Research conducted in the past decade indicates that schizophrenia is due to a genetic predisposition and environmental stressors early in a child's development (during pregnancy and birth, and/or early childhood) which lead to subtle alterations in the brain that make a person susceptible to developing schizophrenia. Additional environmental factors and stresses later in life (during childhood, adolescence and young adulthood) can either damage the already vulnerable brain further and trigger schizophrenia or lessen the expression of neurodevelopmental defects and decrease the risk of schizophrenia. In fact experts now say that schizophrenia (and all other mental illness) is caused by a combination of biological, psychological and social factors, and this understanding of mental illness is called the bio-psycho-social model.

While the precise mechanisms that underlie the development of schizophrenia are just starting to be understood research does suggest many important actions that individuals and families can take (or avoid) to lower the risk of schizophrenia and other mental illnesses. In this document we've identified the specific actions that research suggests are most likely to reduce your, or your child's, risk of mental illness.

We are indebted to the following schizophrenia researchers for their input on this document:
Cheryl Corcoran, M.D. of New York's schizophrenia evaluation & prevention center,
Kristin Cadenhead, M.D. of San Diego's UCSD schizophrenia CARE center, and
Sophia Vinogradov, M.D. of San Francisco's UCSF schizophrenia PART program.

Scientists now know that genes are not destiny. While a person may have some of the genes that are associated with increased risk of mental illness - research suggests that only if a person is exposed to specific environmental factors and perceived stresses do the genes become active and thereby further increase the risk for, or trigger, the illness. There is no specific amount of genetic or environmental input that has been identified that will ensure someone will or will not develop schizophrenia so it is never to late or too early to begin planning for your mental health and that of your children. Research now shows that in mental health the biology, psychology and social /emotional environment are closely interdependent - so factors in each of these areas are important to address. Please note that the following information is targeted at optimizing children's mental health in general, not just avoidance of schizophrenia.

Before going into the specific risk reduction strategies its important to know the initial risks that a person may face of getting schizophrenia. In the general population, for someone who has no family history of mental illness, the average risk is estimated at approximately 1% (and therefore a 99% probability that the person will not get schizophrenia). If someone who is genetically related to a person in the extended family that does have schizophrenia, then the risk is higher - and the chart below provides a rough estimate of that risk. If, for example, you have an aunt or uncle who developed schizophrenia, then your risk (on average) is estimated at approximately 3% (and therefore there is a 97% probability you won't get schizophrenia). Even for the situation where one parent has schizophrenia the risk is estimated at 13% for a child, which means there is an 87% probability that the person will not develop schizophrenia. If a family has a history of more than one person developing schizophrenia then the risk goes up. People who have a strong history of mental illness in their family may want to consider genetic counseling in addition to the schizophrenia prevention tactics identified below.

(Image Source: Debby Tsuang, M.D., M.Sc., University of Washington/VAPSHCS)

Its also important to keep in mind as you read about the risk factors, that most of these risk factors are associated with approximately a doubling of risk (also called the "Odds Ratio") - which might sound high, but that means that overall for someone with no family history of schizophrenia, that the risk goes from about 1% to 2% (with risk of not getting schizophrenia declining from 99% to 98%). Therefore, for the average person with no family history of schizophrenia or mental illness most of these risk factors may not make a significant difference in terms of total risk of schizophrenia which remains low. At the same time good healthcare, nutrition and a positive emotional environment for women during pregnancy are always important factors for the health of a baby and always recommended by doctors. Research also suggests that nurturing, sensitive child care is also important for the healthy emotional development of children.

Image: Some of the Schizophrenia Environmental Risk Factors - Source; PLOS Medicine (Note: different studies suggest different risk factors - so you will see some variance in the risk number that we quote below for some environmental factors).

The factors listed below matter most significantly for people who have a history of schizophrenia or other mental illness in their family which suggests that a person may have some of the genes, psychological issues or social environmental factors that are associated with schizophrenia risk. At this time little is known about exactly how the environmental exposures identified below increase risk in those with some sort of genetic vulnerability - so don't get too worried if you have in the past experienced a given environmental factor, as its impossible to know for sure how that environmental factor might impact you or your child. Focus on the environmental factors that you still have some influence over.

The take home message is that if you have a family history of mental illness it would likely be beneficial to take some reasonable steps to reduce or avoid exposure to the risk factors -- especially those factors involved in pregnancy, prenatal care and early child care. For teens interested in lowering their risk of schizophrenia, the avoidance of street drugs, maintenance of healthy friendships, and early treatment for any depression, sadness and anxiety/fear is likely to be valuable. At the same time, all of the actions below are likely to help the mental health of any child or person - so the more steps you can take, the better your (or your child's) mental health is likely to be.

