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.
Consider the Timing of Your Pregnancy for an August or September Birth: The research suggests that if you live in the Northern hemisphere, consider avoiding becoming pregnant during April and May, which would result in a child birth in February or March - because children born during the winter months tend to have an average 10% higher rate of schizophrenia. The ideal months to become pregnant if you want the lowest possible risk of schizophrenia are November and December - for a birth in August or September. This is a relatively low-risk element in the environmental factors linked to schizophrenia risk so we don't recommend people worry about it too much. Instead of timing your pregnancy, perhaps a better strategy is to focus on getting enough vitamin D, and avoiding infections as outline in other parts of this document.
Make extra efforts to avoid alcohol and lead exposure during Pregnancy and in the Months Prior to Pregnancy - Compounds that have been identified as potentially toxic compounds for developing baby brains include lead and alcohol. Alcohol should be avoided as early as possible when a woman starts planning for a pregnancy, and by mothers during pregnancy - especially when there is a history of mental illness in the mother or father's family. For maximum safety women may want to stop drinking several months prior to pregnancy as alcohol may damage embryos during early pregnancy. Alcohol even at moderate intakes raises the risk of birth defects and breast cancer, possibly because it interferes with folate (folic acid), an essential B vitamin.
Rapidly growing bodies and unborn children are far more likely to absorb lead that has been swallowed or inhaled, and it poses a grave threat to their long-term health and well-being, experts say.
Children who ingest lead -- usually in the form of dust from deteriorating lead-based paint or from water tainted with lead leached from plumbing -- have reduced potential for lifetime achievement and increased risk of socialization and behavioral problems, according to numerous studies.
Similarly, fetuses that absorb lead from the mother are at a high risk of many types of developmental problems. Epidemiologists report evidence that lead's effects on children can remain undetected for decades until emerging in adulthood in the form of psychiatric diseases such as schizophrenia.
Stress and Pregnancy - The Importance of Low Stress in Brain Development
Make Extra Effort to Maintain Low Levels of Physical, Social and Emotional Stress & Anxiety (worry, fear and perfectionism) During Pregnancy.
Its important for all family members and extended family to make extra effort to create an environment of low stress for the woman during pregnancy to allow healthy brain development of the child. Reseach suggests that high levels of social and emotional stress can have negative impacts on the fetus during pregnancy. The mother and the uterine environment she creates have a major contribution to many aspects of fetal development and a number of key brain development steps that occur during that time impact a child throughout its life. The exact consequences of hormonal variations in the womb on our intelligence, personality, and emotional and physical health is beginning to be understood. There's also an emerging understanding of something called fetal programming, which says that the effects of our life in the womb may be not be felt until decades after we're born, and in ways that are more powerful than previously imagined.
When we feel stressed, we normally experience a range of effects -- our pupils dilate, our blood pressure and heart rate rise, and our emotions heighten. What we don't see are the internal effects. A message reaches the pituitary gland at the base of the brain and is relayed to the adrenal glands, where the stress hormone cortisol is secreted into our bloodstream. The placenta inactivates most of the mother's cortisol before it reaches the fetus, but some of it gets into the fetal bloodstream.
The mother's cortisol also can cause the placenta to release corticotrophin-releasing hormone (CRH), which goes directly to the fetus. This causes the fetus to secrete its own cortisol, which stimulates the placenta to secrete even more CRH, creating for the fetus a self-perpetuating stress-hormone loop.
Janet DiPietro, an associate professor of maternal and child health at the Johns Hopkins School of Public Health and one of the few fetal-behavior specialists in the US, says that research tells us that the fetus is bathed in hormones generated by what the mother is feeling, and these hormones affect the underlying fetal brain environment that shapes its personality and temperament, she says. "Temperament has to be formed this way. It wouldn't make any sense for it not to. I think a woman who is going up and down all day with stress hormones and changes in heart rate and blood pressure causes her fetus to get a very uneven distribution of oxygen. This is not good for its ultimate homeostatic well-being."
