Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-23T21:27:02.229Z Has data issue: false hasContentIssue false
  • English
  • Français

Mortality in offspring of mothers with psychotic disorder

Published online by Cambridge University Press:  30 November 2007

J. Suvisaari ,
L. Häkkinen ,
J. Haukka  and
J. Lönnqvist
J. Suvisaari*
Affiliation:
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, Finland
L. Häkkinen
Affiliation:
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
J. Haukka
Affiliation:
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, Finland
J. Lönnqvist
Affiliation:
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland Department of Psychiatry, University of Helsinki; Helsinki University Central Hospital, Helsinki, Finland
*
*Address for correspondence: J. Suvisaari, M.D., Ph.D., National Public Health Institute, Department of Mental Health and Alcohol Research, Mannerheimintie 166, FIN-00300 Helsinki, Finland. (Email: jaana.suvisaari@ktl.fi)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Previous studies suggest that offspring of mothers with psychotic disorders have an almost two-fold higher mortality risk from birth until early adulthood. We investigated predictors of mortality from late adolescence until middle age in offspring of mothers with psychotic disorders.

Method

The Helsinki High-Risk Study follows up offspring (n=337) of women treated for schizophrenia spectrum disorders in mental hospitals in Helsinki before 1975. Factors related to mortality up to 2005 among offspring of these mothers was investigated with a survival model. Hazard rate ratios (HRR) were calculated using sex, diagnosis of psychotic disorder, childhood socio-economic status, maternal diagnosis, and maternal suicide attempts and aggressive symptoms as explanatory variables. The effect of family was investigated by including a frailty term in the model. We also compared mortality between the high-risk group and the Finnish general population.

Results

Within the high-risk group, females had lower all-cause mortality (HRR 0.43, p=0.05) and mortality from unnatural causes (HRR 0.24, p=0.03) than males. Having themselves been diagnosed with a psychotic disorder was associated with higher mortality from unnatural causes (HRR 4.76, p=0.01), while maternal suicide attempts were associated with higher suicide mortality (HRR 8.64, p=0.03). Mortality in the high-risk group was over two-fold higher (HRR 2.44, p<0.0001) than in the general population, and remained significantly higher when high-risk offspring who later developed psychotic disorders were excluded from the study sample (HRR 2.30, p<0.0001).

Conclusions

Offspring of mothers with psychotic disorder are at increased risk of several adverse outcomes, including premature death.

