophrenia spectrum disorder to prenatal maternal stress, obstetric complications, early infections, and maternal nutrition and other lifestyle factors. We discuss putative mechanisms, including the maternal stress system, perinatal hypoxia, and maternal-offspring immune activation. We propose that gene-environment interactions, timing during development, and sex differentiate the neuropsychiatric outcomes. Future research should pursue the translation of animal studies to humans and the longitudinal associations between early exposures, intermediate phenotypes, and psychiatric disorders. Finally, to paint a comprehensive model of risk and to harness targets for prevention, we argue that risk factors should be situated within the individual's personal ecosystem.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Mylène Lapierre
- Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
| | - Franz Veru
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
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17
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Rodriguez V, Alameda L, Trotta G, Spinazzola E, Marino P, Matheson SL, Laurens KR, Murray RM, Vassos E. Environmental Risk Factors in Bipolar Disorder and Psychotic Depression: A Systematic Review and Meta-Analysis of Prospective Studies. Schizophr Bull 2021; 47:959-974. [PMID: 33479726 PMCID: PMC8266635 DOI: 10.1093/schbul/sbaa197] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to study the association between specific environmental risk factors (ERF) and later development of Bipolar disorder and Psychotic depression. METHODS A systematic search of prospective studies was conducted in MEDLINE, EMBASE and PsycINFO databases, and supplemented by hand searching, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42018092253). Selected ERF included: pre-/peri-natal factors-paternal age at birth, maternal infection, obstetric complications, perinatal stress; early childhood factors-urbanicity at birth, childhood infection, childhood adversity; later life factors-substance misuse, ethnic minority and migration, urbanicity later in life, stressful life events, and traumatic head injury. Pooled effect sizes of the association between these ERF and affective psychoses were calculated from systematically selected studies. When studies examining each ERF were insufficient for meta-analysis, results were presented narratively. RESULTS Forty-six studies were included for quantitative analyses among selected ERF for affective psychosis, with significant association found for paternal age >40 years (OR 1.17, 95%CI 1.12-1.23), early (OR 1.52, 95%CI 1.07-2.17) and late (OR 1.32, 95%CI 1.05-1.67) gestational age, childhood adversity (OR 1.33, 95%CI 1.18-1.50), substance misuse (OR 2.87, 95%CI 1.63-5.50), and being from an ethnic minority (OR 1.99, 95%CI 1.39-2.84). CONCLUSIONS These results suggest some shared environmental load between non-affective and affective psychosis, implying generalized risks for psychosis rather than for specific diagnostic categories. Nonetheless, published studies for some ERF in the affective psychoses are scarce, and further longitudinal studies are needed.
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Affiliation(s)
- Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK,To whom correspondence should be addressed; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London (Denmark Hill Campus), 16 De Crespigny Park, Camberwell, London SE5 8AF, UK; tel: +447-835-076-503, e-mail:
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK,Instituto de Investigación Sanitaria de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Seville, Spain,Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Giulia Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK
| | - Paolo Marino
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK
| | - Sandra L Matheson
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, Australia
| | - Kristin R Laurens
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK,School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience. King’s College of London, London, UK
| | - Evangelos Vassos
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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18
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van Steenwyk G, Gapp K, Jawaid A, Germain P, Manuella F, Tanwar DK, Zamboni N, Gaur N, Efimova A, Thumfart KM, Miska EA, Mansuy IM. Involvement of circulating factors in the transmission of paternal experiences through the germline. EMBO J 2020; 39:e104579. [PMID: 33034389 PMCID: PMC7705452 DOI: 10.15252/embj.2020104579] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Environmental factors can change phenotypes in exposed individuals and offspring and involve the germline, likely via biological signals in the periphery that communicate with germ cells. Here, using a mouse model of paternal exposure to traumatic stress, we identify circulating factors involving peroxisome proliferator-activated receptor (PPAR) pathways in the effects of exposure to the germline. We show that exposure alters metabolic functions and pathways, particularly lipid-derived metabolites, in exposed fathers and their offspring. We collected data in a human cohort exposed to childhood trauma and observed similar metabolic alterations in circulation, suggesting conserved effects. Chronic injection of serum from trauma-exposed males into controls recapitulates metabolic phenotypes in the offspring. We identify lipid-activated nuclear receptors PPARs as potential mediators of the effects from father to offspring. Pharmacological PPAR activation in vivo reproduces metabolic dysfunctions in the offspring and grand-offspring of injected males and affects the sperm transcriptome in fathers and sons. In germ-like cells in vitro, both serum and PPAR agonist induce PPAR activation. Together, these results highlight the role of circulating factors as potential communication vectors between the periphery and the germline.
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Affiliation(s)
- Gretchen van Steenwyk
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
| | - Katharina Gapp
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
- Laboratory of Molecular and Behavioral NeuroscienceETH ZurichZurichSwitzerland
- Gurdon InstituteUniversity of CambridgeCambridgeUK
- Wellcome Trust Sanger InstituteHinxtonUK
- Department of GeneticsUniversity of CambridgeCambridgeUK
| | - Ali Jawaid
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
- Laboratory of Translational Research in Neuropsychiatric DisordersBRAINCITY Nencki‐EMBL Center of Excellence for Neural Plasticity and Brain DisordersWarsawPoland
| | - Pierre‐Luc Germain
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Statistical Bioinformatics GroupSwiss Institute of BioinformaticsZürichSwitzerland
| | - Francesca Manuella
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
| | - Deepak K Tanwar
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
- Statistical Bioinformatics GroupSwiss Institute of BioinformaticsZürichSwitzerland
| | - Nicola Zamboni
- Institute of Molecular Systems BiologyETH ZurichZurichSwitzerland
| | - Niharika Gaur
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
| | - Anastasiia Efimova
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
| | - Kristina M Thumfart
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
| | - Eric A Miska
- Gurdon InstituteUniversity of CambridgeCambridgeUK
- Wellcome Trust Sanger InstituteHinxtonUK
- Department of GeneticsUniversity of CambridgeCambridgeUK
| | - Isabelle M Mansuy
- Laboratory of NeuroepigeneticsBrain Research InstituteMedical Faculty of the University of ZurichZurichSwitzerland
- Institute for NeuroscienceDepartment of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Zurich Neuroscience CenterETH Zurich and University of ZurichZurichSwitzerland
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19
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Ramadhan MHA, Putri AK, Melinda D, Habibah U, Fajriyah UN, Aini S, Prananjaya BA, Ikhsan DS. Children's Mental Health in the Time of COVID-19: How Things Stand and the Aftermath. Malays J Med Sci 2020; 27:196-201. [PMID: 33154711 PMCID: PMC7605835 DOI: 10.21315/mjms2020.27.5.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
Currently, the world is facing immediate and unexpected changes every day due to the coronavirus disease 2019 (COVID-19) pandemic. These environmental stimulations have an impact on mental health, particularly in the case of children. Worldwide measures such as quarantine, social and physical distancing, and school closure can potentially take a toll on children’s mental health, in both the short and long terms. Grief, adjustment disorder and acute stress disorder (ASD) are some of the mental health issues that children are prone to suffer during a pandemic, leading to mood disorder, psychosis and even suicidal tendency, if not addressed and treated timely. As the pandemic continues, it is crucial to monitor children’s mental health status. Parents/caregivers must receive continuous guidance on handling the situation appropriately. Both professionals and families/caregivers must tend to children’s mental health needs to safeguard their overall well-being.