This happens because maternal stress triggers the secretion of not only cortisol but another stress hormone, adrenaline. Adrenaline and adrenaline-like stress hormones can cause uterine contractions that disturb the fetus and can constrict blood vessels that diminish blood flow -- and oxygen -- to the fetus. Lack of oxygen to the fetus brain is well known to be harmful to the brain and has been identified as an important factor in increasing risk for schizophrenia. Maternal factors such a stress and stress hormones have been shown to play a significant role in pregnancy outcomes related to premature birth - another factor that is associated with underweight babies and higher risk of schizophrenia.
A study of pregnant women during the Quebec ice storm also concluded that stress during pregnancy significantly stalls children's brain development, making them less intelligent, more anxious and more prone to bad behaviour. The children of pressured pregnant mothers even had mismatched fingerprints, a sure sign of impairment during the development of the fetal brain. Billed as the first scientific look at the impact of stress on unborn babies, the project found toddlers whose mothers were under the most strain during the storm had IQs almost 20 points lower on average than the offspring of lower-stressed women. Additional research studies have further suggested that lower IQs are associated with higher risk for psychosis and schizophrenia.
In another study that demonstrates how stress impacts brain development, a research program completed in 2001 found that women who have had a major stressful event - death of a spouse, job loss, or a long-distance move - midway through their pregnancy may have a greater chance of having an autistic child than do their unstressed counterparts, say researchers at The Ohio State University Medical Center.
And, in yet another recent study (2006) research suggests that women who work more than 32 hours a week in stressful jobs risk the health of their unborn child. Babies born to these women have been found to be five ounces lighter than the average birth weight - the same as those of pregnant smokers. (low birthweight is very bad for babies; where the woman is of normal size, a low birth weight baby suggests the developing child experienced poor nutrition, low oxygen, high stress, or other problems in the womb. Moreover low birthweight is associated with greatly increased risk for many physical and mental disorders including low IQ, and significantly increased risk of psychiatric disorders).
The results provide fresh evidence of the effect of stress on a developing baby and has led the man in charge of the research to call on pregnant women to work no more than 24 hours a week. The study, involving 7,000 women, and conducted by the Amsterdam Born Children and their Development research group, also found that mothers suffering from stress are more likely to have babies that cry excessively.
And it revealed that mothers who worked long hours have an increased risk of developing pre-eclampsia, a serious complication of pregnancy caused by a defect in the placenta that restricts blood flow to the baby. Prof Gouke Bonsel, who headed the study, said: "Women with high stress jobs would do better to work no more than 24 hours per week from the beginning of pregnancy.''
Dr. Janet DiPietro believes maternal stress can "affect the set point for stress responsiveness" in the developing baby. In other words, children born to mothers who have especially strong reactions to stress may themselves grow up to be hot reactors.
Although we respond to emotional stress differently because it is filtered through our individual personality and temperament, we don't always know how we're reacting physically. In her research, DiPietro finds that when women are asked to describe how they feel when put to stress tests, their answers often don't correspond to their measured stress levels. A number of women who said they didn't feel especially stressed were in fact highly stressed, according to the monitors, and some who said they felt stressed had relatively low measured stress levels.
While research definitely suggests that high levels of stress is bad for the fetus during pregnancy, and research also suggests that babies with genes associated with mental are more sensitive to stress, moderate levels of maternal psychological stress during pregnancy may actually enhance fetal maturation for some babies, according to researchers from the Johns Hopkins University and the National Institute of Child Health and Human Development, in a study is published in the May/June 2006 edition of the journal Child Development.
The authors found one exception to their study results: the children of women who regarded their pregnancy as more negative than positive showed slightly poorer emotional control and attention capacity.
DiPietro believes pessimism is a major generator of stress and stress hormones. She says an expectant mother's stress burden is greatly eased when she views her pregnancy optimistically and chooses to focus on its positive aspects and doesn't worry much. (for more information on how to develop this positive attitude, we highly recommend the books "Feeling Good" and "When Panic Attacks: The New Anxiety Therapy That Can Change Your Life by Dr. David Burns, and Mindset by Dr. Carol Dweck.)
