CommentaryPrenatal famine and adult mental illness: Interpreting concordant and discordant results from the Dutch and Chinese Famines
Section snippets
Data on prenatal famine
The Dutch and Chinese Famine studies were conducted as “natural experiments” although obviously precipitated by human policies that could hardly be considered “natural”. There are many variations in design but all include i) a well-defined population affected by a major exposure, ii) limited ability of individuals within this affected population to avoid the exposure, iii) an unexposed comparison population that is similar in other ways (Susser, Schwartz, Morabia, & Bromet, 2006). A
The Dutch Famine schizophrenia studies
Based on the findings in the D2 cohort described above, and the emerging view that schizophrenia had origins in early neurodevelopment, the initial study hypothesized that first trimester exposure to nutritional deficiency would be related to risk of schizophrenia in offspring (Susser & Lin, 1992). We compared the exposed and unexposed groups with respect to hospitalizations for schizophrenia recorded in the Dutch national registries from 1978 to 1989. Severe exposure was defined as average
Future directions
The most parsimonious and plausible interpretation of these concordant results is that periconceptional starvation is linked to increased risk of schizophrenia by an effect on fetal neurodevelopment. In theory, other pathways remain possible, such as selective ability to conceive under famine conditions (Lumey et al., 2011), or effects of preconceptional starvation on the male germ line. Currently, however, these other pathways have no empirical support. If new evidence emerges, future
Conclusion
We conclude by underscoring the potential benefits for public health that could emerge from valid comparisons across the Dutch and Chinese Famines. When the challenge of studying the same hypothesis can be met, results are especially powerful, and subsequent research can lead to important public health interventions. Again using the example of schizophrenia, emerging evidence increasingly supports the hypothesis that folate plays a crucial role. If future studies produce definitive evidence
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