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Affiliation(s)
| | | | - Diana Melinda
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Umrohtul Habibah
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | | | - Syarifah Aini
- Department of Psychiatry, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | | | - Diyaz Syauqi Ikhsan
- Department of Psychiatry, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
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20
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Reddaway J, Brydges NM. Enduring neuroimmunological consequences of developmental experiences: From vulnerability to resilience. Mol Cell Neurosci 2020; 109:103567. [PMID: 33068720 PMCID: PMC7556274 DOI: 10.1016/j.mcn.2020.103567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
The immune system is crucial for normal neuronal development and function (neuroimmune system). Both immune and neuronal systems undergo significant postnatal development and are sensitive to developmental programming by environmental experiences. Negative experiences from infection to psychological stress at a range of different time points (in utero to adolescence) can permanently alter the function of the neuroimmune system: given its prominent role in normal brain development and function this dysregulation may increase vulnerability to psychiatric illness. In contrast, positive experiences such as exercise and environmental enrichment are protective and can promote resilience, even restoring the detrimental effects of negative experiences on the neuroimmune system. This suggests the neuroimmune system is a viable therapeutic target for treatment and prevention of psychiatric illnesses, especially those related to stress. In this review we will summarise the main cells, molecules and functions of the immune system in general and with specific reference to central nervous system development and function. We will then discuss the effects of negative and positive environmental experiences, especially during development, in programming the long-term functioning of the neuroimmune system. Finally, we will review the sparse but growing literature on sex differences in neuroimmune development and response to environmental experiences. The immune system is essential for development and function of the central nervous system (neuroimmune system) Environmental experiences can permanently alter neuroimmune function and associated brain development Altered neuroimmune function following negative developmental experiences may play a role in psychiatric illnesses Positive experiences can promote resilience and rescue the effects of negative experiences on the neuroimmune system The neuroimmune system is therefore a viable therapeutic target for preventing and treating psychiatric illnesses
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Affiliation(s)
- Jack Reddaway
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Nichola M Brydges
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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21
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Brydges NM, Reddaway J. Neuroimmunological effects of early life experiences. Brain Neurosci Adv 2020; 4:2398212820953706. [PMID: 33015371 PMCID: PMC7513403 DOI: 10.1177/2398212820953706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
Exposure to adverse experiences during development increases the risk of psychiatric illness later in life. Growing evidence suggests a role for the neuroimmune system in this relationship. There is now substantial evidence that the immune system is critical for normal brain development and behaviour, and responds to environmental perturbations experienced early in life. Severe or chronic stress results in dysregulated neuroimmune function, concomitant with abnormal brain morphology and function. Positive experiences including environmental enrichment and exercise exert the opposite effect, promoting normal brain and immune function even in the face of early life stress. The neuroimmune system may therefore provide a viable target for prevention and treatment of psychiatric illness. This review will briefly summarise the neuroimmune system in brain development and function, and review the effects of stress and positive environmental experiences during development on neuroimmune function. There are also significant sex differences in how the neuroimmune system responds to environmental experiences early in life, which we will briefly review.
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Affiliation(s)
- Nichola M Brydges
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Jack Reddaway
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
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22
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Ghosh R, Dubey MJ, Chatterjee S, Dubey S. Impact of COVID -19 on children: special focus on the psychosocial aspect. Minerva Pediatr 2020; 72:226-235. [DOI: 10.23736/s0026-4946.20.05887-9] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:347-349. [PMID: 32224303 PMCID: PMC7118598 DOI: 10.1016/s2352-4642(20)30096-1] [Citation(s) in RCA: 379] [Impact Index Per Article: 94.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Jia Jia Liu
- Peking University Health Science Center, Peking University, Beijing 100191, China,National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Yanping Bao
- Peking University Health Science Center, Peking University, Beijing 100191, China,National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Xiaolin Huang
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Jie Shi
- Peking University Health Science Center, Peking University, Beijing 100191, China,National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Lin Lu
- Institute of Mental Health, Peking University Sixth Hospital and National Clinical Research Center for Mental Disorders, Peking University, Beijing 100191, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100191, China; International Data Group/Mcgovern Institute for Brain Research at Peking University, Peking University, Beijing 100191, China.
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Ellman LM, Murphy SK, Maxwell SD, Calvo EM, Cooper T, Schaefer CA, Bresnahan MA, Susser ES, Brown AS. Maternal cortisol during pregnancy and offspring schizophrenia: Influence of fetal sex and timing of exposure. Schizophr Res 2019; 213:15-22. [PMID: 31345704 PMCID: PMC7074891 DOI: 10.1016/j.schres.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Maternal stress during pregnancy has been repeatedly linked to increased risk for schizophrenia; however, no study has examined maternal cortisol during pregnancy and risk for the disorder. Study aims were to determine whether prenatal cortisol was associated with risk for schizophrenia and risk for an intermediate phenotype-decreased fetal growth-previously linked to prenatal cortisol and schizophrenia. Timing of exposure and fetal sex also were examined given previous findings. METHODS Participants were 64 cases diagnosed with schizophrenia spectrum disorders (SSD) and 117 controls from a prospective birth cohort study. Maternal cortisol was determined from stored sera from each trimester and psychiatric diagnoses were assessed from offspring using semi-structured interviews and medical records review. RESULTS Maternal cortisol during pregnancy was not associated with risk for offspring schizophrenia. There was a significant interaction between 3rd trimester cortisol and case status on fetal growth. Specifically, cases exposed to higher 3rd trimester maternal cortisol had significantly decreased fetal growth compared to controls. In addition, these findings were restricted to male offspring. CONCLUSIONS Our results indicate that higher prenatal cortisol is associated with an intermediate phenotype linked to schizophrenia, fetal growth, but only among male offspring who developed schizophrenia. Findings were consistent with evidence that schizophrenia genes may disrupt placental functioning specifically for male fetuses, as well as findings that males are more vulnerable to maternal cortisol during pregnancy. Finally, results suggest that examining fetal sex and intermediate phenotypes may be important in understanding the mechanisms involved in prenatal contributors to schizophrenia.
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Affiliation(s)
- Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Seth D Maxwell
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Evan M Calvo
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Thomas Cooper
- Analytic Psychopharmacology, Nathan S. Kline Institute, 140 Old Orangeburg Road Orangeburg, NY 10962, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Catherine A Schaefer
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Michaeline A Bresnahan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Ezra S Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Alan S Brown
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
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Lipner E, Murphy SK, Ellman LM. Prenatal Maternal Stress and the Cascade of Risk to Schizophrenia Spectrum Disorders in Offspring. Curr Psychiatry Rep 2019; 21:99. [PMID: 31522269 PMCID: PMC7043262 DOI: 10.1007/s11920-019-1085-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Disruptions in fetal development (via genetic and environmental pathways) have been consistently associated with risk for schizophrenia in a variety of studies. Although multiple obstetric complications (OCs) have been linked to schizophrenia, this review will discuss emerging evidence supporting the role of prenatal maternal stress (PNMS) in the etiology of schizophrenia spectrum disorders (SSD). In addition, findings linking PNMS to intermediate phenotypes of the disorder, such as OCs and premorbid cognitive, behavioral, and motor deficits, will be reviewed. Maternal immune and endocrine dysregulation will also be explored as potential mechanisms by which PNMS confers risk for SSD. RECENT FINDINGS PNMS has been linked to offspring SSD; however, findings are mixed due to inconsistent and retrospective assessments of PNMS and lack of specificity about SSD outcomes. PNMS is also associated with various intermediate phenotypes of SSD (e.g., prenatal infection/inflammation, decreased fetal growth, hypoxia-related OCs). Recent studies continue to elucidate the impact of PNMS while considering the moderating roles of fetal sex and stress timing, but it is still unclear which aspects of PNMS (e.g., type, timing) confer risk for SSD specifically. PNMS increases risk for SSD, but only in a small portion of fetuses exposed to PNMS. Fetal sex, genetics, and other environmental factors, as well as additional pre- and postnatal insults, likely contribute to the PNMS-SSD association. Longitudinal birth cohort studies are needed to prospectively illuminate the mechanisms that account for the variability in outcomes following PNMS.