DiPietro finds that highly pressured mothers-to-be tend to have more active fetuses -- and more irritable infants. "The most stressed are working pregnant women," says DiPietro. "These days, women tend to work up to the day they deliver, even though the implications for pregnancy aren't entirely clear yet. That's our cultural norm, but I think it's insane."
Some researchers agree that working can be an enormous stress, but emphasize that pregnancy hormones help to buffer both mother and fetus. Individual reactions to stress also matter. "The pregnant woman who chooses to work is a different woman already from the one who chooses not to work,"
She's also different from the woman who has no choice but to work. DiPietro's studies show that the fetuses of poor women are distinct neurobehaviorally-less active, with a less variable heart rate-- from the fetuses of middle-class women. Yet "poor women rate themselves as less stressed than do working middle-class women," she notes. DiPietro suspects that inadequate nutrition and exposure to pollutants may significantly affect the fetuses of poor women.
Stress, diet, and toxins may combine to have a harmful effect on intelligence. A recent study by biostatistician Bernie Devlin, Ph.D., of the University of Pittsburgh, suggests that genes may have less impact on IQ than previously thought and that the environment of the womb may account for much more. "Our old notion of nature influencing the fetus before birth and nurture after birth needs an update," DiPietro insists. "There is an pre-birth environment, too, that is provided by the mother."
Additional insights into the impact of stress on a developing baby came in a study designed to find out why African-American babies are twice as likely to have low birth weight than white babies. On average, African-American babies weigh about one-half to two-thirds of a pound less than white babies and significantly less than Hispanic, Native American, and American-born Asian babies.
Because birth weight is vital to the overall health of a baby, this weight difference is significant and may be one reason why African-American babies have double the infant-mortality rate of white babies.
Because the weight difference has remained so consistent over the years, genes were widely assumed to be the cause. Dr. James Collins, medical director of the neonatal intensive-care unit at Children's Memorial Hospital in Chicago, wasn't so sure. He devised a study by examining the birth records of three groups of newborns: babies born to US-born African-American women; white women; and African-born black women living in the US.
He looked at the records of nearly 90,000 babies and compared their birth weights. In a study published in the New England Journal of Medicine, he effectively debunked the genetic theory of birth weight.
Both white and African-born mothers gave birth to babies of similar birth weights, but the American-born African-American mothers had babies of lower birth weight. If genes were the controlling factor, the birth weights of babies born to the African-American and African-born black women should have been equivalent.
So what is the cause of lower-birth-weight African-American babies? Collins doesn't think the major factor is diet; he thinks it's the mother's stress.
"It may not just be the stress the expectant mother experiences," Collins says. "It may go back to her mother or her mother's mother. A grandmother may give birth to a low-birth-weight baby, who in turn gives birth to a low-birth-weight child. It may be an intergenerational effect we're seeing."
Collins says the mother's stress could be related to poverty, racism, and the climate of fear in the neighborhoods in which many of them live. The stress they feel probably is also layered with feelings of pessimism and hopelessness. White women subjected to similar emotional stresses also have lower-birth-weight babies.
Extreme emotional stress is thought to put developing babies at risk for a variety of physical disorders. Fetal researcher Peter Nathanielsz notes that many years ago the French discovered that physical and emotional stress led to terrible outcomes for the babies of young laundry mistresses. "The French finally figured out these women worked long and hard and stood on their feet all day," he says. "As a result, their blood pooled in their feet and their fetuses didn't get enough blood."
Animal studies have found that high cortisol levels can weaken cells and interfere with fetal brain development, resulting in a wide range of brain and behavior problems for the offspring. A Finnish study found children born to mothers who suffered the emotional shock of losing their husband had a bigger risk of developing serious mental disorders (for example, studies suggest that the risk of the child developing schizophrenia is increased by 600%). The researchers cautioned that the shock didn't directly cause the illnesses; rather, it appears to be a factor for offspring with an underlying genetic susceptibility. Nonetheless, the study points out how important a mother's state of mind may be in the development of her unborn child.
The study also underscores the notion that in life, including prenatal life, timing can be everything. The affected children were born to mothers who learned of their husbands' deaths in the second trimester. Mothers who received the jolting news in the first or third trimesters did not have children with a higher risk of mental disorders.
