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Unwanted children at increased risk of schizophrenia

Children who are unwanted are two and a half times more likely to develop schizophrenia than those who are either wanted or wanted but "mistimed," according to researchers from the University of Oulu (British Journal of Psychiatry 1996;169:637-40).

They collected data prospectively in 1996 on 11 017 people from northern Finland-- 96% of all births in the area during that year. Mothers were asked in the sixth and seventh months of pregnancy whether the pregnancy was wanted, mistimed but wanted, or unwanted.

A total of 76 cases of schizophrenia were found between the ages of 16 and 28 in the whole birth cohort. The cumulative incidence of schizophrenia was 0.6% (44 cases out of 6858 births) for those born from a wanted pregnancy, 0.5% (13 out of 2628) for those born from a mistimed pregnancy, and 1.5% (18 out of 1238) for those from an unwanted pregnancy.

This effect remained significant after accounting for a range of social and physical variables, including maternal age, parity, social class, weight at birth, mother's frame of mind during pregnancy, perinatal brain damage, and admission to hospital during the first 28 days of life.

The authors say that the increased risk of schizophrenia among children born from unwanted pregnancies could not be entirely explained by known risk factors for the illness. They suggest that stress during pregnancy may affect fetal brain development. It may also imply continuing stress after childbirth, leading to an abnormal family atmosphere during childhood affecting emotional and cognitive development and so giving rise to schizophrenia, they suggest.

Alternatively, being wanted and reared in a propitious family atmosphere may be a protective factor for schizophrenia in those who may be vulnerable for other reasons.

Dr Jay Smith, consultant in rehabilitation psychiatry at City and Hackney Community NHS Trust, said: "This is an interesting and important study. The majority of recent efforts to clarify the aetiology of schizophrenia have focused on neurobiology, and the early mother-infant relationship has been overlooked."

The influence of the infant-mother relationship in schizophrenia has been known since early this century, but conclusions have been based on retrospective data that have been used to reconstruct a patient's infancy. The current research gives empirical data which tend to confirm that early difficulties in this crucial relationship are important, said Dr Smith.--ZOSIA KMIETOWICZ, medical journalist, London

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