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Affiliation(s)
- Emily Lipner
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA.
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Early Parental Death and Risk of Psychosis in Offspring: A Six-Country Case-Control Study. J Clin Med 2019; 8:jcm8071081. [PMID: 31340495 PMCID: PMC6679091 DOI: 10.3390/jcm8071081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
Evidence for early parental death as a risk factor for psychosis in offspring is inconclusive. We analyzed data from a six-country, case-control study to examine the associations of early parental death, type of death (maternal, paternal, both), and child’s age at death with psychosis, both overall and by ethnic group. In fully adjusted multivariable mixed-effects logistic regression models, experiencing early parental death was associated with 1.54-fold greater odds of psychosis (95% confidence interval (CI): 1.23, 1.92). Experiencing maternal death had 2.27-fold greater odds (95% CI: 1.18, 4.37), paternal death had 1.14-fold greater odds (95% CI: 0.79, 1.64), and both deaths had 4.42-fold greater odds (95% CI: 2.57, 7.60) of psychosis compared with no early parental death. Experiencing parental death between 11 and 16 years of age had 2.03-fold greater odds of psychosis than experiencing it before five years of age (95% CI: 1.02, 4.04). In stratified analyses, experiencing the death of both parents had 9.22-fold greater odds of psychosis among minority ethnic groups (95% CI: 2.02–28.02) and no elevated odds among the ethnic majority (odds ratio (OR): 0.96; 95% CI: 0.10–8.97), which could be due in part to the higher prevalence of early parental death among minority ethnic groups but should be interpreted cautiously given the wide confidence intervals.
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Abel KM, Heuvelman H, Rai D, Timpson NJ, Sarginson J, Shallcross R, Mitchell H, Hope H, Emsley R. Intelligence in offspring born to women exposed to intimate partner violence: a population-based cohort study. Wellcome Open Res 2019; 4:107. [PMID: 31681855 PMCID: PMC6820818 DOI: 10.12688/wellcomeopenres.15270.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Intimate partner violence (IPV) is a risk factor for developmental problems in offspring. Despite a high prevalence of IPV in the UK and elsewhere, the longer-term outcomes of offspring born to exposed mothers remain under-researched. Methods: Population-based cohort study. We assessed IPV prevalence by type and timing for 3,153 mother-child pairs with complete data within our study population and examined associations between IPV and offspring IQ. We used multiple-imputation to evaluate bias due to our exclusion of observations with missing covariate data. Results: Nearly one in five mothers reported IPV during the study period, with 17.6% reporting emotional violence and 6.8% reporting physical violence. Taking into account potential confounders, the IQ scores of children born to mothers exposed to physical violence remained lower than those of maternally unexposed children (full-scale IQ = -2.8 points [95%CI -4.9 to -0.7], verbal IQ = -2.2 [95%CI -4.4 to -0.1], performance IQ = -2.7 [95%CI -5.0 to -0.5]) and odds of below-average intelligence (IQ<90) remained increased for full-scale (OR 1.48 [95%CI 1.03 to 2.14] and performance IQ (OR 1.48 [95%CI 1.08 to 2.04]) but not verbal IQ (OR 1.06 [95%CI 0.69 to 1.64]). Most physical violence occurred postnatally, and relative odds were most substantial when mothers were exposed to violence across pre-/perinatal and postnatal study periods (OR performance IQ<90 = 2.97 [95%CI 1.30 to 6.82]). Conclusions: Maternal exposure to physical IPV is associated with lower offspring IQ at age 8. Associations persisted after adjusting for potential confounders and were driven by violence occurring postnatally.
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Affiliation(s)
- Kathryn M Abel
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Rd, Prestwich, Manchester, M25 3BL, UK
| | - Hein Heuvelman
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Avon & Wiltshire Mental Health Partnership NHS Trust, Jenner House, Langley Park, Chippenham, SN15 1GG, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jane Sarginson
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
| | - Rebekah Shallcross
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Heather Mitchell
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Rd, Prestwich, Manchester, M25 3BL, UK
| | - Holly Hope
- Centre for Women’s Mental Health, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Richard Emsley
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Song M, Wang L, Zhao XC, Li N, Wang R, Gao YY, Yu LL, An CX, Wang XY. The prevalence and risk of DSM-IV axis I disorder in adults with early-life earthquake stress: A cross-sectional study. Int J Dev Neurosci 2019; 76:65-71. [PMID: 31229525 DOI: 10.1016/j.ijdevneu.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Tangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976. In the present study, we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period. METHODS This cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan, Hebei province, 2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size. We recruited subjects who were born between July 29, 1975 and April 28, 1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake, respectively. Current psychiatric diagnoses and lifetime psychiatric diagnoses were obtained through the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Research Version. Unconditional logistic regression analysis was performed to analyze risk factors of mental disorders. RESULTS Totally1380 subjects were included with 392 subjects exposed to the earthquake in the fetal period, 399 subjects who experienced the earthquake during their infancy, and 589 subjects who had no exposure to the earthquake. Twenty-one (2.7%; current 1.9%) subjects exposed to earthquake were diagnosed with major depressive disorderversus 2.3% (current 1.5%) in the non-exposure group. Five (0.6%; current 0.6%) subjects with exposure to earthquake had bipolar disorder versus 0.9% in the non-exposure group.Thirteen (1.6%; current 1.6%) subjects with exposure to earthquake had schizophreniaversus 0.2% in the non-exposure group (P=0.006). Furthermore, 5.2% (current 3.7%) subjects with exposure to earthquake had anxiety disorders versus 5.7% (current 3.9%) in the non-exposure group. Moreover, 8.1% (current 7.0%)subjects with exposure to earthquake had alcohol use disorders versus 7.1% (current 5.3%) in the non-exposure group. Furthermore, the prevalence of schizophrenia of the prenatal exposure group (2.3%) was significantly higher than the other two groups (χ2 = 10.273, P = 0.006); however, no statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders among the three groups (P > 0.05). Our multivariate regression analysis showed that prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders. CONCLUSION Adults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy. No statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders between those exposed and those not exposed to earthquake. Furthermore, prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.