While most women in North America don't live under conditions of extreme stress. Nonetheless, DiPietro thinks that as a society we are putting too much stress on pregnant women.
"For thousands of years, some cultures, like the Chinese, have had strict prohibitions against exposing pregnant women to stress," she says. "One woman from China told me that her parents did not tell her pregnant sister that their grandmother had died. They waited until after she delivered to tell her."
Not so in the United States, she says. "Our society has gone crazy with our policy to work right up until the time you have a child," DiPietro adds. "In our study we found women tend to work until the day they go into labor. Then after a few weeks at home, they return to work. It's absurd. They don't catch up on their sleep for years. They are too mentally and physically depleted. This is just so foolish, and now it's become the norm."
Peter Nathanielsz says wakefulness and rest patterns are important in pregnancy, because animal studies indicate that continual disruption of maternal and fetal circadian rhythms may be harmful. "A pregnant woman who gets up at 3 in the morning to go to work or take one of their kids to a hockey rink puts a lot of stress on her and the fetus she carries," he adds.
Expectant mothers are also cautioned about exercising beyond their established limits or in conditions such as hot weather or high altitudes that they're not accustomed to. Both can stress the fetus by depriving it of needed oxygen.
"We have to understand our own biology during pregnancy," Dr. Nathanielsz says. "We ignore it at our peril."
Because temperament and personality are critical to stress reaction, there's some disagreement as to how much a woman can reduce emotional stress and what kind of impact that will have on her unborn child. "We can say stress is bad," says DiPietro, "but that doesn't tell women what to do about it."
For that reason, other than encouraging pregnant women to think positive thoughts and to try to avoid placing stress on themselves, there's been little concrete advice. (for more information on how to "think positive thoughts" - see the software/web sites listed at the end of the recommended reading list below).
Dr. Nathanielsz proposes a simple prescription: "The best thing pregnant women can do is lie down and relax as much as they can during the day," he says. "This will ease their stress, bring maximum blood and oxygen to the fetus, and enhance the health of their pregnancy."
Its also very valuable for women who are pregnant to have close and frequent interactions with their close friends and family members that make them feel good and who they can discuss issues and challenges with. Isolation from friends and family during pregnancy is a type of stress - especially if the husband/father is not frequently available for support, or if there are significant issues with the relationship between husband and wife.
Husbands should be extra emotionally supportive during their wife's pregnancy, and make extra effort to make things easy for pregnant woman so as to make their pregnancy as low stress as possible.
How to Lower Stress, Anxiety, Worry and Depression Before Pregnancy:
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.
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).
Recommended Books: These books should be available from your local libraries.
Work on developing a positive perspective on life's challenges with a "growth mindset". Read the following book: Mindset: The New Psychology of Success By Dr. Carol Dweck, Stanford University. Learn more here: The Effort Effect (Stanford University Alumni Magazine)
Pregnancy Considerations for both Husband and Wife - Following is a list of pregnancy-related points that suggested different ways in which schizophrenia risk for a child might be lowered by actions taken before and during pregnancy.Research suggests that the more of these actions that can be taken, the lower the potential risk for schizophrenia for the child.
Pregnant women must be sure to get enough of the key vitamins for the child's healthy brain development
Be sure to take the recommended levels of Vitamin D, Folic Acid, Choline, Omega 3 and Omega 6 Fatty Acids (and all the other vitamins typically seen in a prenatal vitamin). To be effective, folic acid should be taken before pregnancy to prevent developmental defects. The simplest way to increase folic acid levels is by taking vitamin supplements, but it is also advisable to eat folate-rich foods such as green vegetables (broccoli, spinach), citrus fruits (oranges, limes, grapefruit) or wholemeal products such as 100% whole wheat bread or high-fibre cereals. Despite the proven value of folic acid, a recent March of Dimes survey found that only 32 percent of American women of childbearing age -- including pregnant women -- took folic-acid supplements.
