Skip to main content

Advertisement

SpringerLink
Log in

Prenatal war exposure and schizophrenia in adulthood: evidence from the Sino-Japanese War of 1937–1945

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

Abstract

Purpose

This study aimed to examine the long-term effect of prenatal exposure to the Sino-Japanese War during 1937–1945 on risk of schizophrenia in adulthood among Chinese wartime survivors.

Methods

We obtained data from the Second National Sample Survey on Disability conducted in 31 provinces in 2006. We restricted our analysis to 369,469 adults born between 1931 and 1950. Schizophrenia was ascertained by psychiatrists based on the International Statistical Classification of Diseases 10th Revision. War intensity was assessed by the ratio of war-caused civilian casualties to the pre-war population. The effect of prenatal exposure to war on schizophrenia was estimated by difference-in-difference models, established by examining the variation of war across birth cohorts.

Results

In the male population, war cohorts of 1937–1946 had no significant higher odds of schizophrenia compared with the pre-war cohorts of 1931–1936. In the female population, war cohorts were 1.16 (95% CI 1.01, 1.33) times more likely than pre-war cohorts to have schizophrenia. Sensitive analyses show that our estimates of war effect on schizophrenia were robust and valid.

Conclusions

Prenatal exposure to the Sino-Japanese War of 1937–1945 had long-run detrimental effect on risk of schizophrenia in the female adults. Further investigations are warranted to extend the enduring wartime impact on other health outcomes in China.

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

Similar content being viewed by others

References

  1. Levy BS, Sidel VW (2007) War and public health. Oxford University Press, Oxford

    Google Scholar 

  2. Murray CJ, King G, Lopez AD, Tomijima N, Krug EG (2002) Armed conflict as a public health problem. BMJ 324(7333):346–349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Levy BS, Sidel VW (2009) Health effects of combat: a life-course perspective. Ann Rev Public Health 30(30):123–136. https://doi.org/10.1146/annurev.publhealth.031308.100147

    Article  Google Scholar 

  4. Ahlstram C (1991) Casualties of conflict: report for the protection of victims of war. Department of Peace and Conflict, Uppsala University, Uppsala 84(3):622–623

    Google Scholar 

  5. Minoiu C, Shemyakina ON (2014) Armed conflict, household victimization, and child health in Côte d’Ivoire. J Dev Econ 108(5):237–255

    Article  Google Scholar 

  6. Peattie MR, Drea EJ, Van de Ven HJ (2011) The battle for China: essays on the military history of the Sino-Japanese War of 1937–1945. Stanford University Press, Stanford

    Google Scholar 

  7. Che Y, Du J, Lu Y, Tao Z (2015) Once an enemy, forever an enemy? The long-run impact of the Japanese invasion of China from 1937 to 1945 on trade and investment. J Int Econ 96(1):182–198

    Article  Google Scholar 

  8. Hu S (1991) Seven decades of the Chinese Communist Party. Chinese Communist Party History Publishing House, Beijing

    Google Scholar 

  9. Li Z (2015) Introduction of the series of investigations on the human casualties and property losses in China during the Sino-Japanese War. CPC Hist Stud 28(1):5–12

    Google Scholar 

  10. van Os J, Selten JP (1998) Prenatal exposure to maternal stress and subsequent schizophrenia. The May 1940 invasion of The Netherlands. Br J Psychiatry 172(4):324–326. https://doi.org/10.1192/bjp.172.4.324

    Article  PubMed  Google Scholar 

  11. Levine SZ, Levav I, Goldberg Y, Pugachova I, Becher Y, Yoffe R (2016) Exposure to genocide and the risk of schizophrenia: a population-based study. Psychol Med 46(4):855–863. https://doi.org/10.1017/s0033291715002354

    Article  CAS  PubMed  Google Scholar 

  12. Selten J-P, Cantor-Graae E, Nahon D, Levav I, Aleman A, Kahn RS (2003) No relationship between risk of schizophrenia and prenatal exposure to stress during the Six-Day War or Yom Kippur War in Israel. Schizophr Res 63(1):131–135