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Affiliation(s)
- Mei Song
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Lan Wang
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Xiao-Chuan Zhao
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Na Li
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Ran Wang
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Yuan-Yuan Gao
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Lu-Lu Yu
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Cui-Xia An
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
| | - Xue-Yi Wang
- Department of Psychiatry, First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, Shijiazhuang, China
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Hantsoo L, Kornfield S, Anguera MC, Epperson CN. Inflammation: A Proposed Intermediary Between Maternal Stress and Offspring Neuropsychiatric Risk. Biol Psychiatry 2019; 85:97-106. [PMID: 30314641 PMCID: PMC6309506 DOI: 10.1016/j.biopsych.2018.08.018] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/03/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
During pregnancy, programming of the fetal central nervous system establishes vulnerabilities for emergence of neuropsychiatric phenotypes later in life. Psychosocial influences during pregnancy, such as stressful life events and chronic stress, correlate with offspring neuropsychiatric disorders and inflammation, respectively. Stress promotes inflammation, but the role of inflammation as a mediator between maternal psychosocial stress and offspring neuropsychiatric outcomes has not been extensively studied in humans. This review summarizes clinical evidence linking specific types of stress to maternal inflammatory load during pregnancy. We propose that inflammation is a mediator in the relationship between psychosocial stress and offspring neuropsychiatric outcomes, potentially influenced by poor maternal glucocorticoid-immune coordination. We present relevant experimental animal research supporting this hypothesis. We conclude that clinical and preclinical research supports the premise that stress-induced maternal immune activation contributes in part to prenatal programming of risk. Programming of risk is likely due to a combination of vulnerabilities, including multiple or repeated inflammatory events; timing of such events; poor maternal regulation of inflammation; genetic vulnerability; and lifestyle contributors.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Sara Kornfield
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Montserrat C Anguera
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Schepanski S, Buss C, Hanganu-Opatz IL, Arck PC. Prenatal Immune and Endocrine Modulators of Offspring's Brain Development and Cognitive Functions Later in Life. Front Immunol 2018; 9:2186. [PMID: 30319639 PMCID: PMC6168638 DOI: 10.3389/fimmu.2018.02186] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022] Open
Abstract
Milestones of brain development in mammals are completed before birth, which provide the prerequisite for cognitive and intellectual performances of the offspring. Prenatal challenges, such as maternal stress experience or infections, have been linked to impaired cognitive development, poor intellectual performances as well as neurodevelopmental and psychiatric disorders in the offspring later in life. Fetal microglial cells may be the target of such challenges and could be functionally modified by maternal markers. Maternal markers can cross the placenta and reach the fetus, a phenomenon commonly referred to as “vertical transfer.” These maternal markers include hormones, such as glucocorticoids, and also maternal immune cells and cytokines, all of which can be altered in response to prenatal challenges. Whilst it is difficult to discriminate between the maternal or fetal origin of glucocorticoids and cytokines in the offspring, immune cells of maternal origin—although low in frequency—can be clearly set apart from offspring's cells in the fetal and adult brain. To date, insights into the functional role of these cells are limited, but it is emergingly recognized that these maternal microchimeric cells may affect fetal brain development, as well as post-natal cognitive performances and behavior. Moreover, the inheritance of vertically transferred cells across generations has been proposed, yielding to the presence of a microchiome in individuals. Hence, it will be one of the scientific challenges in the field of neuroimmunology to identify the functional role of maternal microchimeric cells as well as the brain microchiome. Maternal microchimeric cells, along with hormones and cytokines, may induce epigenetic changes in the fetal brain. Recent data underpin that brain development in response to prenatal stress challenges can be altered across several generations, independent of a genetic predisposition, supporting an epigenetic inheritance. We here discuss how fetal brain development and offspring's cognitive functions later in life is modulated in the turnstile of prenatal challenges by introducing novel and recently emerging pathway, involving maternal hormones and immune markers.
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Affiliation(s)
- Steven Schepanski
- Laboratory of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Developmental Neurophysiology, Institute of Neuroanatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Buss
- Institute of Medical Psychology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Development, Health, and Disease Research Program, University of California, Irvine, Orange, CA, United States
| | - Ileana L Hanganu-Opatz
- Developmental Neurophysiology, Institute of Neuroanatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra C Arck
- Laboratory of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Weinstein Y, Levav I, Gelkopf M, Roe D, Yoffe R, Pugachova I, Levine SZ. Association of maternal exposure to terror attacks during pregnancy and the risk of schizophrenia in the offspring: A population-based study. Schizophr Res 2018; 199:163-167. [PMID: 29685420 DOI: 10.1016/j.schres.2018.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 01/12/2023]
Abstract
This study tested the hypothesis that maternal exposure to terror attacks during pregnancy is associated with the risk of schizophrenia in the offspring. A population-based study was conducted of Israeli children born between 1975 and 1995 and that were registered in the Ministry of Interior and followed up in the Ministry of Health from birth to 2015 for the risk of schizophrenia (N = 201,048). The association between maternal exposure to terror attacks during pregnancy and the risk of schizophrenia in the offspring was quantified with relative risks (RR) and their 95% confidence intervals (CI) fitting Cox regression models unadjusted and adjusted for confounders. Sensitivity analyses were performed to test the robustness of the results. The RR of schizophrenia in offspring of mothers exposed to terror attacks during pregnancy compared to offspring of mothers not exposed during pregnancy were estimated unadjusted (RR = 2.51, 95% CI, 1.33, 4.74) and adjusted (RR = 2.53, 95% CI, 1.63, 3.91). In the sensitivity analyses adjusted RRs were estimated using a sibling-based study design (2.85, 95% CI: 1.31-6.21) and propensity matching (2.45, 95% CI: 1.58-3.81). Maternal exposure to terror attacks during pregnancy was associated with an increased risk of schizophrenia in the offspring, possibly indicating a critical period of neurodevelopment that is sensitive to the stress of terror attacks and affected by epigenetic modifications.
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Affiliation(s)
- Yael Weinstein
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rinat Yoffe
- Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
| | - Inna Pugachova
- Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Coughlan H, Cannon M. Does childhood trauma play a role in the aetiology of psychosis? A review of recent evidence. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.116.015891] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SummaryThere has been a resurgence of interest in the role of childhood trauma in the aetiology of psychosis. In this review, recent findings on the association between childhood trauma and a continuum of psychotic symptoms are presented. Evidence of the association between specific childhood trauma subtypes and psychotic symptoms is examined, with a brief discussion of some current hypotheses about the potential mechanisms underlying the associations that have been found. Some practice implications of these findings are also highlighted.Learning Objectives• Identify findings from recent meta-analyses on the association between childhood trauma and a range of psychotic outcomes, from non-clinical psychotic experiences to psychotic disorders• Consider which childhood traumas are the most potent in the context of psychotic outcomes• Recognise that the relationships between childhood trauma, psychotic symptoms and other psychopathology are complex, dynamic and multidimensional
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Abbott PW, Gumusoglu SB, Bittle J, Beversdorf DQ, Stevens HE. Prenatal stress and genetic risk: How prenatal stress interacts with genetics to alter risk for psychiatric illness. Psychoneuroendocrinology 2018; 90:9-21. [PMID: 29407514 DOI: 10.1016/j.psyneuen.2018.01.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/20/2018] [Accepted: 01/21/2018] [Indexed: 02/07/2023]
Abstract
Risk for neuropsychiatric disorders is complex and includes an individual's internal genetic endowment and their environmental experiences and exposures. Embryonic development captures a particularly complex period, in which genetic and environmental factors can interact to contribute to risk. These environmental factors are incorporated differently into the embryonic brain than postnatal one. Here, we comprehensively review the human and animal model literature for studies that assess the interaction between genetic risks and one particular environmental exposure with strong and complex associations with neuropsychiatric outcomes-prenatal maternal stress. Gene-environment interaction has been demonstrated for stress occurring during childhood, adolescence, and adulthood. Additional work demonstrates that prenatal stress risk may be similarly complex. Animal model studies have begun to address some underlying mechanisms, including particular maternal or fetal genetic susceptibilities that interact with stress exposure and those that do not. More specifically, the genetic underpinnings of serotonin and dopamine signaling and stress physiology mechanisms have been shown to be particularly relevant to social, attentional, and internalizing behavioral changes, while other genetic factors have not, including some growth factor and hormone-related genes. Interactions have reflected both the diathesis-stress and differential susceptibility models. Maternal genetic factors have received less attention than those in offspring, but strongly modulate impacts of prenatal stress. Priorities for future research are investigating maternal response to distinct forms of stress and developing whole-genome methods to examine the contributions of genetic variants of both mothers and offspring, particularly including genes involved in neurodevelopment. This is a burgeoning field of research that will ultimately contribute not only to a broad understanding of psychiatric pathophysiology but also to efforts for personalized medicine.
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Affiliation(s)
- Parker W Abbott
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA.
| | - Serena B Gumusoglu
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA.
| | - Jada Bittle
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA.
| | - David Q Beversdorf
- Interdisciplinary Neuroscience Program, Interdisciplinary Intercampus Research Program, Thompson Center for Autism and Neurodevelopment Disorders, Departments of Radiology, Neurology and Psychological Sciences, University of Missouri, Columbia, MO, USA.
| | - Hanna E Stevens
- Department of Psychiatry, University of Iowa Carver College of Medicine, 1310 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA, 52242, USA; Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, 2312 PBDB, 169 Newton Rd., Iowa City, IA, 52246, USA.