These vitamins have also been identified as reducing risk of brain defects and of low-birth weight babies. Low birth weight is associated with adult psychological distress, researchers report. A study published in the July 2005 issue of the British Journal of Psychiatry found that children born full term but weighing less than 5.5 lbs had a 50% increased risk of psychological distress in later life. This remained the case after taking into account potential confounding factors. Researchers have found a strong link between folic acid levels in the blood and birth weight. For each unit change in folic acid level, the baby's weight increased by 14 per cent. The result emphasises the importance of folic acid in the diet of pregnant women or those trying to have a child.
In April, 2007 a new study came out that indicated that supplementation with multivitamins during pregnancy may boost the birth weight of newborns, and "In light of these benefits and the low cost of the supplements, multivitamins should be considered for all pregnant women," wrote lead author Wafaie Fawzi in the New England Journal of Medicine.
The research is of particular importance since an estimated 20 million children worldwide are born with low birth weight, defined as less than 2,500 grams (5.5 pounds), with over 95 per cent these underweight babies born in developing countries. Low birth weight has been linked to higher risks of negative health outcomes, including neonatal and infant mortality, poor growth and cognitive development, and higher risks of chronic diseases later in life, like diabetes and heart disease.
Do not smoke cigarettes or use other tobacco products during pregnancy, and avoid second hand smoke
Evidence is very strong that cigarette smoke exposure for a mother during pregnancy lowers birth weight and increases the risks of premature birth, attention deficit hyperactive disorder, and diminished IQ in the child. Of course, all street drugs (cocaine, marijuana / cannabis, etc.) should also be completely avoided during pregnancy.
It may be good for the baby's brain for the mother to continue moderate exercise after start of pregnancy, if a woman has been active before.
Exercising during pregnancy might have unanticipated benefits – at least in mice, a new study suggests. Pups born to active mums developed bigger brains a few weeks after birth.
The growth was confined to a very specific part of the brain linked with intelligence. Compared with the offspring of inactive mothers (those denied an exercise wheel) pups born to active mothers typically developed 40% more cells in the hippocampus, the area of the brain vital for learning and memory. Read the full story: Do active mums produce brainier babies?
Expectant mothers are cautioned about exercising beyond their established limits or in conditions such as hot weather or high altitudes that they're not accustomed to. Both can stress the fetus by depriving it of needed oxygen.
Test for risk of RH blood incompatibility between mother and child, late during the pregnancy or after the pregnancy - Medical professionals (doctors) do this by checking the maternal and paternal blood types to determine if you might be at risk for Rh incompatibility (i.e., if the mother is Rh negative, and the father is Rh positive, then offspring may be Rh positive and at risk for Rh incompatibility). If it's determined that the mother is Rh negative, then theoretically, the Rh negative woman is supposed to receive RhoGAM (immunoglobulin that prevents the maternal immune response to Rh+ blood) late in the pregnancy, and definitely after the delivery. Hemolytic disease of the newborn (potential outcome in the case of mother developing the antibodies against her fetus) is a quite rare occurrence these days in places where the medical care is good. Women should just be aware of their own Rh blood type, and be certain that their gynocologeist/obstetrician is aware of any potential RH blood compatiblity and treatments with respect to giving them RhoGAM (for example, after amnio, late in pregnancy, after miscarriage or abortion, after delivery, etc.).
Consider taking extra precautions to avoid getting the flu, during flu season. Pregnant women may want to reduce their risk of influenza by avoiding large social gatherings, avoiding people who have the flu, avoiding shaking hands with others, and washing hands frequently. A research study by Columbia University has suggested that approximately 14% of schizophrenia cases seem to have been caused by influenza during pregnancy.
Pregnant Women Should Eat a healthy diet with a lot of vegetables and the recommended amount of fish with omega 3 fatty acids. Fruit is also a good addition to the diet. Highly processed foods and junk food should be limited. According to U.S. Department of Agriculture (USDA) guidelines, Americans should consume at least two servings of fruit and three servings of vegetables each day as part of a healthy diet. Researchers from the Johns Hopkins Bloomberg School of Public Health report that Americans are not meeting these minimum levels.
