Skip to main content

Advertisement

SpringerLink
Log in

Adoption, family relations and psychotic symptoms among Palauan adolescents who are genetically at risk for developing schizophrenia

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

This paper focuses on the role of adoption and family relations as moderators of genetic risk for psychotic disorders.

Methods

Participants included 184 adolescents in the Republic of Palau identified to be at genetic risk for schizophrenia and other psychotic disorders. Palau is an island nation in Micronesia with a lifetime prevalence of 1.99% for schizophrenia and 2.67% for psychotic disorders more broadly defined [24]. In Palauan culture, kinship adoption is a common cultural practice; 47 of the 184 participants had been adopted at an early age. The current study was designed to test the hypothesis that adoption would function as a protective factor among Palauan youth at genetic risk for the development of psychotic symptoms. Participants were evaluated for psychotic and other psychiatric symptoms using KSADS-PL [16]. Concurrently, the Youth Self Report [1] was used to assess the perceived quality of family relationships.

Results

Results indicated that adopted adolescents were more likely to develop psychotic symptoms than non-adopted adolescents. However, perceived family relations moderated the association between adoption status and psychotic symptoms, such that adopted adolescents with poorer family relations reported disproportionately higher rates of psychotic symptoms. Family relations also moderated the association between level of genetic risk and psychotic symptoms, independently of adoption status.

Conclusion

Consistent with previous research, adolescents at high genetic risk who reported more positive family relations also reported fewer psychotic symptoms [4, 29].

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Achenbach TM (1991) Manual for the youth self-report and 1991 profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  2. Aiken LS, West SG (1991) Multiple regression: testing and interpreting interactions. Sage Publications, Thousand Oaks

    Google Scholar 

  3. Amminger GP, Leicester S, Yung AR et al (2006) Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high-risk individuals. Schizophr Res 84:67–76

    Article  CAS  PubMed  Google Scholar 

  4. Carter JW, Schulsinger F, Parnas J, Cannon T, Mednick SA (2002) A multivariate prediction model of schizophrenia. Schizophr Bull 28:649–682

    PubMed  Google Scholar 

  5. Collishaw S, Maughan B, Pickles A (1998) Infant adoption: psychosocial outcomes in adulthood. Soc Psychiatry Psychiatr Epidemiol 33:57–65

    Article  CAS  PubMed  Google Scholar 

  6. Compton MT, Kaslow NJ, Walker EF (2004) Observations on parent/family factors that may influence the duration of untreated psychosis among African American first-episode schizophrenia-spectrum patients. Schizophr Res 68:373–385

    Article  PubMed  Google Scholar 

  7. Corcoran C, Walker E, Huot R et al (2003) The stress cascade and schizophrenia: etiology and onset. Schizophr Bull 29:671–692

    PubMed  Google Scholar 

  8. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DC

  9. Dutta R, Greene T, Addington J, Kwame M, Phillips M, Murray R (2007) Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis. Schizophr Bull 33:868–876

    Article  PubMed  Google Scholar 

  10. Goldner EM, Hsu L, Waraich P, Somers J (2002) Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Can J Psychiatry 47:833–843

    PubMed  Google Scholar 

  11. Goldstein MJ (1998) Adolescent behavioral and intrafamilial precursors of schizophrenia spectrum disorders. Int Clin Psychopharmacol 13(Suppl 1):S101–S102

    Article  Google Scholar 

  12. Häfner H, Maurer K, Trendler G, Heiden W, Schmidt M, Könnecke R (2005) Schizophrenia and depression: challenging the paradigm of two separate diseases–a controlled study of schizophrenia, depression and healthy controls. Schizophr Res 77(1):11–24

    Article  PubMed  Google Scholar 

  13. Hezel FX (2001) The new shape of old island cultures: a half century of social change in Micronesia. University of Hawaii Press, Honolulu, p 2001

    Google Scholar 

  14. Hooley J, Gotlib I (2000) A diathesis-stress conceptualization of expressed emotion and clinical outcome. Appl Prev Psychol 9:135–151

    Article  Google Scholar 

  15. Jablensky A (2000) Prevalence and incidence of schizophrenia spectrum disorders: implications for prevention. Aust N Z J Psychiatry 34:S26–S38