Keywords

High-risk studymortalityoffspringpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1203 - 1210
Copyright
Copyright © 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, N (1984). The Scale for the Assessment of Positive Symptoms (SAPS). The University of Iowa: Iowa City.Google Scholar
Andreasen, NC (1982). Negative symptoms in schizophrenia. Definition and reliability. Archives of General Psychiatry 39, 784–788.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV-TR). American Psychological Association: Washington, DC.Google Scholar
Bågedahl-Strindlund, M, Tunell, R, Nilsson, B (1988). Children of mentally ill mothers: mortality and utilization of paediatric health services. Acta Paediatrica Scandinavica 77, 242–250.Google Scholar
Brent, DA, Oquendo, M, Birmaher, B, Greenhill, L, Kolko, D, Stanley, B, Zelazny, J, Brodsky, B, Bridge, J, Ellis, S, Salazar, O, Mann, J (2002). Familial pathways to early-onset suicide attempts. Risk for suicidal behavior in offspring of mood-disordered suicide attempts. Archives of General Psychiatry 59, 801–807.Google Scholar
Brown, GW, Davidson, S (1978). Social class, psychiatric disorder of mother, and accidents to children. Lancet i, 378–381.CrossRefGoogle Scholar
Brown, S (1997). Excess mortality of schizophrenia. A meta-analysis. British Journal of Psychiatry 171, 502–508.Google Scholar
Cadoret, RJ, Yates, WR, Troughton, E, Woodworth, G, Stewart, MA (1995). Genetic-environmental interaction in the genetics of aggressivity and conduct disorders. Archives of General Psychiatry 52, 916–924.Google Scholar
Central Statistical Office of Finland (1989). Classification of Socioeconomic Groups. Central Statistical Office of Finland: Helsinki.Google Scholar
Cobb, BK, Cairns, BD, Miles, MS, Cairns, RB (1995). A longitudinal study of the role of sociodemographic factors and childhood aggression on adolescent injury and ‘close calls’. Journal of Adolescent Health 17, 381–388.CrossRefGoogle ScholarPubMed
Dutta, R, Boydell, J, Kennedy, N, van Os, J, Fearon, P, Murray, RM (2007). Suicide and other causes of mortality in bipolar disorder: a longitudinal study. Psychological Medicine 37, 839–847.CrossRefGoogle ScholarPubMed
Erlenmeyer-Kimling, L (1968). Mortality rates in the offspring of schizophrenic parents and a physiological advantage hypothesis. Nature 220, 798–800.Google Scholar
Erlenmeyer-Kimling, L, Adamo, UH, Rock, D, Roberts, SA, Bassett, AS, Squires-Wheeler, E, Cornblatt, BA, Endicott, J, Pape, S, Gottesman, II (1997). The New York High-Risk Project. Prevalence and comorbidity of axis I disorders in offspring of schizophrenic parents at 25-year follow-up. Archives of General Psychiatry 54, 1096–1102.Google Scholar
Heilä, H, Haukka, J, Suvisaari, J, Lönnqvist, J (2005). Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychological Medicine 35, 725–732.Google Scholar
Johnstone, EC, Ebmeier, KP, Miller, P, Owens, DGC, Lawrie, SM (2005). Predicting schizophrenia: findings from the Edinburgh High-Risk Study. British Journal of Psychiatry 186, 18–25.CrossRefGoogle ScholarPubMed
Joukamaa, M, Heliövaara, M, Knekt, P, Aromaa, A, Raitasalo, R, Lehtinen, V (2001). Mental disorders and cause-specific mortality. British Journal of Psychiatry 179, 498–502.Google Scholar
Kendler, KS, McGuire, M, Gruenberg, AM, O'Hare, A, Spellman, M, Walsh, D (1993). The Roscommon Family Study I. Methods, diagnosis of probands, and risk of schizophrenia in relatives. Archives of General Psychiatry 50, 527–540.Google Scholar
Lawlor, DA, Sterne, JA, Tynelius, P, Davey Smith, G, Rasmussen, F (2006). Association of childhood socioeconomic position with cause-specific mortality in a prospective record linkage study of 1,839,384 individuals. American Journal of Epidemiology 164, 907–915.Google Scholar
Leverton, TJ (2003). Parental psychiatric illness: the implications for children. Current Opinion in Psychiatry 16, 395–402.Google Scholar
Lieb, R, Bronisch, T, Höfler, M, Schreier, A, Wittchen, H-U (2005). Maternal suicidality and risk of suicidality in offspring: findings from a community study. American Journal of Psychiatry 162, 1665–1671.Google Scholar
Lindelius, R (1970). A study of schizophrenia. A clinical, prognostic and family investigation. Acta Psychiatrica Scandinavica 216 (Suppl.), 1–125.Google Scholar
Löffler, W, Häfner, H, Fätkenhauer, B, Maurer, K, Riecher-Rössler, A, Lützhøft, J, Skadhede, S, Munk-Jørgensen, P, Strömgren, E (1994). Validation of Danish case register diagnosis for schizophrenia. Acta Psychiatrica Scandinavica 90, 196–203.CrossRefGoogle ScholarPubMed