Consider having, and raising, your child outside of an urban environment. Research suggests that the average child born and raised in urban environments (compared to rural environments) have up to a two to three times higher risk of developing schizophrenia, and the highest rates of schizophrenia seen in the areas with the highest density of urbanization. Being brought up in a city seems to be a critical factor, and the risk increases the more childhood years spent in an urban environment. For people who do live in a city, the less dense the population, the lower the risk seems to be. In other words, it would seem to be better to live in row housing, than an area with large apartment buildings. The exact factors associated with living in a city that lead to the higher incidence of schizophrenia are unknown at this time. Researchers have theorized that the increased schizophrenia risk may be due to increased transfer of infections (e.g. the flu) in higher density living situations, or higher levels of poverty, interpersonal stress, polution, or noise in cities. Whatever the case, researchers have found that the more years that children spend growing up in an urban city environment, the higher the risk of schizophrenia. Also, reseach data suggests that children with genetic vulnerability are most at risk of the effects of an urban upbringing.
Columbia University schizophrenia researcher Dr. Cheryl Corcoran has, however, suggested that "urban environment" risk factor needs to interpreted with the understanding that the research is still early and you have to be careful about drawing overly general conclusions. Dr. Corcoran suggests, for example, that living on Fifth Avenue (the wealthy upper East side area of New York city close to central park) probably does not increase your risk for schizophrenia as compared to living in upstate (rural) New York. By contrast, living in a poor and highly populated part of a city is more likely to significantly raise the risk of schizophrenia compared to living in a less poor area of a rural or suburban area.
Learn as much as you can about the important new lessons that psychology and neuroscience research is revealing about how to raise babies and children for maximum mental health. Research today is showing that sensitive, calm and nurturing childcare contributes greatly to having a mentally healthy baby.
Additionally, "one of key things research suggests is that parents must be sure not to deny or dismiss a child's fear or distress, but rather to show empathy for it - and then be sure not to become trapped theselves within the child's bad mood but to confront the situation with a reassuring and optimistic sense that something can be done. By seizing moments of distress as an opportunity for empathy and intimacy, and for helping the child grow and learn, such parents become coaches in the art of managing life's ups and downs; in fact evidence suggests that such parenting changes not only how a child behaves but also the child's brain. One sign of this biological shift is that a chid's psysiology develops greater ability to recover from adverse arousal of stresses and strains - which is thought to be important for prevention of many mental disorders." (source: Social Intelligence, by Daniel Goleman, PHD).
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 rare criticism and clear, straightforward communication appears to be protective against the triggering of this genetic risk.
Talaris Research Institute has gathered leading research studies on social and emotional development and merged them into easy-to-read and interesting summaries. Learn about the amazing capabilities of babies and children through age 5 and learn how vital your role is as a parent. Read Summaries Here.
The following news articles focus on new research that shows the importance of teaching children a positive "growth" mindset and how parents can encourage this mindset. A growth mindset is important for children becauseit lowers children's stress levels, reduces risk of anxiety and depression disorders, and helps them make greater effort and a positive perspective in the face of difficulties, thereby increasing the likelihood that children will achieve their goals. With a growth mindset children more accurately see all setbacks or problems as positive challenges, or opportunities for growth and merely part of a normal life and a valuable learning experience. With a "growth mindset" children never need to feel "branded" by any setbacks or perceived failures.
Dr. Dweck, a psychiatry professor at Stanford University, in her book"Mindset: The New Psychology of Success", describes how parents can help children develop a growth mindset:
Every word and action from a parent to a child sends a message. Tomorrow, listen to what you say to your kids and tune in to the messages you're sending. Are they messages that say "You have permanent traits and I'm judging them? Or are they messages that say "You're a developing person and I'm interested in your development"
How do you use praise? Remember that praising children's intelligence or talent is, tempting as it it, sends a fixed-mindset message. It makes their confidence and motivation more fragile and harms their performance. Instead, try to focus on the processes they used - their strategies, their effort or choices. Practice working the process praise into your interactions with your children.
Watch and listen to yourself carefully when your child messes up. Remember that constructive criticism is feedback that helps the child understand how to fix something. Its not feedback that labels or simply excuses the child. At the end of each day, write down the constructive criticism (and process praise) you've given your kids.
