Environment and vulnerability to major psychiatric
illness: a case control study of early parental loss in major depression,
bipolar disorder and schizophrenia.
Agid O, Shapira B, Zislin J, Ritsner M, Hanin B, Murad H, Troudart T,
Bloch M, Heresco-Levy U, Lerer B.
Mol Psychiatry. 1999 Mar;4(2):106-8.
Dept of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem,
The current focus on identifying genes which predispose to psychiatric
illness sharpens the need to identify environmental factors which interact
with genetic predisposition and thus contribute to the multifactorial
causation of these disorders. One such factor may be early parental loss (EPL).
The putative relationship between early environmental stressors such as
parental loss and psychopathology in adult life has intrigued psychiatrists
for most of this century. We report a case control study in which rates of
EPL, due to parental death or permanent separation before the age of 17
years were evaluated in patients with major depression (MD), bipolar
disorder (BPD) and schizophrenia (SCZ), compared to individually matched,
healthy control subjects (MD-Control, 79 pairs; BPD-Control, 79 pairs; SCZ-Control,
76 pairs). Loss of parent during childhood significantly increased the
likelihood of developing MD during adult life (OR=3.8, P=0.001). The effect
of loss due to permanent separation (P=0.008) was more striking than loss
due to death, as was loss before the age of 9 years (OR=11.0, P=0.003)
compared to later childhood and adolescence. The overall rate of EPL was
also increased in BPD (OR=2.6, P=0.048) but there were no significant
findings in any of the subcategories of loss. A significantly increased rate
of EPL was observed in schizophrenia patients (OR=3.8, P=0.01), particularly
before the age of 9 years (OR=4.3, P=0.01). Comparison of psychosocial,
medical and clinical characteristics of subjects with and without a history
of EPL, within the larger patient groups from which the matched samples were
drawn (MD, n=136; BPD, n=107; SCZ, n=160), yielded few significant findings.
Among the controls (n=170), however, subjects who had experienced EPL,
reported lower incomes, had been divorced more frequently, were more likely
to be living alone, were more likely to smoke or have smoked cigarettes and
reported more physical illness (P=0.03-0.001). Long term neurobiological
consequences of early environmental stressors such as maternal deprivation
have been extensively studied in many animal species. Recently, enduring
changes in hypothalamic-pituitary-adrenal axis function, including
corticotrophin releasing factor gene expression, have received particular
attention. Analogous processes may be implicated in the effect of EPL on
human vulnerability to psychopathology, via alterations in responsiveness to
stress. Genetic predisposition may influence the degree of susceptibility of
the individual to the effects of early environmental stress and may also
determine the psychopathological entity to which the individual is rendered
vulnerable as a consequence of the stress.
PMID: 10208448 [PubMed - indexed for MEDLINE]
This article is provided for educational purposes
only. No profit comes from this article. The more exposure I feel this abstract
receives,, the less people with the BP will suffer. Clinicians need this
training. Consumers and families desperately need to be educated. I am deeply
grateful to the researchers that provide us with valuable information in
assisting us with treatment and etiology.
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