Customize your JAMA Network experience by selecting one or more topics from the list below.
St Clair D, Xu M, Wang P, et al. Rates of Adult Schizophrenia Following Prenatal Exposure to the Chinese
Famine of 1959-1961. JAMA. 2005;294(5):557–562. doi:10.1001/jama.294.5.557
Author Affiliations: Bio-X Center, Shanghai
Jiao Tong University, Shanghai (Drs St Clair and Xu), Institute for Nutritional
Sciences, Shanghai Institute of Biological Sciences, Chinese Academy of Sciences
(Drs Xu and He), Fourth People’s Hospital, Wuhu, Anhui (Drs Wang and
Yu), Second People’s Hospital, Huang Shan, Anhui (Dr Fang), Institute
of Population Research, Peking University (Dr Zheng), Shanghai Institute of
Mental Health, Shanghai (Drs Gu and Feng), Department of Psychiatry, University
of Hong Kong, Hong Kong (Dr Sham), and NHGG, Shanghai Jiao Tong University,
Shanghai (Dr He), People’s Republic of China; Department of Mental Health,
University of Aberdeen, Scotland (Drs St Clair and Zhang); and Division of
Psychological Medicine, Institute of Psychiatry, London, England (Dr Sham).
Context Schizophrenia is a common major mental disorder. Intrauterine nutritional
deficiency may increase the risk of schizophrenia. The main evidence comes
from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited
decline in food intake occurred. The most exposed cohort conceived during
the famine showed a 2-fold increased risk of schizophrenia.
Objective To determine whether those who endured a massive 1959-1961 famine in
China experienced similar results.
Design, Setting, and Participants The risk of schizophrenia was examined in the Wuhu region of Anhui,
one of the most affected provinces. Rates were compared among those born before,
during, and after the famine years. Wuhu and its surrounding 6 counties are
served by a single psychiatric hospital. All psychiatric case records for
the years 1971 through 2001 were examined, and clinical and sociodemographic
information on patients with schizophrenia was extracted by researchers who
were blinded to the nature of exposure. Data on number of births and deaths
in the famine years were available, and cumulative mortality was estimated
from later demographic surveys.
Main Outcome Measures Evidence of famine was verified, and unadjusted and mortality-adjusted
relative risks of schizophrenia were calculated.
Results The birth rates (per 1000) in Anhui decreased approximately 80% during
the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and
11.06 in 1961. Among births that occurred during the famine years, the adjusted
risk of developing schizophrenia in later life increased significantly, from
0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative
risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960
and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961.
Conclusion Our findings replicate the Dutch data for a separate racial group and
show that prenatal exposure to famine increases risk of schizophrenia in later
Create a personal account or sign in to: