Association of adoptive family functioning and genetic liability for broad schizophrenia spectrum disorders with adoptees’ psychiatric morbidity:special focus on duration of preadoption out-of-home care, parental loss and familial socioeconomic status

Abstract Earlier research has solidified the role of genetic contributions in the etiology of schizophrenia and other psychiatric disorders. However, complex socio-environmental factors have also long been recognized to have an influence on the processes leading to the onset of psychiatric disorders. According to the vulnerability-stress model, the interaction of biological and environmental risk factors is suggested to play a key part in the development of psychiatric disorders. The study used data from the Finnish Adoptive Family Study of Schizophrenia. The data comprises adoptive families with adoptees who were, by their biological mother, at high (HR) and low (LR) genetic risk for broadly defined schizophrenia spectrum disorders. The ultimate purpose of this doctoral dissertation was to examine the impacts of HR for broad schizophrenia spectrum disorders and family-related environmental factors on the psychiatric morbidity of the adoptees. The environmental factors included duration of preadoption out-of-home care, adoptive family functioning, death and divorce of adoptive parents occurring before the offspring reached the age of 18, and socioeconomic status (SES) of adoptive families. The findings showed that among adoptees with longer time in preadoption out-of-home care (> 6 months), an increased risk for later psychiatric disorders was observed in the HR adoptees. Contrarily, among adoptees with shorter time in preadoption out-of-home care (≤ 6 months), later psychiatric disorders associated with adoptive family functioning. The findings also showed that the likelihood for psychiatric disorders was increased in adoptees raised in adoptive families with dysfunctional processes, especially among the HR adoptees. Furthermore, the findings indicated that dysfunctional family processes and HR for broad schizophrenia spectrum disorders were related to increased likelihood of psychiatric disorders of the adoptees only in families with high SES. In conclusion, the results imply that dysfunctional family processes and HR for broad schizophrenia spectrum disorders may increase the likelihood for psychiatric disorders in offspring both independently and in interaction. Furthermore, the results support the significance of familial SES and early caregiving circumstances in the development of psychiatric disorders.Tiivistelmä Geneettisten tekijöiden tiedetään olevan yhteydessä skitsofrenian ja muiden psykiatristen häiriöiden kehittymiseen. Lisäksi aiempi tutkimuskirjallisuus tukee ympäristön riskitekijöiden merkitystä mielenterveyden häiriöiden kehittymisessä. Haavoittuvuus-stressiteorian mukaan psykiatristen häiriöiden kehittyminen on seurausta biologisten ja ympäristön stressitekijöiden yhdysvaikutuksesta. Tutkimus pohjautuu Suomalainen adoptiolapsiperhe -tutkimuksen aineistoon. Aineisto koostuu adoptioperheistä sekä riski- ja verrokkiadoptiolapsista, joista riskilapsilla on biologisen äidin kautta korkea geneettinen riski skitsofreniaspektrin häiriöiden kehittymiseen. Tämän tutkimuksen perimmäisenä tavoitteena oli selvittää perinnöllisen skitsofrenia-alttiuden ja perheympäristön riskitekijöiden välistä yhteyttä adoptiolasten myöhempiin mielenterveyden häiriöihin. Perheympäristöön liittyviin riskitekijöihin sisältyivät adoptiota edeltäneiden väliaikaisten sijoitusten kesto, arvio adoptioperheen toimivuudesta, adoptiovanhemman menetys (ero tai kuolema) sekä adoptioperheen sosioekonominen asema. Tutkimustulokset osoittivat, että adoptiota edeltävän väliaikaisen sijoituksen ollessa pitkäkestoinen (> 6 kk) perinnöllinen skitsofrenia-alttius oli yhteydessä adoptiolasten myöhempiin mielenterveyden häiriöihin. Sen sijaan lyhytkestoisessa (≤ 6 kk) adoptiota edeltäneessä väliaikaisessa sijoituksessa olleiden lasten kohdalla adoptioperheen toimivuus oli yhteydessä lasten psykiatrisiin häiriöihin. Lisäksi tulokset osoittivat, että adoptiolasten psykiatriset häiriöt lisääntyivät heikommin toimivissa adoptioperheissä, erityisesti riskilapsilla. Huomionarvoista on, että tulokset osoittivat perheen toimivuuden ja adoptiolapsen perinnöllisen skitsofrenia-alttiuden olevan yhteydessä adoptiolasten myöhempiin mielenterveyden häiriöihin ainoastaan perheissä, joiden sosioekonominen asema on korkea. Tutkimustulokset vahvistavat näkemystä perinnöllisen skitsofrenia-alttiuden ja perheen heikentyneen toimivuuden yhteydestä mielenterveyden häiriöiden kehittymiseen niin itsenäisinä tekijöinä kuin yhdysvaikutuksessakin. Lisäksi tulokset vahvistavat käsitystä perheen sosioekonomisen aseman ja lapsen varhaisen kasvuympäristön merkityksestä psykiatristen häiriöiden kehittymisessä

