Probability of marriage and fertility of women suffering from schizophrenia or affective disorders

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Abstract
Schizophrenia and affective disorders are the main forms of severe mental illness among women of childbearing age; earlier this century European and American studies showed that the fertility of these patients was reduced. Since the second world war the development of community-orientated psychiatry appears to have resulted in a lessening of differentials between patients and normal women. The present study was designed to estimate probability of marriage and fertility of such patients in London followingthese developments in psychiatry. Over 1,000women aged 16–50 were selected from 1955-63 admissions to a London hospital, and data were collected from medical records. Owing to the demographic heterogeneity of the sample, the analysis of maximum discriminative power was to compare each patient with a normal woman of corresponding age, observed during identical calendar periods, as derived from Registrar General's estimates. The fertility of each patient was compared with that of a normal woman, controlled for age at and duration of marriage, and an assessment was made of the effect of hospital stay on fertility. Before admission, probability of marriage of schizophrenics was just under three-quarters of that of normal women, and after admission this was greatly reduced to just over one-third of normal; women with affective disorders were very similar to normal women as regards probability of marriage, and also fertility. The fertility of schizophrenics was reduced both before and after admission, and much of the latter reduction depended on the effect of hospital stay; however, this fertility differential was too small to be clinically or socially important. The relevance of these results to the population genetics of schizophrenia is noted. Affective disorders are primarily disorders of mood, usually involving a depression, but in a smaller group of patients periods of excitement or elation involving marked overactivity of thought and behaviour. The patient may return to normal between these periods of illness, and although delusions and hallucinations sometimes occur they are usually less prominent than in schizophrenia. Affective disorders generally become evident later in life than schizophrenia, and they often require shorter periods of in-patient treatment, and the medical prognosis is often more hopeful. The expectation of affective psychoses (the most severe forms of the disorder) for a member of the general population varies between 0·3 and 1% from country to country. Milder conditions have also been included in this study, and the expectation of all these affective disorders is likely to be much higher.

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