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 or lessen the expression of neurodevelopmental defects and decrease the risk of schizophrenia.
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 doing) 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.
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
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 probably 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 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:
Note - for people outside the USA who cannot obtain or afford the books listed below, you may, in many cases, be able to download these books and interviews (or audio books) for free via the emule private file sharing network. To access this network (illegal, in the US) - go to the emule web site, and download the latest "Installer" version of software for your PC, then do searches in the "name" field - on for key words in the title of the book or the author's last name. Where it says "Type" - specify "document", "archive" and "audio" files, in three different searches for each item you're looking for. Specify the "method" to be "global servers". Most of the files being shared on these networks are being made available by millions of high school and university students (and others) around the world. While we have heard that some industry organizations are taking legal action against students who have downloaded music via the emule network, we have not heard of any actions against people who download books and audio books. If you need help in understanding how to use emule - go to the help section of the emule web site. To open .rar files - use the WinRAR application available for download from here.
Personal Schizoprenia Prevention and Risk Reduction Actions
Don't use street drugs, and moderate any use of alcohol. Street drugs have chemicals in them that are harmful to the teen brain. Significant alcohol consumption has also been shown to cause brain damage and potentially increased risk of schizophrenia. Moreover, a significant amount of research indicates that drugs and alcohol are even more risky (more likely to cause serious brain damage) for people who have a history of mental illness in their family. Unfortunately, many people who have mental health problems never get formally evaluated by a qualified psychologist or psychiatrist, and sometimes parents don't know about, or don't tell their children about mental illness that may be in their family (for example, they might just not talk about an uncle or cousin that was always a little strange or eccentric - when in fact the person was mentally ill) so just because you haven't heard of any mental illness in your family - doesn't mean that there wasn't any.
Make an ongoing effort to develop your social skills as much as you can and maintain at least a few close friendships that you can discuss issues with freely. If you have any tendencies towards shyness - make an extra effort to learn about social skills as is covered in the books listed below. Social skills are like any other skills; something that we all must learn about and practice to improve. Some parents are not very good at teaching social skills and so frequently children and young adults must make their own efforts to learn them. The area of "emotional intelligence" is a closely related area that researchers suggested is an important to enhance our knowledge and skills in. Following are some good resources and books that are designed to help you improve these skills:
Avoid social isolation - don't spend too much time alone - try to get out and enjoy time with your friends every day or two, at least. If you go to college, live with roommates that you get along well with, don’t get too isolated.
Make an ongoing effort to maintain friendships with adults who you trust and respect and who are compassionate helpful with any challenges you face. Many people grow up in families where children feel they are unable to talk with their parents. In these cases children may benefit by seeking out other adults and relatives that they feel that they can trust, and who are interested in helping, who they can seek help and advice from. These other adults may be good teachers, school counselors, or family relatives (aunts, uncles, cousins, etc.).
Make an extra effort to learn positive perspectives on the world and situations you encounter. Make sure you understand that setbacks or problems you encounter in life are opportunities for growth and merely part of a normal life and a valuable learning experience. Problems or difficulties are not a statement or judgement about you personally - but simply an indication that you hadn't learned how to solve that given problem yet. With time and effort most problems can be understood and resolved.
Recommended Internet Software: MoodGym - For Prevention of Depression (Free) For this to be most effective, you must work through all the modules of the software.
Listen to this good interview with Dr. Carol Dweck that explains why its important to avoid a "fixed mindset" and to instead to develop a "growth mindset" - so that you understand that setbacks and challenges in life are normal and merely learning experiences that prepare you for greater success in the future.
(Watch Video Below).
Make extra effort to learn how to deal with stress and anxiety / fear (and moderate exposure to such stresses) and get regular exercise. When you do feel stress, depression or sadness, fear or anxiety (high levels of worry, fear, or perfectionism) – discuss the issues with close friends or family members, and read the books listed below to learn the skills that will allow you to reduce the worries, fear and anxiety so as to have a positive outlook on life. Also, be sure to get regular excercise (30 minutes of vigorous excercise three to five times a week).
Seek Help from Qualified Psychologists and Psychistrists if you have problems coping.
Seek out a qualified psychologist or psychiatrist if you are having difficulty dealing with any stress, anxiety and worry, sadness or depression or have any odd thoughts that you don’t understand. Its always better to get help from the psychologist sooner rather than later. If you have a family history of mental illness, be sure to tell the psychologist or psychiatrist because that will help them plan the most effective therapies for you.
If you have a family history of mental illness and live close to one of the Early Psychosis and Schizophrenia Prevention, Evaluation and Treatment centers around the world – definitely visit them for an evaluation or talk to them if you have a strong family background of schizophrenia - for example two or more family members who have had schizophrenia. Also - contact them if you ever experience any of the following symptoms:
Schizophrenia Risk Reduction Actions for Parents and Future Parents
The following schizophrenia prevention strategies are identified to help parents potentially lower the risk of mental illness in their children. While researchers we've talked to believe that it is likely that each of these actions would be helpful in risk reduction for mental illness, definative proof of their effectiveness is not yet available. Given this, the approach for the family members at this web site has been to take the actions that we can to lower the risk of mental illness in our children - but we don't worry about things that we can't do, or haven't done in the past. Its doubtful that anyone will take all the actions identified below. Our focus is instead on taking actions in areas we reasonably can, and looking positively towards the future with the knowledge that we've taken some significant actions to lower risk of mental health problems for our children in the future.