Table of Contents - Schizophrenia Prevention tactics:

• Information for Teens: How to Lower Your Risk for Schizophrenia
  • Don't use street drugs, and moderate any use of alcohol
  • Make an ongoing effort to develop your social skills as much as you can
  • Avoid social isolation
  • Make an ongoing effort to maintain friendships with adults
  • Make an extra effort to learn positive perspectives on the world
  • Make extra effort to learn how to deal with stress and anxiety
  • Seek Help from Qualified Psychologists and Psychiatrists if you have problems coping


• Information for Parents: How to Lower Your Child's Risk for Schizophrenia
  
  
  
  • Relationship & Family Environment Factors
    • Build a relationship, or marry, a person with whom you can have a stable, loving and (mostly) low-stress relationship
    • Make an extra effort to resolve differences. Learn good relationship skills
    • Maximize your own mental health, learn to lower stress, and eliminate anxiety and depression
    
    
  • Pre-Pregnancy Planning for Children's Mental Health
    • Begin prenatal planning at least three months prior to pregnancy
    • Plan your pregnancy; Have a child when you want one, and don't have a child if you don't want one
    • Take a multivitamin daily for 1 to 3 months prior to conception
    • Make sure that any sexually transmitted diseases (eg. Herpes, Chlamydia, etc.) have been treated by a medical professional prior to pregnancy
    • Make an extra effort to be at a healthy weight prior to pregnancy
    • Make extra efforts to avoid alcohol and lead exposure prior to, and during Pregnancy
    • Men should try to plan to have children when they are younger, rather than older
    • Consider having a longer (greater than 27 months) interval between pregnancies, to maximize mental health of children
  
  
  • Stress and Pregnancy; Lower Stress Results in Healthier Brain Development
    • Learn how to Maintain Lower Levels of Physical, Social and Emotional Stress & Anxiety (worry) Immediately before, and during pregnancy
    • How to Lower Stress, Anxiety, Worry and Depression Before Pregnancy
    
    
  • Activites To Take During Pregnancy to Maximize Children's Mental Health
    • During pregnancy be sure to get enough of the key vitamins for the child's healthy brain development
    • Do not smoke cigarettes or use other tobacco products during pregnancy
    • Avoid all medications (unless doctor prescribed) during the pregnancy
    • Avoid Dry Cleaning chemicals during the pregnancy (and keep young children away from recently dry cleaned clothes)
    • It may be good for the baby's brain for the mother to continue moderate exercise after start of pregnancy
    • Test for risk of RH blood incompatibility between mother and child immediately after birth
    • Consider taking extra precautions to avoid getting the flu, during flu season
    • Eat a healthy diet with a lot of vegetables and the recommended amount of fish with omega 3 fatty acids
    • Consider taking extra precautions to minimize risk of baby delivery complications
    • Consider minimizing your exposure to cats during your pregnancy
    • After Birth - Make sure the mental health of the mother is good
    • Breast feed the baby for at least 6 months, unless otherwise directed by a doctor
    • Provide vitamin D supplementation to your child during the first year of life
    • Consider having, and raising, your child outside of an urban environment
      
    
    
  • Childhood Mental Health Maximizing Activities
    • Learn as much as you can about the important new lessons that psychology and neuroscience research is revealing about how to raise children for maximum mental health
    • Teach your children (and yourself) a "Growth Mindset" on life's challenges, to reduce stress and maximize a child's ability to effectively cope with difficulties in life.
    • During the first year of life, the baby should be held by a caring human for 4 hours or more a day
    • Try to moderate the stress that children experience and coach them on how to most effectively and positively deal with the stress they do experience
    • Parents should minimize"Expressed Emotion" (yelling, shouting, arguing, or over-involvement & controlling behavior)
    • Learn from the latest research into child development and practice sensitive, nurturing, low-stress parenting
    • Teach your children a positive, optimistic view on life and life's events
    • Encourage the development of good social skills and friendships for your children
    • A family may want to work on providing an enriched educational, nutritional and social environment for their children
    • If a family emmigrates to a different country, the family should make extra efforts to make sure that the child integrates well in the new country and learns how to strong friendships
    • Try to minimize risk of traumatic events in a child's life
    • Encourage the development of good "reality testing" skills
    • Encourage good head and brain safety practices in children
    • Get early screening and treatment for mental health problems in children