Perinatal Risk Factors in Offenders with Severe Personality Disorder: A Population-Based Investigation

Abstract

Although perinatal factors are associated with the development of several psychiatric disorders, it is unknown whether these factors are linked with personality disorder. Cases of personality disorder were drawn from a national registry of all forensic psychiatric evaluations (n=150). Two control groups were used: 1. A sample of forensic evaluations without any psychiatric disorder (n=97) allowing for a nested case-control investigation; 2: A population-based sample matched by age and gender with no history of psychiatric hospitalization (n=1498). Prematurity (<37 weeks of completed gestation) was significantly associated with a diagnosis of personality disorder, both in the nested and the population-based case-control comparisons with adjusted odds ratios (OR) for this risk factors ranging from 2 to 4. Asphyxia (adjusted OR=2.4, 95% CI: 1.4-4.1) and complicated delivery (adjusted OR=1.5, 1.0-2.1) were associated with personality disorder in the population-based study, and the former remained significant in multivariate models. Overall, perinatal complications were found to be associated with a later diagnosis of personality disorder in this selected sample. As with other psychiatric disorders where such associations have been demonstrated, changes during the perinatal period may lead to abnormal brain development and function.

Late preterm birth, post-term birth, and abnormal fetal growth as risk factors for severe mental disorders from early to late adulthood

“…asphyxia) are more common both among individuals born postterm (Thorngren-Jerneck & Herbst, 2001;Olesen et al 2003) and among individuals born preterm (Gouyon et al 2010). All these factors have also been associated with increased risks of certain mental disorders (Dalman et al 2001;Gardener et al 2009;Räikkönen et al 2009;Ekblad et al2010;Rice et al 2010;Tuovinen et al 2010;Bao et al 2012;Fazel et al 2012).…”

“…This risk extends to different mental disorders across diagnostic boundaries (Abel et al 2010;Fazel et al 2012;D'Onofrio et al 2013). However, most of this evidence comes from studies comparing preterm individuals born at the lowest end of gestational age or birth weight distributions with individuals born at term and/or with normal weight.…”

“…Several studies have shown that preterm birth predicts an increased risk of mental disorders in childhood, adolescence, and young adulthood (Abel et al 2010;Loe et al 2011;El Marroun et al 2012;Fazel et al 2012;Nosarti et al 2012;D'Onofrio et al 2013). This risk extends to different mental disorders across diagnostic boundaries (Abel et al 2010;Fazel et al 2012;D'Onofrio et al 2013).…”

Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring

“…Yet, other large population-based studies with follow-ups until approximately 30–40 years of age have, rather in correspondence with our findings, shown that the risks of suicide attempts [4] , [6] and of psychiatric hospitalizations for any reason [4] in young adulthood increase linearly with increasing maternal parity, and that these increased risks are particularly evident among offspring born as fourth or later-born children [4] , [6] . Previously grand multiparity [1] and higher parity linearly and particularly as being born as a fourth-or later-born child [4] – [5] have also been shown to predict an increased risk of suicide, and third or later-born offspring have been shown to have an increased risk of personality disorders [7] . In contrast, we found no effects of maternal grand multiparity on the risks of suicides or personality disorders.…”

“…These studies have shown that among offspring born to grand multiparous mothers increased risks are evident for alcoholism [2] , mood disorders [2] , schizophrenia [3] , and other psychotic disorders [2] , and suicides [1] . On the other hand, other studies have shown that offspring born as a fourth or later born -child have higher risks of psychiatric hospitalizations for any reason, [4] and of suicides [4] – [5] and suicide attempts [4] , [6] and that offspring born as a third or later-born child have an increased risk of personality disorders [7] in adult life.…”