Interaction of genetic vulnerability to schizophrenia and family functioning in adopted-away offspring of mothers with schizophrenia

Abstract Objective: The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. Methods: The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. Results: Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2–11.4) and LR (OR = 2.6, 95% CI 1.1–6.3) adoptees, but not to early parental death or divorce. Conclusions: The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning

Deficits in adolescent social functioning, dysfunctional family processes and genetic risk for schizophrenia spectrum disorders as risk factors for later psychiatric morbidity of adoptees

Abstract Social functioning deficits during adolescence are associated with later psychiatric morbidity, particularly in offspring at high genetic risk for schizophrenia spectrum disorders. However, a shortcoming of earlier study findings is the lack of control of the impact of the family rearing environment. The study was aimed to examine the association of adoptees’ social functioning during adolescence, adoptive family functioning, and adoptees’ high (HR) or low (LR) genetic risk for schizophrenia spectrum disorders with adoptees’ later psychiatric morbidity. The present subsample from the nationwide Finnish Adoptive Family Study of Schizophrenia included 57 HR and 60 LR adoptees. Adolescent social functioning was assessed using UCLA Social Attainment Survey (UCLA SAS). Adoptive family functioning was based on Global Family Ratings (GFRs) and psychiatric disorders on DSM-III-R criteria. The results indicated that, after controlling for adoptive family functioning and genetic risk for schizophrenia spectrum disorders, deficits in peer relationships during adolescence were associated with an increased likelihood of psychiatric morbidity of adoptees. Our findings highlight social functioning deficits during adolescence, specifically in peer relationships, as plausible independent risk factors for later psychiatric disorders. These results can be utilized in identifying possible at-risk groups and targets for prevention and in developing preventive strategies

Dysfunctional family functioning in high socioeconomic status families as a risk factor for the development of psychiatric disorders in adoptees:the Finnish Adoptive Family Study of Schizophrenia

Abstract Purpose: Earlier findings indicate that socioeconomic status (SES) of family associates with family functioning. This study examined the impacts of family functioning and genetic risk for schizophrenia on psychiatric morbidity of adoptees in families of high SES (HSES) and low SES (LSES). Methods: The study population is a subgroup of the Finnish Adoptive Family Study of Schizophrenia. Of the adoptees, 152 had high genetic risk for schizophrenia spectrum disorders (HR) and 151 adoptees had low risk (LR). Of the adoptees, 185 (HR = 94, LR = 91) were raised in high-SES (HSES) families and 118 (HR = 58, LR = 60) in low-SES (LSES) families. The family SES was determined by the occupational status of the main provider of the family. The functioning of adoptive families was assessed based on Global Family Ratings (GFRs) and psychiatric disorders on DSM-III-R criteria. Results: In the HSES families, the psychiatric morbidity of the adoptees was emphasized by HR (OR = 4.28, CI 2.14–8.56) and dysfunctional family processes (OR = 6.44, CI 2.75–15.04). In the LSES families, the adoptees´ psychiatric morbidity was almost significantly increased by HR (OR = 2.10, CI 0.99–4.45), but not by dysfunctional family processes (OR = 1.33, CI 0.53–3.34). Conclusions: This study showed that in HSES families, dysfunctional family processes and HR for schizophrenia increased the likelihoods for the development of psychiatric disorders in adoptees. The results can be utilized in identifying risk factors in the development of psychiatric disorders and focusing preventative strategies on risk groups with acknowledging the importance of family functioning

Associations of duration of preadoption out-of-home care, genetic risk for schizophrenia spectrum disorders and adoptive family functioning with later psychiatric disorders of adoptees

Abstract The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0–6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children

Adolescent social functioning deficits in association with adoptive family functioning and genetic risk for schizophrenia spectrum disorders:the Finnish adoptive family study of schizophrenia

Abstract Social functioning deficits (SFDs) during adolescence represent potential vulnerability indicators to schizophrenia spectrum disorders, but little is known about how both family environmental and genetic factors contribute to SFDs. The aim of this study was to examine the association of adoptees’ adolescent social functioning with adoptive family functioning and adoptees’ high (HR) or low (LR) genetic risk for schizophrenia spectrum disorders. The present subsample from the nationwide Finnish Adoptive Family Study of Schizophrenia included 88 HR and 83 LR adoptees. Adolescent social functioning was assessed using UCLA Social Attainment Survey. Assessment of adoptive family functioning was based on Global Family Ratings. Results indicated that dysfunctional family processes and high genetic risk for schizophrenia spectrum disorders contributed approximately equally to adoptees’ adolescent social functioning. Our findings underscore the importance of functional family processes in adolescent social functioning, particularly in individuals at high genetic risk for severe psychiatric disorder