Bereavement During Pregnancy, Early Childhood and Psychosis Risk

MedicalResearch.com Interview with:
Prof. Kathryn M Abel
Professor of Psychiatry & Honorary Consultant Psychiatrist
University of Manchester and Honorary Senior Lecturer at the Institute of Psychiatry, London.

MedicalResearch.com: What are the main findings of the study?

Answer: The main study findings were that exposure of a mother to a severe psychological stress of losing a close family member up to either 6 months before conception or at any time during pregnancy did not increase risk of subsequent psychotic illness in the offspring. Secondly, we found during childhood, if a close family member died then, especially a sibling of the child or one of their parents, these children were at slightly increased risk of developing a psychotic illness later in life. This was most likely to happen following a sudden death especially suicide and in particular following suicide a psychotic mood disorder was more likely than other kinds of psychosis such as schizophrenia (although the risk of schizophrenia was also increased following suicide). This effect was not accounted for by having  a family history of a psychotic illness or suicide.
MedicalResearch.com: Were any of the findings unexpected?

Answer: The lack of prenatal effect was unexpected although it was entirely consistent with the largest previous study to date which had found the same lack of effect of prenatal severe bereavement on schizophrenia or bipolar disorder risk. We were particularly interested to find that cause of death was important in predicting risk and that timing of exposure to a death in the close family in childhood was so important and consistently we find that the earlier in childhood this occurred, the greater the risks tended to be in later life.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: More thought is needed in supporting families and young children with experience of close family bereavement and in mitigating other known risk factors for psychosis such as bullying and social deprivation. It is likely that GPs can have a key role in helping to support bereaved children and families and in working closely with education and social care agencies to consider reducing the opportunity for exposure to other risks that might be avoided.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: More work is needed to understand mechanisms of risk but also of resilience in families in particular perhaps in families with a history of psychotic disorders. These findings should be replicated in other non-European populations. We cannot assume that animal models are likely to be salient to all human populations and circumstances.

Citation:

Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study

BMJ 2014;348:f7679 doi: 10.1136/bmj.f7679

K M Abel professor, H P Heuvelman doctoral student, L Jörgensen research associate, C
Magnusson professor, S Wicks postdoctoral research associate, E Susser professor, J Hallkvist postdoctoral research assistant, C Dalman associate professor