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Published Online: 3 October 2018

Intellectual Disability and Psychotic Disorders in Children: Association With Maternal Severe Mental Illness and Exposure to Obstetric Complications in a Whole-Population Cohort

Abstract

Objective:

Children of mothers with severe mental illness are at significantly increased risk of developing intellectual disability. Obstetric complications are also implicated in the risk for intellectual disability. Moreover, children of mothers with severe mental illness are more likely to be exposed to obstetric complications. The purpose of this study was to examine the independent and joint contributions of familial severe mental illness and obstetric complications to the risk of intellectual disability.

Method:

Record linkage across Western Australian whole-population psychiatric, inpatient, birth, and midwives’ registers identified 15,351 children born between 1980 and 2001 to mothers with severe mental illness and 449,229 children born to mothers with no mental illness. Multivariable models were adjusted for paternal psychiatric status, parental intellectual disability, and other family and sociodemographic covariates.

Results:

The risk of intellectual disability was increased among children of mothers with severe mental illness compared with children of unaffected mothers. The impact varied across maternal diagnostic groups. For children of mothers with schizophrenia, the unadjusted odds ratio was 3.8 (95% CI=3.0, 4.9) and remained significant after simultaneous adjustment for exposure to obstetric complications and other covariates (odds ratio=1.7, 95% CI=1.3, 2.3). The odds ratio for exposure to obstetric complications also remained significant after adjustment (odds ratio=1.7, 95% CI=1.6, 1.8). For intellectual disability of a genetic basis, the adjusted odds ratio for maternal schizophrenia was elevated but not statistically significant. Among children with intellectual disability, 4.2% later developed a psychotic disorder, compared with 1.1% of children without intellectual disability.

Conclusions:

Maternal severe mental illness and exposure to obstetric complications contribute separately to the risk of intellectual disability, suggesting potentially different causal pathways.

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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: 1232 - 1242
PubMed: 30278792

History

Received: 24 October 2017
Revision received: 15 February 2018
Revision received: 3 May 2018
Revision received: 21 May 2018
Accepted: 29 May 2018
Published online: 3 October 2018
Published in print: December 01, 2018

Keywords

  1. Schizophrenia
  2. Obstetric Complications
  3. Intellectual disability
  4. Genetic Liability
  5. Severe mental illness

Authors

Details

Patsy Di Prinzio, M.Biostat. [email protected]
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Vera A. Morgan, M.Soc.Sc., Ph.D.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Jonas Björk, Ph.D.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Maxine Croft, Ph.D.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Ashleigh Lin, Ph.D.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Assen Jablensky, M.D., D.M.Sc.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.
Thomas F. McNeil, Ph.D.
From the Division of Psychiatry, Neuropsychiatric Epidemiology Research Unit, the University of Western Australia Medical School, Perth, Australia; the Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; the Telethon Kids Institute, University of Western Australia, Perth; and the Division of Psychiatry, Centre for Research in Clinical Neurosciences, University of Western Australia Medical School, Perth.

Notes

Send correspondence to Ms. Di Prinzio ([email protected]).
Previously presented as a poster at the 4th Schizophrenia International Research Society Conference, Florence, Italy, April 3, 2016, and as an oral presentation at the Society for Mental Health Research Conference, Adelaide, Australia, December 4, 2014.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Swedish Research Council (SIMSAM LUND)10.13039/100009155: 340-2013-5474, K2006-21X-03793-35-3
March of Dimes Foundation10.13039/100000912: 12-FY04-48, 12-FY07-224
The Barbara Fish Donation for High-risk Schizophrenia Research:
Stanley Foundation:
National Health and Medical Research Council Early Career Fellowship: 1072593
National Health and Medical Research Council10.13039/501100000925: 303235, 458702, APP1002259, APP1080606
Supported by grants from the Australian National Health and Medical Research Council (NHMRC) (grants 303235, 458702, APP1002259, and APP1080606); the March of Dimes (grants 12-FY04-48 and 12-FY07-224); the Stanley Foundation, Swedish Research Council (grants SIMSAM LUND 340-2013-5474 and K2006-21X-03793-35-3); and the Barbara Fish Donation for High-Risk Schizophrenia Research. Dr Lin is supported by an NHMRC Early Career Fellowship (grant 1072593).

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