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Published Online: 1 December 2011

Increased Risk of Schizophrenia From Additive Interaction Between Infant Motor Developmental Delay and Obstetric Complications: Evidence From a Population-Based Longitudinal Study

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Abstract

Objective:

Obstetric complications and developmental delay are well-established risk factors for schizophrenia. The authors investigated whether these risk factors interact in an additive manner to further increase risk for schizophrenia.

Method:

The study population encompassed all individuals born in Helsinki between 1962 and 1969 who had developmental records archived in the Helsinki City Archives. Through linkage between the Finnish Population Register, the Finnish Hospital Discharge Register, and the Child Health Archives, child health cards were traced for 189 individuals who had received a diagnosis of schizophrenia and 189 healthy comparison subjects, individually matched to case subjects on gender and year of birth. Child health cards from the Child Health Archives contain detailed prospective developmental data from birth as well as an indicator of fetal distress, as measured by the Apgar score. Detailed developmental data from the first year of life were extracted.

Results:

Delayed attainment of milestones in infancy significantly increased the risk of later development of schizophrenia in a dose-response manner. There was no significant main effect of obstetric complications on risk for schizophrenia and no significant association between obstetric complications and subsequent developmental delay. However, the additive effect of obstetric complications and delayed attainment of developmental milestones significantly increased the risk of schizophrenia beyond that associated with each factor independently (odds ratio=4.6, 95% confidence interval=1.3–17.2).

Conclusions:

These data provide evidence that underlying neurodevelopmental vulnerability, as indexed by delayed attainment of milestones, combined with obstetric adversity significantly increases the risk of schizophrenia in adulthood.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1295 - 1302
PubMed: 21890789

History

Received: 5 January 2011
Revision received: 1 June 2011
Accepted: 24 June 2011
Published online: 1 December 2011
Published in print: December 2011

Authors

Details

Mary C. Clarke, Ph.D.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Antti Tanskanen, Ph.Lic.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Matti Huttunen, M.D., Ph.D.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
David A. Leon, Ph.D.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Robin M. Murray, M.D., D.Sc.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Peter B. Jones, M.D., Ph.D.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Mary Cannon, M.D., Ph.D.
From the Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin; the Department of Mental Health, National Institute for Health and Welfare, Helsinki; the London School of Hygiene and Tropical Medicine, London; the Division of Psychological Medicine, Institute of Psychiatry, King's College London; and the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.

Notes

Address correspondence to Dr. Clarke ([email protected]).

Funding Information

Dr. Murray has received honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Lilly, Janssen, and Novartis. Dr. Jones has received research support from GlaxoSmithKline; he is also on the scientific advisory board for Roche. All other authors report no financial relationships with commercial interests.Supported by the Stanley Medical Research Institute (Drs. Cannon and Clarke); the Wellcome Trust (United Kingdom) (Dr. Cannon); a Grable Independent Investigator Award from NARSAD (Dr. Cannon); a Clinician Scientist Award (CSA/2004/1) from the Health Research Board (Ireland) (Dr. Cannon); and the European Community's Seventh Framework Program under grant agreement Health-F2-2009-241909 (project EU-GEI) (Drs. Cannon and Clarke).

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