ABSTRACT
OBJECTIVE: Previous studies indicate that a poor family environment might affect vulnerability for the later manifestation of psychotic illness. The current study aims to examine family functioning prior to the onset of psychosis. METHOD: Subjects were 42,948, 17-year old males with behavioural disturbances who were asked about the functioning of their family by the Israeli Draft Board. Data on later psychiatric hospitalizations were obtained from a National Psychiatric Hospitalization Registry. RESULTS: Poorer self-reported family functioning was associated with greater risk for later hospitalization for psychosis [adjusted hazard ratio (HR) = 1.16, 95% CI = 1.05-1.27], with a trend in the same direction for schizophrenia (adjusted HR = 1.1, 95% CI = 0.98-1.24). CONCLUSION: In male adolescents with behavioural disturbances, perceived poorer family functioning is associated with increased risk for non-affective psychotic disorders and schizophrenia. These data do not enable us to determine if perceived familial dysfunction increases vulnerability for psychosis, if premorbid behavioural abnormalities disrupt family life, or neither.
Subject(s)
Family Conflict/psychology , Mental Disorders/psychology , Psychotic Disorders/psychology , Schizophrenia/diagnosis , Schizophrenic Psychology , Self Disclosure , Adolescent , Adult , Cross-Sectional Studies , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Israel , Male , Mass Screening , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Military Personnel/psychology , Military Personnel/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Risk Factors , Schizophrenia/epidemiology , Social EnvironmentABSTRACT
BACKGROUND: Being a small and culturally different minority, or having a different appearance, has been invoked to account for the increased prevalence of psychotic disorders among immigrants. The majority of the Jewish Israeli population are first- or second-generation immigrants from Europe, North Africa or Asia, and during the late 1980s and 1990s, 885 000 persons immigrated to Israel from the former Soviet Union and 43 000 immigrated from Ethiopia. These Ethiopian immigrants came from a very different culture compared to the rest of the population, and have a distinct appearance. To further understand the association between immigration and schizophrenia, we compared risk for later schizophrenia between adolescents who immigrated from Ethiopia with risk among the other immigrant groups, and with native-born Israelis. MethodOf 661 792 adolescents consecutively screened by the Israeli Draft Board, 557 154 were native-born Israelis and 104 638 were immigrants. Hospitalization for schizophrenia was ascertained using a National Psychiatric Hospitalization Case Registry. All analyses controlled for socio-economic status (SES). RESULTS: Risk for schizophrenia was increased among both first- [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.18-2.22] and second-generation immigrants [HR 1.41, 95% CI 1.01-1.95 (one immigrant parent) and HR 1.49, 95% CI 1.11-2.0 (two immigrant parents)]. When risk for schizophrenia was calculated for each immigrant group separately, immigrants from Ethiopia were at highest risk of later schizophrenia (HR 2.95, 95% CI 1.88-4.65). ConclusionThis comparison between diverse groups of immigrants supports the notion that immigrants who differ in culture and appearance from the host population are at increased risk for schizophrenia.