    Article  PubMed  Google Scholar 

  13. Imamura Y, Nakane Y, Ohta Y, Kondo H (1999) Lifetime prevalence of schizophrenia among individuals prenatally exposed to atomic bomb radiation in Nagasaki City. Acta Psychiatr Scand 100(5):344–349

    Article  CAS  PubMed  Google Scholar 

  14. He Y (1979) Who actually fought the Sino-Japanese War, 1937–45? Lee Ming Company, Kuching

    Google Scholar 

  15. Zheng X, Chen R, Li N, Du W, Pei L, Zhang J, Ji Y, Song X, Tan L, Yang R (2012) Socioeconomic status and children with intellectual disability in China. J Intellect Disabil Res: JIDR 56(2):212–220. https://doi.org/10.1111/j.1365-2788.2011.01470.x

    Article  CAS  PubMed  Google Scholar 

  16. Zheng X, Chen G, Song X, Liu J, Yan L, Du W, Pang L, Zhang L, Wu J, Zhang B, Zhang J (2011) Twenty-year trends in the prevalence of disability in China. Bull World Health Organ 89(11):788–797. https://doi.org/10.2471/BLT.11.089730

    Article  PubMed  PubMed Central  Google Scholar 

  17. He P, Chen G, Wang Z, Guo C, Zheng X (2017) Children with motor impairment related to cerebral palsy: prevalence, severity and concurrent impairments in China. J Paediatr Child Health 53(5):480–484

    Article  PubMed  Google Scholar 

  18. Barker DJ (1990) The fetal and infant origins of adult disease. BMJ 301(6761):1111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Barker DJ (1995) The fetal and infant origins of disease. Eur J Clin Investig 25(7):457–463

    Article  CAS  Google Scholar 

  20. Lee C (2014) In utero exposure to the Korean War and its long-term effects on socioeconomic and health outcomes. J Health Econ 33(1):76–93

    Article  PubMed  Google Scholar 

  21. Susser E, St Clair D (2013) Prenatal famine and adult mental illness: interpreting concordant and discordant results from the Dutch and Chinese Famines. Soc Sci Med (1982) 97:325–330. https://doi.org/10.1016/j.socscimed.2013.02.049

    Article  Google Scholar 

  22. WHO (2001) International classification of functioning, disability and health: ICF. Encycl Public Health 7(3):802–822

    Google Scholar 

  23. Nations U (2001) Guidelines and principles for the development of disability statistics. United Nations Publications, New York

    Google Scholar 

  24. Zhang J (2010) Study of disability survey method institute of population research (in Chinese). Peking University, Beijing

    Google Scholar 

  25. Liu T, Song X, Chen G, Buka SL, Zhang L, Pang L, Zheng X (2013) Illiteracy and schizophrenia in China: a population-based survey. Soc Psychiatry Psychiatr Epidemiol 48(3):455–464. https://doi.org/10.1007/s00127-012-0552-3

    Article  PubMed  Google Scholar 

  26. Liu T, Song X, Chen G, Paradis AD, Zheng X (2014) Prevalence of schizophrenia disability and associated mortality among Chinese men and women. Psychiatry Res 220(1):181–187. https://doi.org/10.1016/j.psychres.2014.04.042

    Article  PubMed  Google Scholar 

  27. Ulug B, Ertugrul A, Gögüs A, Kabakcı E (2001) Reliability and validity of the Turkish version of the World Health Organization disability assessment schedule (WHO–DAS-II). Turk J Psychiatry 12(4):121–130

    Google Scholar 

  28. St Clair D, Xu M, Wang P, Yu Y, Fang Y, Zhang F, Zheng X, Gu N, Feng G, Sham P, He L (2005) Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959–1961. JAMA 294(5):557–562. https://doi.org/10.1001/jama.294.5.557