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Maxwell SD, Fineberg AM, Drabick DA, Murphy SK, Ellman LM. Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 46:381-397. [PMID: 28393324 PMCID: PMC5828524 DOI: 10.1007/s10802-017-0299-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of "high-risk" individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their "low-risk" counterparts.
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Affiliation(s)
- Seth D Maxwell
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Anna M Fineberg
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Deborah A Drabick
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Shannon K Murphy
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
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Lindgren M, Mäntylä T, Rikandi E, Torniainen-Holm M, Morales-Muñoz I, Kieseppä T, Mantere O, Suvisaari J. Childhood adversities and clinical symptomatology in first-episode psychosis. Psychiatry Res 2017; 258:374-381. [PMID: 28867407 DOI: 10.1016/j.psychres.2017.08.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 11/28/2022]
Abstract
In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with psychotic disorders and have an effect on symptomatology and functioning. We explored eleven negative childhood experiences and their influence on clinical symptoms among young adults with first-episode psychosis (FEP, n = 75) and matched population controls (n = 51). Individuals with FEP reported more adversities than controls. Specifically serious conflicts within the family, bullying at school, maternal mental health problems, and one's own and parents' serious illness during childhood were experienced by the patients more often than by controls. In the FEP group, the severity of adversity was associated with increased anxiety, manic, and obsessive-compulsive symptoms, but not with the severity of positive psychotic symptoms. Adversity produced a more pronounced effect on symptoms in male patients than in female patients. To conclude, in line with earlier studies of more chronic psychosis, a majority of the participants with FEP reported exposure to childhood adversities, with the FEP group reporting more adversities than controls. High levels of mood and anxiety symptoms in patients with FEP may be related to cumulative exposure to childhood adversities. This should be taken into account in the treatment for FEP.
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Affiliation(s)
- Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Minna Torniainen-Holm
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Isabel Morales-Muñoz
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, McGill University, Montréal, QC, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
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Debost JC, Debost M, Grove J, Mors O, Hougaard DM, Børglum AD, Mortensen PB, Petersen L. COMT Val158Met and MTHFR C677T moderate risk of schizophrenia in response to childhood adversity. Acta Psychiatr Scand 2017; 136:85-95. [PMID: 28556887 DOI: 10.1111/acps.12761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Mesolimbic dopamine sensitization has been hypothesized to be a mediating factor of childhood adversity (CA) on schizophrenia risk. Activity of catechol-O-methyltransferase (COMT) Val158Met increases mesolimbic dopamine signaling and may be further regulated by methylenetetrahydrofolate reductase (MTHFR) C677T. This study investigates the three-way interaction between CA, COMT, and MTHFR. METHODS We conducted a nested case-control study on individuals born after 1981, linking population-based registers to study the three-way interaction. We included 1699 schizophrenia cases and 1681 controls, and used conditional logistic regression to report incidence rate ratios (IRRs). RESULTS Childhood adversity was robustly associated with schizophrenia. No main genetic effects were observed. MTHFR C677T increased schizophrenia risk in a dose-dependent manner per MTHFR T allele (P = 0.005) consequent upon CA exposure. After inclusion of the significant (P = 0.03) COMT × MTHFR × CA interaction, the risk was further increased per high-activity COMT Val allele. Hence, exposed COMT Val/Val and MTHFR T/T carriers had an IRR of 2.76 (95% CI, 1.66-4.61). Additional adjustments for ancestry and parental history of mental illness attenuated the results with the interaction being only marginally significant. CONCLUSION MTHFR C677T and COMT Val158Met interact with CA to increase risk of schizophrenia.
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Affiliation(s)
- J-C Debost
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - M Debost
- Department of Internal Medicine, Randers Regional Hospital, Randers NØ, Denmark
| | - J Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark.,iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
| | - O Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark.,Centre for Psychiatric Research, Aarhus University Hospital Risskov, Aarhus, Denmark
| | - D M Hougaard
- Danish Centre for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - A D Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
| | - P B Mortensen
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - L Petersen
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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Keyes KM, Susser E. Invited Commentary: An Ingenious Approach to Examining the Relationship Between Maternal Stress and Offspring Health? Am J Epidemiol 2017; 185:329-332. [PMID: 28158433 DOI: 10.1093/aje/kww173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/20/2016] [Indexed: 12/16/2022] Open
Abstract
The potentially deleterious effects on offspring health of excess maternal stress in pregnancy are important to understand-both whether observed associations are causal and through what mechanisms their effects may exert an influence. In this issue of the Journal, Räikkönen et al. (Am J Epidemiol. 2012;000(0):000-000) provide an ingenious test of a potential pathway through which maternal stress may influence offspring development. Licorice consumption is known to disrupt the ability of the placental enzyme 11β-hydroxysteroid dehydrogenase type 2 to inactivate cortisol before it reaches the fetus, leading to higher levels of cortisol exposure. Higher levels of cortisol exposure are also hypothesized to underlie the mechanism through which maternal stress may disrupt fetal development. Thus licorice consumption may serve, in some ways, to mimic maternal stress. The authors report associations between heavy licorice consumption during pregnancy and a wide range of offspring outcomes, including changes in pubertal timing, intelligence quotient, and mental health. In our view, these results should be considered preliminary; more work needs to be completed to determine the relationship of prenatal licorice consumption to these outcomes. Nonetheless, these intriguing and suggestive results demonstrate that this line of work should be given high priority, and they set the stage for additional research moving forward.
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Debost JCPG, Larsen JT, Munk-Olsen T, Mortensen PB, Meyer U, Petersen L. Joint Effects of Exposure to Prenatal Infection and Peripubertal Psychological Trauma in Schizophrenia. Schizophr Bull 2017; 43:171-179. [PMID: 27343007 PMCID: PMC5216853 DOI: 10.1093/schbul/sbw083] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Prenatal infection and traumatizing experiences have both been linked with schizophrenia, but none of these factors seem sufficient to cause the disorder. However, recent evidence suggests that these environmental insults act in synergy to increase schizophrenia risk. OBJECTIVE To estimate the independent and joint effects of exposure to prenatal infection and peripubertal psychological trauma on the risk of schizophrenia. DESIGN Danish nationwide registers were linked in this prospective cohort study. We used survival analysis to report incidence rate ratios (IRRs) and corresponding 95% confidence intervals (95% CIs). Analyses were adjusted for age and calendar period and stratified by sex. PARTICIPANTS A total of 979701 persons born between 1980 and 1998 were followed up from January 1, 1995 through December 31, 2013, with 9656 having a hospital contact for schizophrenia. RESULTS Females exposed to prenatal infection had a significantly increased risk of schizophrenia (IRR: 1.61, 95% CI: 1.30-2.00), but not males (IRR: 0.99, 95% CI: 0.77-1.28). Peripubertal trauma was associated with increased risk in both sexes. Males, however, had a significantly higher risk of schizophrenia after exposure to both prenatal infection and peripubertal psychological trauma (IRR: 2.85, 95% CI: 2.32-3.51), with significant interaction between infection and peripubertal trauma on the multiplicative scale (P = .007). CONCLUSIONS Our study demonstrated for the first time that prenatal infection and psychological trauma in peripubertal life can act in synergy to increase the risk of schizophrenia, with a potentially stronger susceptibility in males.