    PubMed  Google Scholar 

  16. Kaufman J, Birmaher B, Brent D, Rao U (1997) Schedule for affective disorders and schizophrenia for school-age children, present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988

    Article  CAS  PubMed  Google Scholar 

  17. Kendler KS (1997) The genetic epidemiology of psychiatric disorders: a current perspective. Soc Psychiatry Psychiatr Epidemiol 32:5–11

    Article  CAS  PubMed  Google Scholar 

  18. King S (2000) Is expressed emotion cause or effect in the mothers of schizophrenic young adults? Schizophr Res 45:65–78

    Article  CAS  PubMed  Google Scholar 

  19. Kirkbride JB, Fearon P, Morgan C et al (2006) Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes. Arch Gen Psychiatry 63:250–258

    Article  PubMed  Google Scholar 

  20. Levy-Shiff R (2001) Psychological adjustment of adoptees in adulthood: family environment and adoption-related correlates. Int J Behav Dev 25:97–104

    Article  Google Scholar 

  21. McGrath JJ (2005) Myths and plain truths about schizophrenia epidemiology—the NAPE lecture 2004. Acta Psychiatr Scand 111:4–11

    Article  CAS  PubMed  Google Scholar 

  22. Miller B, Fan X, Grotevant H, Christensen M, Coyl D, van Dulmen M (2000) Adopted adolescents’ overrepresentation in mental health counseling: adoptees’ problems or parents’ lower threshold for referral? J Am Acad Child Adolesc Psychiatry 39(12):1504–1511

    Article  CAS  PubMed  Google Scholar 

  23. Myles-Worsley M, Blailes F, Ord LM, Weaver S, Dever G, Faraone SV (2007) The Palau early psychosis study: distribution of cases by level of genetic risk. Am J Med Genet B Neuropsychiatr Genet 144B:5–9

    Article  PubMed  Google Scholar 

  24. Myles-Worsley M, Coon H, Tiobech J et al (1999) Genetic epidemiological study of schizophrenia in Palau, Micronesia: prevalence and familiality. Am J Med Genet 88:4–10

    Article  CAS  PubMed  Google Scholar 

  25. Myles-Worsley M, Tiobech J, Blailes F, Yano VM, Faraone SV (2007) Recurrence risk to offspring in extended multiplex schizophrenia pedigrees from a Pacific Island isolate. Am J Med Genet B Neuropsychiatr Genet 144:41–44

    Google Scholar 

  26. O’Brien MP, Gordon JL, Bearden CE, Lopez SR, Kopelowicz A, Cannon TD (2006) Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophr Res 81:269–275

    Article  PubMed  Google Scholar 

  27. Parnas J, Teasdale TW, Schulsinger H (1985) Institutional rearing and diagnostic outcome in children of schizophrenic mothers: a prospective high-risk study. Arch Gen Psychiatry 42:762–769

    CAS  PubMed  Google Scholar 

  28. Rescorla L, Achenbach T, Ivanova M et al (2007) Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries. J Consult Clin Psychol 75:351–358

    Article  PubMed  Google Scholar 

  29. Schiffman J, LaBrie J, Carter J, Cannon T, Schulsinger F, Parnas J, Mednick S (2002) Perception of parent–child relationships in high-risk families and adult schizophrenia outcome of offspring. J Psychiatr Res 36:41–47

    Article  PubMed  Google Scholar 

  30. Schimmelmann BG, Conus P, Cotton S, McGorry PD, Lambert M (2007) Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophr Res 95(1–3):1–8

    Article  PubMed  Google Scholar 

  31. Scott J, Martin G, Bor W, Sawyer M, Clark J, McGrath J (2009) The prevalence and correlates of hallucinations in Australian adolescents: results from a national survey. Schizophr Res 107:179–185

    Article  PubMed  Google Scholar 

  32. Sheskin D (2004) Handbook of parametric and nonparametric statistical procedures, 3rd edn. Chapman & Hall/CRC, Boca Raton

    Google Scholar 

  33. Smith DR (1983) Palauan social structure. Rutgers University Press, New Brunswick

    Google Scholar 

  34. Tandon R, Keshavan MS, Nasrallah HA (2008) Schizophrenia, “Just the facts” what we know in 2008. 2. Epidemiology and etiology. Schizophr Res 102:1–18