    Article  CAS  PubMed  Google Scholar 

  29. Chi J (1987) A history of the investigation of China’s losses during World War II. Academia Historica Press, Taiwan

    Google Scholar 

  30. Akbulut-Yuksel M (2017) War during childhood: the long run effects of warfare on health. J Health Econ 53(5):117–130

    Article  PubMed  Google Scholar 

  31. Bertrand M, Duflo E, Mullainathan S (2004) How much should we trust differences-in-differences estimates? Q J Econ 119(1):249–275

    Article  Google Scholar 

  32. Athey S, Imbens GW (2006) Identification and inference in nonlinear difference-in-differences models. Econometrica 74(2):431–497

    Article  Google Scholar 

  33. Puhani PA, Sonderhof K (2010) The effects of a sick pay reform on absence and on health-related outcomes. J Health Econ 29(2):285–302

    Article  PubMed  Google Scholar 

  34. Almond D, Edlund L, Li H, Zhang J (2007) Long-term effects of the 1959–1961 China famine: Mainland China and Hong Kong. National Bureau of Economic Research. http://www.nber.org/papers/w13384. Accessed 6 March 2017

  35. Akbulut-Yuksel M (2014) Children of War: the long-run effects of large-scale physical destruction and warfare on children. J Hum Res 49(3):634–662

    Article  Google Scholar 

  36. Huang C, Guo C, Nichols C, Chen S, Martorell R (2014) Elevated levels of protein in urine in adulthood after exposure to the Chinese famine of 1959–61 during gestation and the early postnatal period. Int J Epidemiol 43(6):1806–1814. https://doi.org/10.1093/ije/dyu193

    Article  PubMed  PubMed Central  Google Scholar 

  37. Huang C, Li Z, Wang M, Martorell R (2010) Early life exposure to the 1959–1961 Chinese famine has long-term health consequences. J Nutr 140(10):1874–1878. https://doi.org/10.3945/jn.110.121293

    Article  CAS  PubMed  Google Scholar 

  38. Huang C, Li Z, Narayan KV, Williamson D, Martorell R (2010) Bigger babies born to women survivors of the 1959–1961 Chinese famine: a puzzle due to survival selection? J Develop Orig Health Dis 1(6):412–418

    Article  CAS  Google Scholar 

  39. Huang C, Phillips MR, Zhang Y, Zhang J, Shi Q, Song Z, Ding Z, Pang S, Martorell R (2013) Malnutrition in early life and adult mental health: evidence from a natural experiment. Soc Sci Med (1982) 97(4):259–266. https://doi.org/10.1016/j.socscimed.2012.09.051

    Article  Google Scholar 

  40. Lee C (2017) Long-term health consequences of prenatal exposure to the Korean War. Asian Popul Stud 13(1):101–117. https://doi.org/10.1080/17441730.2016.1249608

    Article  Google Scholar 

  41. Korinek K, Teerawichitchainan B (2014) Military service, exposure to trauma, and health in older adulthood: an analysis of Northern Vietnamese survivors of the Vietnam War. Am J Public Health 104(8):1478–1487

    Article  PubMed  PubMed Central  Google Scholar 

  42. Saha S, Chant D, McGrath J (2007) A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 64(10):1123–1131. https://doi.org/10.1001/archpsyc.64.10.1123

    Article  PubMed  Google Scholar 

  43. Laursen TM, Nordentoft M, Mortensen PB (2014) Excess early mortality in schizophrenia. Ann Rev Clin Psychol 10(1):425–448. https://doi.org/10.1146/annurev-clinpsy-032813-153657

    Article  Google Scholar 

  44. Devakumar D, Birch M, Osrin D, Sondorp E, Wells JC (2014) The intergenerational effects of war on the health of children. BMC Med 12(1):57. https://doi.org/10.1186/1741-7015-12-57

    Article  PubMed  PubMed Central  Google Scholar 

  45. Watts C, Zimmerman C (2002) Violence against women: global scope and magnitude. The Lancet 359(9313):1232–1237

    Article  Google Scholar 

  46. Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, Marks JS (2000) Violence and reproductive health: current knowledge and future research directions. Matern Child Health J 4(2):79–84

    Article  CAS  PubMed  Google Scholar 

  47. Simic S, Idrizbegovic S, Jaganjac N, Boloban H, Puvacic J, Gallic A, Dekovic S (1995) Nutritional effects of the siege on new-born babies in Sarajevo. Eur J Clin Nutr 49(S2):S33–S36

    PubMed  Google Scholar 

  48. Saigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. The Lancet 371(9608):261–269

    Article  Google Scholar 

  49. Xu MQ, Sun WS, Liu BX, Feng GY, Yu L, Yang L, He G, Sham P, Susser E, St Clair D, He L (2009) Prenatal malnutrition and adult schizophrenia: further evidence from the 1959–1961 Chinese famine. Schizophr Bull 35(3):568–576. https://doi.org/10.1093/schbul/sbn168

    Article  PubMed  PubMed Central  Google Scholar 

  50. Susser E, Neugebauer R, Hoek HW, Brown AS, Lin S, Labovitz D, Gorman JM (1996) Schizophrenia after prenatal famine. Further evidence. Arch Gen Psychiatry 53(1):25–31

    Article  CAS  PubMed  Google Scholar 

  51. He P, Chen G, Guo C, Wen X, Song X, Zheng X (2018) Long-term effect of prenatal exposure to malnutrition on risk of schizophrenia in adulthood: evidence from the Chinese famine of 1959–1961. Eur Psychiatry 51(6):42–47. https://doi.org/10.1016/j.eurpsy.2018.01.003

    Article  PubMed  Google Scholar 

  52. Radtke KM, Ruf M, Gunter HM, Dohrmann K, Schauer M, Meyer A, Elbert T (2011) Transgenerational impact of intimate partner violence on methylation in the promoter of the glucocorticoid receptor. Transl Psychiatry 1(7):e21

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Gooch E (2017) Estimating the long-term impact of the Great Chinese Famine (1959–61) on Modern China. World Dev 89(1):140–151. https://doi.org/10.1016/j.worlddev.2016.08.006

    Article  Google Scholar 

  54. Chen Y, Zhou LA (2007) The long-term health and economic consequences of the 1959–1961 famine in China. J Health Econ 26(4):659–681. https://doi.org/10.1016/j.jhealeco.2006.12.006

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the provincial and municipal federations of disabled people for their support in data collection and management. The work was supported by Peking University’s Start-up Fund (No. BMU2018YJ004), the Key National Project (973) of Study on the Mechanisms of Interaction between Environment and Genetics of Birth Defects in China (Grant No. 2007CB5119001), the Key State funds for social science project (Research on Disability Prevention Measurement in China, Grant No. 09&ZD072), and the State Scholarship Fund (Grant No. 201606010254).

Author information

Authors and Affiliations

  1. China Center for Health Development Studies, Peking University, Beijing, China

    Ping He

  2. Institute of Population Research, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing, 100871, People’s Republic of China

    Ping He, Yanan Luo, Chao Guo, Gong Chen, Xinming Song & Xiaoying Zheng

  3. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Ping He

  4. APEC Health Science Academy (HeSAY), Peking University, Beijing, China

    Chao Guo & Xiaoying Zheng

Authors
  1. Ping He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanan Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xinming Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoying Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaoying Zheng.

Ethics declarations

Conflict of interest

The authors declare that they have no potential conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

He, P., Luo, Y., Guo, C. et al. Prenatal war exposure and schizophrenia in adulthood: evidence from the Sino-Japanese War of 1937–1945. Soc Psychiatry Psychiatr Epidemiol 54, 313–320 (2019). https://doi.org/10.1007/s00127-018-1584-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1584-0

Keywords

Search

Navigation