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Affiliation(s)
- Jean-Christophe P. G. Debost
- National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark;,*To whom correspondence should be addressed; National Centre for Register-based Research, Faculty of Business and Social Sciences, Department of Economics and Business, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus, Denmark; tel: +45-51372371, fax: +45-87164601, e-mail:
| | - Janne Tidselbak Larsen
- National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | | | - Urs Meyer
- Institute of Pharmacology and Toxicology, University of Zurich—Vetsuisse, Zurich, Switzerland
| | - Liselotte Petersen
- National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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39
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Sugawara N, Danjo K, Furukori H, Sato Y, Tomita T, Fujii A, Nakagami T, Kitaoka K, Yasui-Furukori N. Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan. Neuropsychiatr Dis Treat 2017; 13:779-784. [PMID: 28331330 PMCID: PMC5356920 DOI: 10.2147/ndt.s127053] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work-family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. METHODS In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work-Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. RESULTS The relationship between emotional exhaustion and occupational factors, including quantitative workload and the variance in workload, disappeared with the addition of WFC (each work interference with family [WIF] or family interference with work [FIW]). The relationship between emotional exhaustion and mental demands disappeared only with the addition of WIF. The relationship between depressive symptoms and variance in workload disappeared with the addition of WFC (each WIF or FIW). CONCLUSION Our findings may encourage hospital administrators to consider the risks of medical staff WFC. Furthermore, longitudinal investigations into the factors associated with WFC are required for administrative and psychological interventions.
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Affiliation(s)
- Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori
| | | | - Hanako Furukori
- Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi
| | - Yasushi Sato
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori; Department of Psychiatry, Mutsu General Hospital, Mutsu
| | - Tetsu Tomita
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori; Department of Psychiatry, Hirosaki-Aiseikai Hospital, Kitazono, Hirosaki
| | - Akira Fujii
- Department of Psychiatry, Seihoku-Chuoh Hospital, Goshogawara, Aomori
| | - Taku Nakagami
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori; Department of Psychiatry, Odate Municipal General Hospital, Odate, Akita
| | - Kazuyo Kitaoka
- Mental Health Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori
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Butler TR, Karkhanis AN, Jones SR, Weiner JL. Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders. Alcohol Clin Exp Res 2016; 40:1202-14. [PMID: 27154240 DOI: 10.1111/acer.13075] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/24/2016] [Indexed: 01/01/2023]
Abstract
Individuals diagnosed with anxiety-related illnesses are at increased risk of developing alcoholism, exhibit a telescoped progression of this disease and fare worse in recovery, relative to alcoholics that do not suffer from a comorbid anxiety disorder. Similarly, preclinical evidence supports the notion that stress and anxiety represent major risk factors for the development of alcohol use disorder (AUD). Despite the importance of understanding the link between anxiety and alcoholism, much remains unknown about the neurobiological substrates underlying this relationship. One stumbling block has been the lack of animal models that reliably reproduce the spectrum of behaviors associated with increased vulnerability to these diseases. Here, we review the literature that has examined the behavioral and neurobiological outcomes of a simple rodent adolescent social isolation procedure and discuss its validity as a model of vulnerability to comorbid anxiety disorders and alcoholism. Recent studies have provided strong evidence that adolescent social isolation of male rats leads to the expression of a variety of behaviors linked with increased vulnerability to anxiety and/or AUD, including deficits in sensory gating and fear extinction, and increases in anxiety measures and ethanol drinking. Neurobiological studies are beginning to identify mesolimbic adaptations that may contribute to the behavioral phenotype engendered by this model. Some of these changes include increased excitability of ventral tegmental area dopamine neurons and pyramidal cells in the basolateral amygdala and significant alterations in baseline and stimulated catecholamine signaling. A growing body of evidence suggests that adolescent social isolation may represent a reliable rodent model of heightened vulnerability to anxiety disorders and alcoholism in male rats. These studies provide initial support for the face, construct, and predictive validity of this model and highlight its utility in identifying neurobiological adaptations associated with increased risk of developing these disorders.
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Affiliation(s)
- Tracy R Butler
- Department of Psychology , University of Dayton, Dayton, Ohio
| | - Anushree N Karkhanis
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Sara R Jones
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jeffrey L Weiner
- Department of Physiology and Pharmacology , Wake Forest School of Medicine, Winston Salem, North Carolina
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O'Neill SM, Curran EA, Dalman C, Kenny LC, Kearney PM, Clarke G, Cryan JF, Dinan TG, Khashan AS. Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study. Schizophr Bull 2016; 42:633-41. [PMID: 26615187 PMCID: PMC4838084 DOI: 10.1093/schbul/sbv152] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the biological plausibility of an association between obstetric mode of delivery and psychosis in later life, studies to date have been inconclusive. We assessed the association between mode of delivery and later onset of psychosis in the offspring. A population-based cohort including data from the Swedish National Registers was used. All singleton live births between 1982 and 1995 were identified (n= 1,345,210) and followed-up to diagnosis at age 16 or later. Mode of delivery was categorized as: unassisted vaginal delivery (VD), assisted VD, elective Caesarean section (CS) (before onset of labor), and emergency CS (after onset of labor). Outcomes included any psychosis; nonaffective psychoses (including schizophrenia only) and affective psychoses (including bipolar disorder only and depression with psychosis only). Cox regression analysis was used reporting partially and fully adjusted hazard ratios (HR) with 95% confidence intervals (CI). Sibling-matched Cox regression was performed to adjust for familial confounding factors. In the fully adjusted analyses, elective CS was significantly associated with any psychosis (HR 1.13, 95% CI 1.03, 1.24). Similar findings were found for nonaffective psychoses (HR 1.13, 95% CI 0.99, 1.29) and affective psychoses (HR 1.17, 95% CI 1.05, 1.31) (χ(2)for heterogeneityP= .69). In the sibling-matched Cox regression, this association disappeared (HR 1.03, 95% CI 0.78, 1.37). No association was found between assisted VD or emergency CS and psychosis. This study found that elective CS is associated with an increase in offspring psychosis. However, the association did not persist in the sibling-matched analysis, implying the association is likely due to familial confounding by unmeasured factors such as genetics or environment.
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Affiliation(s)
- Sinéad M O'Neill
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Eileen A Curran
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institute, Karolinska, Sweden
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | | | - Gerard Clarke
- Laboratory of NeuroGastroenterology, APC Microbiome Institute; Department of Psychiatry
| | - John F Cryan
- APC Microbiome Institute; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | | | - Ali S Khashan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; Department of Epidemiology and Public Health;
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Björkenstam E, Kosidou K, Björkenstam C. Childhood household dysfunction and risk of self-harm: a cohort study of 107 518 young adults in Stockholm County. Int J Epidemiol 2016; 45:501-11. [DOI: 10.1093/ije/dyw012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/12/2022] Open
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Hollander AC, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ 2016; 352:i1030. [PMID: 26979256 PMCID: PMC4793153 DOI: 10.1136/bmj.i1030] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether refugees are at elevated risk of schizophrenia and other non-affective psychotic disorders, relative to non-refugee migrants from similar regions of origin and the Swedish-born population. DESIGN Cohort study of people living in Sweden, born after 1 January 1984 and followed from their 14th birthday or arrival in Sweden, if later, until diagnosis of a non-affective psychotic disorder, emigration, death, or 31 December 2011. SETTING Linked Swedish national register data. PARTICIPANTS 1,347,790 people, including people born in Sweden to two Swedish-born parents (1,191,004; 88.4%), refugees (24,123; 1.8%), and non-refugee migrants (132,663; 9.8%) from four major refugee generating regions: the Middle East and north Africa, sub-Saharan Africa, Asia, and Eastern Europe and Russia. MAIN OUTCOME MEASURES Cox regression analysis was used to estimate adjusted hazard ratios for non-affective psychotic disorders by refugee status and region of origin, controlling for age at risk, sex, disposable income, and population density. RESULTS 3704 cases of non-affective psychotic disorder were identified during 8.9 million person years of follow-up. The crude incidence rate was 38.5 (95% confidence interval 37.2 to 39.9) per 100,000 person years in the Swedish-born population, 80.4 (72.7 to 88.9) per 100,000 person years in non-refugee migrants, and 126.4 (103.1 to 154.8) per 100,000 person years in refugees. Refugees were at increased risk of psychosis compared with both the Swedish-born population (adjusted hazard ratio 2.9, 95% confidence interval 2.3 to 3.6) and non-refugee migrants (1.7, 1.3 to 2.1) after adjustment for confounders. The increased rate in refugees compared with non-refugee migrants was more pronounced in men (likelihood ratio test for interaction χ(2) (df=2) z=13.5; P=0.001) and was present for refugees from all regions except sub-Saharan Africa. Both refugees and non-refugee migrants from sub-Saharan Africa had similarly high rates relative to the Swedish-born population. CONCLUSIONS Refugees face an increased risk of schizophrenia and other non-affective psychotic disorders compared with non-refugee migrants from similar regions of origin and the native-born Swedish population. Clinicians and health service planners in refugee receiving countries should be aware of a raised risk of psychosis in addition to other mental and physical health inequalities experienced by refugees.