Mann, JJ, Waternaux, C, Haas, GL, Malone, KM (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry 156, 181–189.Google Scholar
McGuffin, P, Farmer, A, Harvey, I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT System. Archives of General Psychiatry 48, 764–770.Google Scholar
Molnar, BE, Berkman, LF, Buka, SL (2001). Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychological Medicine 31, 965–977.Google Scholar
Niemi, LT, Suvisaari, JM, Haukka, JK, Lönnqvist, JK (2004 a). Do maternal psychotic symptoms predict offspring's psychotic disorder? Findings from the Helsinki High-Risk Study. Psychiatry Research 125, 105–115.CrossRefGoogle ScholarPubMed
Niemi, LT, Suvisaari, JM, Haukka, JK, Lönnqvist, JK (2005). Childhood predictors of future psychiatric morbidity in offspring of mothers with psychotic disorder: results from the Helsinki High-Risk Study. British Journal of Psychiatry 186, 108–114.Google Scholar
Niemi, LT, Suvisaari, JM, Haukka, JK, Wrede, G, Lönnqvist, JK (2004 b). Cumulative incidence of mental disorders among offspring of mothers with psychotic disorder: results from the Helsinki High-Risk Study. British Journal of Psychiatry 185, 11–17.CrossRefGoogle ScholarPubMed
Ösby, U, Brandt, L, Correia, N, Ekbom, A, Sparén, P (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry 58, 844–850.CrossRefGoogle ScholarPubMed
Owens, DG, Johnstone, EC (2006). Precursors and prodromata of schizophrenia: findings from the Edinburgh High Risk Study and their literature context. Psychological Medicine 36, 1501–1514.Google Scholar
Pensola, T, Martikainen, P (2004). Life-course experiences and mortality by adult social class among young men. Social Science and Medicine 58, 2149–2170.Google Scholar
Perälä, J, Suvisaari, J, Saarni, SI, Kuoppasalmi, K, Isometsä, E, Pirkola, S, Partonen, T, Tuulio-Henriksson, A, Hintikka, J, Kieseppä, T, Härkänen, T, Koskinen, S, Lönnqvist, J (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry 64, 19–28.CrossRefGoogle ScholarPubMed
Power, C, Hyppönen, E, Smith, GD (2005). Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. American Journal of Public Health 95, 1396–1402.Google Scholar
R Development Core Team (2005). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.Google Scholar
Räsänen, P, Tiihonen, J, Isohanni, M, Moring, J, Koiranen, M (1998). Juvenile mortality, mental disturbances and criminality: a prospective study of the Northern Finland 1966 birth cohort. Acta Psychiatrica Scandinavica 97, 5–9.Google Scholar
Sauvola, A, Räsänen, PK, Joukamaa, MI, Jokelainen, J, Järvelin, M-R, Isohanni, MK (2001). Mortality of young adults in relation to single-parent family background. A prospective study of the Northern Finland 1966 birth cohort. European Journal of Public Health 11, 284–286.Google Scholar
Statistics Finland (2006). Causes of Death 2005. Statistics Finland: Helsinki, Finland.Google Scholar
Therneau, T, Offord, J (1999). Expected Survival Based on Hazard Rates. Technical Report no. 63, Section of Biostatistics, Mayo Clinic, 18 February 1999. Rochester, MN (http://cancercenter.mayo.edu/mayo/research/biostat/upload/63.pdf). Accessed 31 January 2007.Google Scholar
Therneau, TM, Grambsch, PM, Pankratz, VS (2003). Penalized survival models and frailty. Journal of Computational and Graphical Statistics 12, 156–175.Google Scholar
Valiakalayil, A, Paulsen, LA, Tibbo, P (2004). Burden in adolescent children of parents with schizophrenia. The Edmonton High Risk Project. Social Psychiatry and Psychiatric Epidemiology 39, 528–535.Google Scholar
Webb, R, Abel, K, Pickles, A, Appleby, L (2005). Mortality in offspring of parents with psychotic disorders: a critical review and meta-analysis. American Journal of Psychiatry 162, 1045–1056.CrossRefGoogle ScholarPubMed
Webb, RT, Abel, KM, Pickles, AR, Appleby, L, King-Hele, SA, Mortensen, PB (2006). Mortality risk among offspring of psychiatric inpatients: a population-based follow-up to early adulthood. American Journal of Psychiatry 163, 2170–2177.Google Scholar
Webb, RT, Pickles, AR, Appleby, L, Mortensen, PB, Abel, KM (2007). Death by unnatural causes during childhood and early adulthood in offspring of psychiatric inpatients. Archives of General Psychiatry 64, 345–352.Google Scholar
Wrede, G, Mednick, SA, Huttunen, MO, Nilsson, CG (1980). Pregnancy and delivery complications in the births of an unselected series of Finnish children with schizophrenic mothers. Acta Psychiatrica Scandinavica 62, 369–381.Google Scholar