Parents often set goals their children can work toward. Remember that having innate talent is not a goal. Expanding skills and knowledge is. Pay careful attention to the goals you set for your children.
Many parents think that when they judge and punish they are teaching, as in "I'll teach you a lesson you'll never forget". What are they teaching? They are teaching their children that if they go against parents' rules or values they'll be judged and punished. They're not teaching their children how to think through the issues and come to ethical, mature decisions on their own. They're not teaching their children that the channels of communication are open. The next time you're in a position to discipline, ask yourself, What is the message I'm sending here: is it "I will judge and punish you?" or "I will help you think and learn?"
Parents can encourage the growth mindset on a daily basis. At the dinner table each evening parents can structure the discussion around a growth mindset, asking each child (and each other): What did you learn today?, What mistake did you make that taught you something?, What did you try hard at today?. You go around the table with each question, excitedly discussing your own and one another's effort, strategies, setbacks and learning.
During the first year of life, ideally the baby should be held by a sensitive, responsive and caring human for at least 4 hours a day.
Research suggests that babies who are held and carried frequently and get their need for touch well-met in their first year do not become clingy and overly dependent. Instead, they become well "attached" to their parents and caregivers, and have lower anxiety levels, they cry much less and they grow to become happier, more independent, more loving and more social than babies who spend much of their infancy in infant seats, swings, etc. that don't provide babies with human contact.
Try to moderate the stress that children experience and help coach them on how to most effectively and positively deal with the stress they do experience. Also - parents should make an extra effort to learn to manage your own stress levels because children pick up stress from their parents. Evidence continues to mount that prenatal and early childhood stressful experiences can have profound long-term effects on the developing central nervous system and its regulation of basic physiology, psychology, and immune function. Stresses such as neglect and abuse during infancy may result in memory loss and impaired cognitive abilities that manifest later in life, a University of California , Irvine, study has found.
Parents should work to minimize"Expressed Emotion" (yelling, shouting, arguing, or over-involvement & controlling behavior) between the parents, or directed at the children. Parents that raise their voices frequently and attempt to over-control their children can cause a great deal of stress for their children - and increased levels of stress in the family environment is, for children, associated with increased risk of depression and anxiety, in addition to schizophrenia. High levels of expressed emotion is considered by most psychologists and psychiatrists to be an indicator of a dysfunctional family because it is in contradiction to the warm, nurturing, empathetic approach to parenting that research indicates results in children with the lowest level of mental health problems.
Research suggests that if disagreements between adults and children can usually be handled with relative calm and rational discussions, the mental health of children is likely to be maximized and the child will learn good problem solving and conflict resolution skills that will be of value throughout their lives. Parents who have difficulty controlling their emotions may benefit from books such as Feeling Good and The Feeling Good Handbook and by working with a psychologist or therapist who can help teach them skills for emotional control and anger management. Over-involvement and controlling behavior is a common symptom of anxiety (worry / fear) which can be treated with psychotherapy (cognitive behavioral therapy).
It is likely to be helpful to teach children a positive, optimistic view on life and life's events and challenges. Research suggests that a positive "growth-oriented" approach to life will make the child more resilient to stress and negative events in their life and thereby lowering the risk of anxiety disorders, depression and other mental illnesses. When setbacks are viewed as learning opportunities, and "increased effort" is rewarded by parents - children learn to be persistent and not to let "failures" define them.
How people think about the events in their lives affects their brain chemistry, and probably even the risk for schizophrenia. This suggests that parents can teach their children how to think about the problems they encounter and the stresses in their lives – in a manner which may be more healthy (less stressful) and that may result in lower risk for mental illness. For example, Dr. Martin Seligman, a well known psychologist at the University of Pennsylvania has written books that propose that teaching children an optimistic interpretation of the world results in children that have greater resiliency in the face of challenges and stress – and lower rates of mental illness (especially depression and anxiety).