    Article  PubMed  Google Scholar 

  35. Tienari P, Wahlberg KE, Wynne LC (2006) Finnish Adoption Study of Schizophrenia: implications for family interventions. Fam Syst Health 24:442–451

    Google Scholar 

  36. Tienari P, Wynne LC, Sorri A et al (2004) Genotype–environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. Br J Psychiatry 184:216–222

    Article  PubMed  Google Scholar 

  37. The European Network of Schizophrenia Networks for the study of gene–environment interactions (EU–GEI) (2008) Schizophrenia etiology: do gene–environment interactions hold the key? Schizophr Res 102:21–26

    Google Scholar 

  38. Treide, D (2004) Adoption in Micronesia. In: Bowie F (ed) Cross-cultural approaches to adoption. Routledge, London, pp 127–142

  39. Tsuang M (2000) Schizophrenia: genes and environment. Biol Psychiatry 47:210–220

    Article  CAS  PubMed  Google Scholar 

  40. van Os J, Hanssen M, Bijl RV, Ravelli A (2000) Strauss (1969) revisited: a psychosis continuum in the general population. Schizophr Res 45:11–20

    Article  PubMed  Google Scholar 

  41. van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39:179–195

    Article  PubMed  Google Scholar 

  42. Wahlberg KE, Wynne LC, Hakko H et al (2004) Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders. Psychol Med 34:1531–1541

    Article  PubMed  Google Scholar 

  43. Wynne LC, Tienari P, Nieminen P et al (2006) I. Genotype–environment interaction in the schizophrenia spectrum: genetic liability and global family ratings in the Finnish Adoption Study. Fam Process 45:419–434

    Article  PubMed  Google Scholar 

  44. Yung AR, Nelson B, Baker K, Buckby JA, Baksheev G, Cosgrave EM (2009) Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Aust N Z J Psychiatry 43:118–128

    Article  PubMed  Google Scholar 

  45. Yung AR, Yuen HP, McGorry PD et al (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 39:964–971

    PubMed  Google Scholar 

  46. Zandi T, Havenaar JM, Limburg-Okken AG, van Es H, Sidali S, Kadri N, van den Brink W, Kahn RS (2008) The need for culture-sensitive diagnostic procedures: a study among psychotic patients in Morocco. Soc Psychiatry Psychiatr Epidemiol 43:244–250

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported with funds from National Institute of Mental Health grant number MH5418 and Fogarty International Center Grant number 5R21TW007803. We would like to thank Marina Myles-Worsley for facilitating access to data and her helpful comments throughout the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Palau Youth Project, Ministry of Health, P. O. Box 6027, Koror, 96940, Palau

    Laura Ierago, Cynthia Malsol, Techong Singeo, Yuri Kishigawa, Francisca Blailes, Stevenson Kuartei, Josepha Tiobech & Berrymoon Watson

  2. Department of Psychiatry, School of Medicine, University of Utah, 30 N. 1900 E., Salt Lake City, UT, 84132-2502, USA

    Lisa Ord

  3. Center for Addictions and Behavioral Health Research, University of Wisconsin-Milwaukee, P. O. Box 786, Milwaukee, WI, 53201, USA

    Paul Florsheim

  4. School of Behavioural Science, University of Melbourne, Melbourne, VIC, 3010, Australia

    Lisa Phillips

  5. Palau Community College, P. O. Box 9, Koror, 96940, Palau

    Hilda Ngiralmau

Authors
  1. Laura Ierago
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia Malsol
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Techong Singeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuri Kishigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisca Blailes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa Ord
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Florsheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lisa Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stevenson Kuartei
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Josepha Tiobech
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Berrymoon Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hilda Ngiralmau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Florsheim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ierago, L., Malsol, C., Singeo, T. et al. Adoption, family relations and psychotic symptoms among Palauan adolescents who are genetically at risk for developing schizophrenia. Soc Psychiat Epidemiol 45, 1105–1114 (2010). https://doi.org/10.1007/s00127-009-0154-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-009-0154-x

Keywords

Search

Navigation