Done D J, Johnstone E C, Frith C D, Golding J, Shepherd P M, Crow T J
Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex.
BMJ. 1991 Jun 29;302(6792):1576-80. doi: 10.1136/bmj.302.6792.1576.
To evaluate whether events occurring at or around the time of birth contribute to the onset of psychotic illness in adult life. DESIGN-Pregnancy and birth complications as possible causes of adult mental illness were studied in the population sample of the British perinatal mortality survey. Subsequent psychiatric admissions were independently identified through the Mental Health Enquiry and records of regional and special health authorities. Logistic regression was used to compare data on perinatal deaths with those on survivors to determine factors independently associated with perinatal death, and this equation was then used to calculate the risk of perinatal death for each survivor.
16,980 people born in a single week in 1958 (the British perinatal mortality survey sample), including 252 patients admitted to psychiatric care; case notes of 235 patients were supplied.
Patients with a schizophrenic illness (whether defined by "broad" (n = 57) or "narrow" (n = 35) diagnostic criteria) did not have a greater mean risk of perinatal death than the population in general, but there was some evidence of increased liability (relative risk 2.43; 95% confidence interval 1.17 to 5.05) for those with affective psychosis (n = 32). Specific high risk variables for affective psychosis were decreased gestation time (273.9 v 281.2 days; mean difference 7.3 days, 95% confidence interval 3.1 to 11.5; p less than 0.002) and prescription of vitamin K to the child in the first week of life (19% of patients v 5% of controls, p = 0.016).
The findings give no support to theories that factors predicting perinatal mortality contribute significantly to causation of schizophrenic illness. Further investigation of decreased gestation length in relation to affective disorder is required.
评估出生时或出生前后发生的事件是否会导致成年后精神疾病的发作。设计——在英国围产期死亡率调查的人群样本中，研究怀孕和分娩并发症作为成人精神疾病可能病因的情况。随后通过心理健康调查以及地区和特殊卫生当局的记录独立确定精神科住院情况。使用逻辑回归比较围产期死亡数据和幸存者数据，以确定与围产期死亡独立相关的因素，然后用该方程计算每个幸存者的围产期死亡风险。
1958年某一周出生的16980人（英国围产期死亡率调查样本），其中包括252名接受精神科护理的患者；提供了235名患者的病历。
患有精神分裂症的患者（无论根据“宽泛”（n = 57）还是“狭义”（n = 35）诊断标准定义）围产期死亡的平均风险并不高于总体人群，但有一些证据表明情感性精神病患者（n = 32）的患病风险增加（相对风险2.43；95%置信区间1.17至5.05）。情感性精神病的具体高风险变量包括妊娠时间缩短（273.9天对281.2天；平均差异7.3天，95%置信区间3.1至11.5；p<0.002）以及在出生后第一周给婴儿使用维生素K（19%的患者对5%的对照组，p = 0.016）。
研究结果不支持预测围产期死亡率的因素会显著导致精神分裂症病因的理论。需要进一步研究妊娠长度缩短与情感障碍的关系。