Build a relationship, or marry, a person with whom you can have a stable, loving and (mostly) low-stress relationship and a healthy family life. Some characteristics of healthy families as stated by family relationship expert Dr. D. Reiss, of George Washington University:
Healthy families speak clearly. They are not rigid in their discussions, nor are they confused and chaotic.
They tend to agree more often than disagree and are able to assert themselves without offending others.
They have a friendly environment and are able to disagree without upsetting other members.
They show variation in affect (mood) ; they can express happiness or sadness to each other.
They have a good sense of humor and have the ability to laugh at themselves.
They respect each other's need for privacy and do not engage in mind reading (thinking that they can tell exactly what a person is thinking).
They negotiate and compromise.
In families that function effectively, grudges are not held very long. Arguments are short and followed by more friendly interactions.
The Finnish Adoptive Family Study of Schizophrenia has confirmed that genetics plays a major role in the risk of development of schizophrenia. It also found that persons with a genetic risk of schizophrenia are especially sensitive to the emotional climate of their family environment. A child-rearing environment that is sensitive and nurturing, with infrequent criticism and clear, straightforward communication appears to be protective against the triggering of this genetic risk.
If there are difficulties in the marital relationship, make an extra effort to resolve the differences to both people's satisfaction. Learn conflict resolution skills. Conflict resolution skills are important in relationships; if a couple is having difficulty, they should make an extra effort to learn the positive relationship skills that are the key to a happy and loving family. Additionally, if either person in the relationship has any type of mental illness, including depression, anxiety (excessive worry or fears), Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder, etc.) its important that the person get treatment and become as well as possible prior to getting pregnant and having children. See a qualified family therapist, psychologist or psychiatrist if the problems continue. Maternal depression during pregnancy is very harmful and is associated with approximately a 200% increase in risk for the child developing schizophrenia as well as many other mental illnesses and cognitive development problems. (for related issues see the topic below on stress and pregnancy, and the topic on child development).
To help maintain your mental health be sure to get regular excercise (30 minutes of vigorous excercise three to five times a week).
Recommended Internet Software (Free): MoodGym - For Prevention of Depression For this software to be most effective, you must work through all the modules of the software.
Web psychotherapy 'just as good' as face to face therapy (BBC) - this story suggests that some web therapy may be as helpful as therapy with a psychologist - so it seems like a good idea to try web therapy (as in the above links).
A General Theory of Love By Thomas Lewis, FariAmini, Richard Lannon - This book discusses the science of human emotions and how love changes and guides who we are and what we become. It explains how relationships function and how parents shape a child’s developing self, with emphasis on the idea that our emotional ties determine our mood, stabilize and maintain our health, and change the structure of our brains.
Pre-Pregnancy Planning- Actions you can do prior to pregnancy that research suggests may lower risk of the child developing schizophrenia or other mental illness.
Begin prenatal planning at least three months prior to pregnancy - get a pre-pregnancy checkup well in advance of conception. According to a National Center for Health Statistics survey, more than one in four expectant mothers in the US received inadequate prenatal care. Its also important to discuss with the doctor any medications you may have taken in the recent past, or are taking.
Plan your pregnancy; Have a child when you want one, and don't have a child if you don't want one
Research suggests that children from unwanted pregnancies have a 250% to 300% higher than average risk of schizophrenia, when compared to children that are planned and desired by its parents. Researchers believe that this higher risk may be due to the mental stress that the mother of an unwanted child is experiencing, or poorer prenatal care that typically takes place with unwanted pregnancies. In unwanted pregnancies mothers may pay less attention to getting the proper nutrition and care during the pregnancy and during early childhood. (Source: British Medical Journal)
A (2004) study results suggest that use of multivitamins prior to conception may reduce the risk of preterm birth. Dr. A. Vahratian and colleagues at the University of Michigan wrote, "Previous research suggests that multivitamin use before and during pregnancy can diminish diet-related deficiencies of certain micronutrients and potentially prevent preterm birth."
In their study they found that "results suggest that, compared with nonusers, women who take multivitamin supplements prior to conception may have a reduced risk of preterm birth.
Make an extra effort to be at a healthy weight (Body Mass Index between 18.5 and 24.9) prior to pregnancy - Research suggests that being at a healthy weight prior to pregnancy increases the health of the baby. However, just as having too much weight is not healthy for the mother or baby, research also suggests that being too slim can also be a negative. An optimal weight is approximately a BMI of 22 or 23.
Early
Schizophrenia Screening Test 
by Dr. David Burns