Encourage and Assist the development of good social skills for your children - Research suggests that better social skills should help lower social stress for a child throughout life. Poor social skills (negative symptoms) are a defining symptom of schizophrenia. Some research being done suggests that extra effort in helping children develop good social skills during childhood may lower risk of schizophrenia later in life. Research suggests that children learn most of their early social skills from their parents. If a parent's social skills are not strong (i.e. a person has difficulty making and maintaining strong friendships and positive social interactions) then a child is at increased risk of not learning good social skills - which leads to social isolation and stress.
Please note that research shows that children are unable to learn much in the way of social skills prior to age three - and every child develops at a slightly different rate and in different ways. Research suggests that it would be beneficial for the child's development for parents to be encouraging of children's social development after age three - in a sensitive and positive approach.
Following are some readings and software programs that may provide some education and assistance for children in this area:
Social Skills (also called emotional and social intelligence by researchers) has become increasingly identified as factors in mental health and success in life.
Researchers have found that social skill deficits tend to be very common in people who develop schizophrenia, and that when people who have schizophrenia are taught better social skills that there is a reduction in the severity of the "negative" symptoms. This research seems to suggest that putting extra effort into teaching children good social skills and emotional management may reduce the risk of schizophrenia. Some of the same research is being applied in autism therapy and risk reduction and the same tools that are used in improving the social skills in autistic children may also be of value in improving social skills and emotional management in children at risk for schizophrenia. Teaching children good social skills and "emotional intelligence" is important for all children - so putting extra effort on it for children with a family history of mental illness is not a wasted effort.
Computer software has been developed to specifically teach children emotional understanding and effective social skills (and again, these are primarily focused on helping children with autism, but research suggests that there are social skills deficit aspects to autism that relate to children at risk for schizophrenia). Following is information on two such software programs that are available to the public:
Another Tool that researchers are using that coaches people on understanding and recognizing emotions is Dr. Paul Ekman's training CD on emotions. To learn more about Dr. Ekman - visit his web site.
If the Family Emigrates to a different country, the family should make extra efforts to make sure that the child integrates well in the new environment and makes strong friendships. The social stress that is associated with significant changes of environment for children, (and racism and bullying that may take place in a new country) is associated with a higher risk of schizophrenia.
Encourage the development of good "reality testing" skills for your children so that they can better determine what is real and what is fantasy. Psychiatrists we've talked to have suggested that children who are taught good "reality testing" skills may be at lower risk for psychosis because of they can more quickly and accurately distinguishing between what is real and what is fantasy. Psychiatrists also tell us that in general it is a bad thing to give children contradictory information about
the environment (usually done with the intent of "protecting" the child, for example a parent who has just been crying, telling the child that they are not sad, etc.).
Related Books:
A children's book (for children age 6 to 12 years old) "Maybe Yes, Maybe No", By Dan Barker. This book is a child's introduction to healthy skepticism. The book's ten-year-old heroine, Andrea, is "always asking questions," writes author Dan Barker, because she thinks "you should prove the truth of a strange story before you believe it."This book teaches the essentials of critical thinking - "Check it out," "Repeat the experiment," " Try to prove it wrong," "It has to make sense"- illustrating each of these rules with clear examples. Appropriate for elementary school and early middle school.
Encourage good head and brain safety practices in children
Head injury has been linked to a significant (300%) increase in schizophrenia risk for those children who are biologically predisposed to schizophrenia. Such head safety practices as proper use of baby car seats, wearing a helmet when riding a bicycle, and wearing a seat belt while riding in a car, should be strongly encouraged by parents.
Get early screening and treatment for mental health problems in children
The early symptoms of most mental illnesses start when children are very young with more subtle symptoms. Research is now showing that early treatment of mental health problems is an important step in prevention of mental illnesses and it is therefore encouraged for parents to get their children screening, and if need be - treated, as early as possible. Like most illnesses - the sooner you can identify and treat mental illness, the greater the chance that you can avoid the most serious consequences. Early mental health issues that parents should watch for (between the ages of 3 and 6) and consult psychologists about include social anxiety/shyness, social isolation, ongoing sadness, fears and sleep problems, and conduct disorders.
by Dr. David Burns
