Gottesman Flashcards
title
disorders in offspring with two psychiatrically ill parents.
background
Investigated couples who have psychiatric illnesses and their offspring to calculate the risk of their offspring also being diagnosed with a psychiatric illness.
aim
To investigate the importance of genetic influence on offspring, where both parents have been admitted with a severe psychiatric disorder (hospitalised).
sample
-Ps born from population of approx 2.7 million Danish ppl born before 1997 who had identifiable mother & father.
-data sampled in 2007 so youngest ps was 10 yrs old.
-196 couples both people diagnosed with schizophrenia- and their 270 children.
-83 couples both people diagnosed with bipolar- and their 146 children.
-sample represented target group of families where both parents had severe mental illness.
-for comparison- samples where only 1 parent had schizophrenia (8006 couples with 13,878 children) or bipolar (11,995 couples with 23,152 children) were also drawn.
-Rates of mental disorders also recorded from remainder of population where neither parents had schizophrenia/bpd.
procedure - type of study
Cohort study: looking at a cohort of a population (born between 2 dates)
Records of families from national register in Denmark were used.
Ps were born/ alive after 1968 up to 1997, offspring followed up to 52 years old.
procedure- type of experiment
Natural experiment/ Quasi
Naturally occurring groups.
Independent variable
Parental diagnosis of schizophrenia, bpd or related psychotic condition in accordance with World Health Organisation system for classifying disorders (ICD).
Dependent variable
Offspring diagnosis of any mental illness according to the ICD.
Results- schizophrenia
Risk of schizophrenia in 270 offspring of 196 parent couples both admitted to psychiatric facility with schizophrenia diagnosis was 27.3% compared to 7% with only one of the two diagnosed.
Results- bpd
Risk of bipolar was 24.9% in 145 offspring of 83 couples admitted with bpd compared to 4.4% with only one parent ever admitted.
0.48% with neither parent admitted.
Results- risk of ANY psychiatric disorder
Maximum risks of ANY psychiatric disorders in offspring of parents both with schizophrenia or bpd were 67.6% in both with schizophrenia and 44.2% in both with bpd respectively.
Conclusions
There is a greater risk of being admitted with psychological disorder if BOTH parents have been admitted compared to general population.
Strengths of Gottesman’s study.
-Supports medical model because it supports biological explanation of mental illness, specifically a genetic link.
-High in ecological validity
-Large sample means it’s representative
-Ethical- records are available from national statistics and in public domain, anonymity was assured
-Valid- diagnosis overtime from ICD-8 to ICD-10 was valid.
-Useful in family planning- advising people on risks associated with having children, adopting and genetic counselling, although Gottesman advises there is need for well informed counsellors to help with this.
Weaknesses of Gottesman’s study
-genetics are only partly responsible, otherwise identical twins would have 100% concordance rates, therefore raising problem or nature vs nurture; hard to separate out the influence of nature vs nurture.
-Reductionist: difficult to rule out influence of shared environment.
-May be unethical to use results to discriminate people from having children, adopting or for increasing health insurance premiums.
-Gottesman cites the Nazi policy of eugenics as an extreme response to info on genetic transference of certain characteristics.
-Study only included patients with hospital admissions for schiz/bpd excluding those treated as outpatients or who had symptoms but weren’t treated or experiencing a diff mental illness.
-only included most severe cases of mental disorders- this bias could mean conclusions cannot apply to all cases, only severe disorders have convincing genetic component.
-Ethnocentric- Denmark, may be different in other countries where healthcare is not free.