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Affiliation(s)
- Anna-Clara Hollander
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Henrik Dal
- Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
| | - Glyn Lewis
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
| | - James B Kirkbride
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
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44
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Fineberg AM, Ellman LM, Schaefer CA, Maxwell SD, Shen L, Chaudhury NH, Cook AL, Bresnahan MA, Susser ES, Brown AS. Fetal exposure to maternal stress and risk for schizophrenia spectrum disorders among offspring: Differential influences of fetal sex. Psychiatry Res 2016; 236:91-97. [PMID: 26753951 PMCID: PMC4767153 DOI: 10.1016/j.psychres.2015.12.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/15/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023]
Abstract
Exposure to adverse life events during pregnancy has been linked to increased risk of schizophrenia spectrum disorders (SSD) in offspring. Nevertheless, much of the previous work inferred maternal stress from severe life events rather than directly assessing maternal reports of stress. The present study aimed to examine maternal reports of stress during pregnancy and risk for offspring SSD. Participants were 95 SSD cases and 206 controls who were offspring from a large birth cohort study that followed pregnant women from 1959 to 1966. During pregnancy interviews, women were asked if anything worrisome had occurred recently. Interviews were qualitatively coded for stress-related themes, including reports of daily life stress, by two independent raters. None of the maternal psychosocial stress themes were significantly associated with increased odds of offspring SSD in analyses of the full sample. However, results indicated a significant daily life stress by infant sex interaction. Maternal daily life stress during pregnancy was associated with significantly increased odds of SSD among male offspring. Findings suggest sex-specific fetal sensitivity to maternal reported daily life stress during pregnancy on risk for SSD, with males appearing to be more vulnerable to the influences of maternal stress during pregnancy.
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Affiliation(s)
- Anna M Fineberg
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA.
| | | | - Seth D Maxwell
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Ling Shen
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Nashid H Chaudhury
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA
| | - Aundrea L Cook
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Michaeline A Bresnahan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Ezra S Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Alan S Brown
- Department of Psychiatry, Columbia University, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Liang H, Olsen J, Yuan W, Cnattingus S, Vestergaard M, Obel C, Gissler M, Li J. Early Life Bereavement and Schizophrenia: A Nationwide Cohort Study in Denmark and Sweden. Medicine (Baltimore) 2016; 95:e2434. [PMID: 26817875 PMCID: PMC4998249 DOI: 10.1097/md.0000000000002434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We aimed to examine whether early life bereavement, as indicator of severe stress, was associated with an increased risk of schizophrenia later in life.Based on population registers, we established a cohort of all children born in Denmark (N = 1 686 416) and Sweden (N = 2 563 659) from 1973 to 1997. Children were categorized as exposed if they lost a first-degree relative during the first 18 years of life. Outcome is the first diagnosis of schizophrenia as either inpatient or outpatient. Log-linear Poisson regression models were used to estimate incidence rate ratios (IRRs).A total of 188,850 children (4.6%) experienced death of a first-degree relative from birth to 18 years of age. Compared with unexposed children, those exposed had overall a 39% higher risk of schizophrenia (= 1.39, 95% CI [confidence interval]: 1.32-1.47). The IRR was particularly high if the family member committed suicide (aIRR = 2.11, 95% CI: 1.90-2.34) or died due to an injury or accident (aIRR = 1.44, 95% CI: 1.27-1.63). The IRR of schizophrenia decreased with increasing child's age at bereavement (P < 0.0001). Children who experienced >1 death during the first 18 years of life (aIRR = 1.79, 95% CI: 1.46-2.19) had a higher risk than those with a single death (aIRR = 1.37, 95% CI: 1.30-1.45).The study suggested that exposure to death of a first-degree relative before 18 years was associated with an increased risk of schizophrenia in later life. The complex mechanisms behind these associations remain to be elucidated.
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Affiliation(s)
- Hong Liang
- From the Department of Reproductive Epidemiology and Social Science (HL, WY), National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, China; Department of Clinical Epidemiology (JO, JL), Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology (JO), School of Public Health, University of California, Los Angeles, California, USA; Reproduction and Development Institute (WY), Fudan University, Shanghai, China; Department of Medicine (SC), Clinical Epidemiology Unit, Karolinska Institutet, Sweden; Section for General Practice (MV, CO), Department of Public Health, Aarhus University, Denmark; Research Unit of General Practice (MV, CO), Department of Public Health, Aarhus University, Denmark; and National Institute for Health and Welfare (MG), Finland and Nordic School of Public Health, Sweden
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46
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Söderlund J, Wicks S, Jörgensen L, Dalman C. Comparing cohort incidence of schizophrenia with that of bipolar disorder and affective psychosis in individuals born in Stockholm County 1955-1967. Psychol Med 2015; 45:3433-3439. [PMID: 26189466 DOI: 10.1017/s0033291715001336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Perinatal factors are associated with increased risk for both schizophrenia and bipolar disorder. Improvements in obstetric and maternal healthcare and positive socioeconomic development in Sweden from the 1950s onwards could be expected to affect incidence estimates. However, commonly incidence rates are calculated during a specific year, i.e. time of diagnosis, which mirrors proximal precipitating risk factors. To examine whether incidence estimates are compatible with the hypothesis of an impact of perinatal exposures on the risk of the different disorders we here instead calculate incidence rates for consecutive birth cohorts born between 1955 and 1967. We hypothesized that schizophrenia incidence would be more affected compared to bipolar disorder and other affective psychoses since most perinatal risk factors are more pronounced in schizophrenia aetiology. METHOD Birth cohorts of individuals born in Sweden and resident in Stockholm (N = 2,16,322), were followed in The National Patient Register regarding incident inpatient episodes Incident cases/10,000 person-years and birth cohort were calculated. Linear regression was used to estimate change in incidence rate. RESULTS We found stable birth cohort-based incidence estimates for bipolar disorder and other affective psychoses, but a continuous reduction in incidence estimates for schizophrenia as well as other non-affective psychoses in subsequent birth cohorts from 1955 to 1967. CONCLUSIONS The consecutive birth cohort-based incidence estimates unveiled patterns that are compatible with the hypothesis of an impact of early life exposures decreasing over time, in the aetiology of schizophrenia, whereas this pattern is less apparent in affective psychoses..
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Affiliation(s)
- J Söderlund
- Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - S Wicks
- Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - L Jörgensen
- Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - C Dalman
- Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
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Debost JC, Petersen L, Grove J, Hedemand A, Khashan A, Henriksen T, Mors O, Hollegaard M, Hougaard D, Nyegaard M, Børglum A, Mortensen PB. Investigating interactions between early life stress and two single nucleotide polymorphisms in HSD11B2 on the risk of schizophrenia. Psychoneuroendocrinology 2015; 60:18-27. [PMID: 26115144 DOI: 10.1016/j.psyneuen.2015.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND To examine the risk of schizophrenia in a Danish population after exposure to early life stress, and whether this risk is modified by DNA sequence variation, specifically two single nucleotide polymorphisms (SNPs) (rs5479 and rs56303414) from the gene HSD11B2. This gene encodes the enzyme 11-β hydroxysteroid dehydrogenase type 2 which converts active cortisol into inactive cortisone. METHODS A two-stage analysis involving (1) a population-based cohort study, and (2) a nested case-control study using genotype information. Stage 1 included 1,141,447 people; here, we calculated incidence rate ratios (IRR) for the risk of schizophrenia among children of mothers who experienced loss or serious illness of close relatives before, during, and after pregnancy. In stage 2, we genotyped rs5479 and rs56303414 among 1275 schizophrenia cases and 1367 controls, and investigated interactions between genotypes and early life stress on the risk of schizophrenia. RESULTS In stage 1, no increased risk of schizophrenia was found in offspring after exposure during pregnancy, but offspring exposed to early life stress at age 0-2 years had a significantly increased risk of schizophrenia (adjusted IRR 1.18, 95% confidence interval 1.07-1.31). For rs5479, the minor allele was nucleotide A, and the major allele was nucleotide C. No interaction was found between rs5479 and exposure during pregnancy. Individuals with the minor A allele of rs5479, however, had a significantly increased risk of schizophrenia after exposure to early life stress at age 3-9 years (adjusted IRR 2.06, 1.04-4.06). No interaction was found between rs56303414 and exposure in any of the time periods. CONCLUSION No association was found between exposure to early life stress during pregnancy and schizophrenia in the offspring investigated, whereas individuals exposed to early life stress within the first two years of life had an increased risk. No interaction was found between HSD11B2 and exposure during pregnancy, but individuals with the A allele of rs5479 had an increased risk of schizophrenia after exposure at age 3-9 years.
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Affiliation(s)
- Jean-Christophe Debost
- National Center for Register-based Research, Department of Economics and Business, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.
| | - Liselotte Petersen
- National Center for Register-based Research, Department of Economics and Business, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Department of Biomedicine, Aarhus University, Denmark; Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark; iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
| | - Anne Hedemand
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Department of Biomedicine, Aarhus University, Denmark; Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Ali Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Tine Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark; Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
| | - Mads Hollegaard
- Danish Centre for Neonatal Screening, Statens Serum Institut, Denmark
| | - David Hougaard
- Danish Centre for Neonatal Screening, Statens Serum Institut, Denmark
| | - Mette Nyegaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Department of Biomedicine, Aarhus University, Denmark; iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
| | - Anders Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Department of Biomedicine, Aarhus University, Denmark; iSEQ, Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Center for Register-based Research, Department of Economics and Business, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
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Su X, Xu B, Liang H, Olsen J, Yuan W, Cnattingius S, László KD, Li J. Prenatal maternal bereavement and risk of eating disorders in infants and toddlers: a population-based cohort study. BMC Psychiatry 2015; 15:229. [PMID: 26403981 PMCID: PMC4582887 DOI: 10.1186/s12888-015-0612-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 09/17/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prenatal stress has been associated to a number of neuropsychiatric diseases but its role on the development of eating disorders (ED) remains unknown. Infants and toddlers with feeding or eating disorders are also at an increased risk of such diseases in later childhood and adolescence. We aimed to examine whether prenatal stress following maternal bereavement is associated with ED in infants and toddlers. METHODS This population-based cohort study included children born from 1977 to 2008 in Denmark (N = 2,127,126) and from 1977 to 2006 in Sweden (N = 2,974,908). Children were categorized as exposed if they were born to mothers who lost a close relative one year prior to or during pregnancy and were categorized as unexposed otherwise. They were followed until the age of 3 for a first diagnosis of ED. Poisson regression models were used to examine incidence rate ratio (IRR) between the exposed and the unexposed cohort. RESULTS A total of 9,403 ED cases were identified and 179 of whom were in the exposed cohort. Offspring born to mothers bereaved by loss of a core family member (older child or spouse) within the six months before pregnancy had a higher risk of ED than the unexposed offspring (IRR: 1.63, 95% confidence intervals (CI): 1.07-2.47). In stratified analyses, bereavement during the six months before pregnancy was associated with an increased risk of ED in boys (IRR: 2.21, 95% CI: 1.28-3.82), but not in girls (IRR: 1.18, 95% CI: 0.61-2.27). DISCUSSION This is the first population-based study to explore the association between prenatal stress and the risk of ED in infants and toddlers within two Nordic countries. This study added new evidence of early life stress for etiology of ED while the potential mechanism still needs further studies. CONCLUSIONS Prenatal stress following maternal bereavement by loss of a core family member is associated with an increased risk of ED among infants and toddlers. The six months before conception may be a susceptible time window, especially for boys.
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Affiliation(s)
- Xiujuan Su
- Department of Women's and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, PR China. .,Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, PR China.
| | - Hong Liang
- Department of Reproductive Epidemiology and Social Science, National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, 200032, PR China.
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
| | - Wei Yuan
- Department of Reproductive Epidemiology and Social Science, National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai Institute of Planned Parenthood Research, Shanghai, 200032, PR China.
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
| | - Krisztina D. László
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Jiong Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark.
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Li J, Yang H, Guldin MB, Vedsted P, Vestergaard M. Increased utilisation of primary healthcare in persons exposed to severe stress in prenatal life: a national population-based study in Denmark. BMJ Open 2015; 5:e005657. [PMID: 25573520 PMCID: PMC4289719 DOI: 10.1136/bmjopen-2014-005657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Recent studies have suggested that stress in a pregnant mother may affect the future health of the unborn child negatively. An excellent proxy for health problems is the use of healthcare resources. Using nationwide data, we examined whether persons born to mothers who lost a close relative during pregnancy have more contacts to general practice. DESIGN Population-based cohort study. SETTING Denmark. PARTICIPANTS We included all children born in Denmark from 1973 to 2002 (N=2 032 528). Exposure of prenatal stress was defined as maternal bereavement by the death of a close relative during the antenatal period. The outcome of interest was contact with general practice between 2003 and 2009 when the participants were between 1 and 35 years of age. Poisson regression was used to assess the association between exposure and outcome. OUTCOME MEASURES Contacts to general practitioner. RESULTS Overall, persons exposed to prenatal stress had 2% more GP contacts than those not exposed, primarily due to increased utilisation of healthcare services during late adolescence and early adulthood. The exposed persons born to mothers who had lost a spouse had a higher risk (relative risk (RR) 1.12, 95% CI 1.10 to 1.14) and so did those born to mothers who had lost a close relative due to unexpected death (RR 1.06, 95% CI 1.05 to 1.06). Exposed persons had more contacts to general practice in daytime and more psychometric tests, talk therapies and C reactive protein tests than unexposed persons. CONCLUSIONS Prenatal stress following maternal bereavement was associated with a slightly increased utilisation of primary healthcare, mainly due to increased healthcare needs related to mental health and infections. Understanding how stress during pregnancy influences the future health of the child is an important aspect of prenatal care.
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Affiliation(s)
- Jiong Li
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hu Yang
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Mai-Britt Guldin
- Research Unit of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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50
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Hunter EM. Indigenous health: radical hope or groundhog day? Med J Aust 2014; 200:621-2. [PMID: 24938331 DOI: 10.5694/mja14.00557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Ernest M Hunter
- Cairns Institute, James Cook University, Cairns, QLD, Australia.
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