St Clair D, Xu M, Wang P, Yu Y, Fang Y, Zhang F et al. Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959-1961. JAMA 294: 557-562

University of Aberdeen, Aberdeen, Scotland, United Kingdom
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2005; 294(5):557-62. DOI: 10.1001/jama.294.5.557
Source: PubMed


Schizophrenia is a common major mental disorder. Intrauterine nutritional deficiency may increase the risk of schizophrenia. The main evidence comes from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited decline in food intake occurred. The most exposed cohort conceived during the famine showed a 2-fold increased risk of schizophrenia.
To determine whether those who endured a massive 1959-1961 famine in China experienced similar results.
The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. Wuhu and its surrounding 6 counties are served by a single psychiatric hospital. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers who were blinded to the nature of exposure. Data on number of births and deaths in the famine years were available, and cumulative mortality was estimated from later demographic surveys.
Evidence of famine was verified, and unadjusted and mortality-adjusted relative risks of schizophrenia were calculated.
The birth rates (per 1000) in Anhui decreased approximately 80% during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the adjusted risk of developing schizophrenia in later life increased significantly, from 0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960 and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961.
Our findings replicate the Dutch data for a separate racial group and show that prenatal exposure to famine increases risk of schizophrenia in later life.

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    • "the consequences of the Chinese Famine for perceived health and socioeconomic outcomes in midlife. Previous research on the Chinese Famine mostly relied on samples with limited regional coverage and yielded mixed findings (Almond et al., 2007; Chen and Zhou, 2007; Gørgens et al., 2012; Huang et al., 2010, 2012; Luo et al., 2006; Meng and Qian, 2009; Mu and Zhang, 2011; St Clair et al., 2005; Xu et al., 2009; Yang et al., 2008), and none of them examined perceived health, an important predictor of mortality (Idler and Benyamini, 1997). "
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    ABSTRACT: This research investigates long-term consequences of early-life malnutrition by examining effects of the 1959-61 Chinese Famine. Taking into account temporal and geographic variations in famine severity, we construct a difference-in-differences estimator to identify effects of early-life exposure to famine on perceived health and socioeconomic outcomes in midlife. Using a sample of 1,716 adults born in 1955 through 1966 in rural China from a nationally representative survey—the 2005 Chinese General Social Survey—we find that the famine had adverse effects on mid-life health for males born into families where at least one parent was a Communist Party member and females regardless of parental party membership. Being born during the famine had no effects on years of education or income for either gender. Quantile regressions suggest intense mortality selection among males who had no party-affiliated parents. Our study highlights the importance of timing and contexts of life experiences in shaping health.
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    • "Investigating gene-environmental interaction, a social deficit has been revealed in SNAP-25 knockout mice, which represents a synaptic protein involved in neurotransmitter release, combined with prenatal stress paradigm (Oliver and Davies, 2009). Some retrospective studies investigated consequences of prenatal food starvation during the " Dutch hunger winter 1944– 1945 " (Susser et al., 1996; Hoek et al., 1998) and Chinese famine during 1959–1961 (St Clair et al., 2005; Xu et al., 2009). In these investigations, famine episodes of mothers were related to increased risk for schizophrenia in the offspring. "
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    • "Others have also suggested that some chronic diseases are influenced by exposure to environmental factors early in life [23] [24]. Diabetes [25], schizophrenia [26], and lung disease [27] might also find their origins in early life. Mechanisms for the developmental origins of disease hypothesis. "
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