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Exposure to genocide and the risk of schizophrenia: a population-based study

Published online by Cambridge University Press:  01 December 2015

S. Z. Levine ,
I. Levav ,
Y. Goldberg ,
I. Pugachova ,
Y. Becher  and
R. Yoffe
S. Z. Levine*
Affiliation:
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
I. Levav
Affiliation:
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
Y. Goldberg
Affiliation:
Department of Statistics, Faculty of Social Sciences, University of Haifa, Haifa, Israel
I. Pugachova
Affiliation:
Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
Y. Becher
Affiliation:
Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
R. Yoffe
Affiliation:
Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
*
*Address for correspondence: S. Z. Levine, Ph.D., Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel. (Email: slevine@univ.haifa.ac.il)
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Abstract

Background

No evidence exists on the association between genocide and the incidence of schizophrenia. This study aims to identify critical periods of exposure to genocide on the risk of schizophrenia.

Method

This population-based study comprised of all subjects born in European nations where the Holocaust occurred from 1928 to 1945, who immigrated to Israel by 1965 and were indexed in the Population Register (N = 113 932). Subjects were followed for schizophrenia disorder in the National Psychiatric Case Registry from 1950 to 2014. The population was disaggregated to compare groups that immigrated before (indirect exposure: n = 8886, 7.8%) or after (direct exposure: n = 105 046, 92.2%) the Nazi or fascist era of persecutions began. The latter group was further disaggregated to examine likely initial prenatal or postnatal genocide exposures. Cox regression modelling was computed to compare the risk of schizophrenia between the groups, adjusting for confounders.

Results

The likely direct group was at a statistically (p < 0.05) greater risk of schizophrenia (hazard ratio = 1.27, 95% confidence interval 1.06–1.51) than the indirect group. Also, the likely combined in utero and postnatal, and late postnatal (over age 2 years) exposure subgroups were statistically at greater risk of schizophrenia than the indirect group (p < 0.05). The likely in utero only and early postnatal (up to age 2 years) exposure subgroups compared with the indirect exposure group did not significantly differ. These results were replicated across three sensitivity analyses.

Conclusions

This study showed that genocide exposure elevated the risk of schizophrenia, and identified in utero and postnatal (combined) and late postnatal (age over 2 years) exposures as critical periods of risk.

Keywords

Fetal originsholocaustmalnutritionrefugeesschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 4 , March 2016 , pp. 855 - 863
Copyright
Copyright © Cambridge University Press 2015 

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