Ajay Risal , Hema TharoorDept. of Psychiatry , KMC , Manipal

KANCIPS-08

BIRTH ORDER AND PSYCHOPATHOLOGY

BACKGROUND

The ordinal position a child holds within the sibling ranking predicts intellectual functioning, personality & behaviour

The subject of extensive research: Alcohol abuse (Conley,1980) Infantile Autism (Tsai & Stewart ,1983) Delinquency (Calhoun,1984)

COHORT STUDIES A cohort of New Zealand children:

Significantly more girls, first borns &children from small families had DSM-III disorders

(Michael Feehan et al, 1994) Northern Finland 1966 Birth Cohort: Specific birth order status is an independent

risk factor for schizophrenia (Bender KG,2001)

AIM “To examine the association between

birth order & development of psychopathology among the patients attending in-patient or out-patient psychiatry services in Kasturba Hospital, Manipal”

MATERIALS AND METHODS

I. Methodology:Institutional Ethics Committee clearance

was taken

Retrospective file review of patients admitted in psychiatry ward or evaluated in psychiatry OPD between 1st Jan’07-31st June’07 was done

II. Sample size:

684 patients, divided in three groups : Group I(Adult general psychiatry)- 527 Group II (Childhood mental illness)- 47

Group III (Substance use disorders)- 110

III. Procedure :

Detailed review of patient related variables such as age of onset of illness, order of birth, family type, family history of mental illness and psychiatry diagnosis (ICD-10) generated were studied and compared

IV. Statistical analysis:

SPSS software package (Version 13, SPSS Inc., Chicago , USA) was used to analyze the data

Descriptive statistics and One way ANOVA was used to evaluate the effect of birth order on psychopathology

RESULTS:

Table 1:Age of onset of mental illnessGroups Age of onset (Mean +/-SD)

Group I (N=527) 33.01 (+/- 15.073)

Group II (N=47) 11.68 (+/- 4.764)

Group III (N=110) 26.74 (+/- 7.529)

RESULTS:GROUP I (N=527)Table 2: Distribution of birth order & diagnosis

Birth order 1 2 3 4 5 6 6+ Last

Diagnosis n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)

Depression * 33 (24)

24(27.6)

18(27.3)

14(37.8)

9 (39.1)

9 (60)

5(27.8)

32 (26)

Anxiety Disorder

24(17.5)

9 (10.3)

11 (16.7)

5 (13.5)

3 (13)

2 (13.3)

2 (11.1)

17 (13.8)

SomatoformDisorder

16(11.7)

- 11 (16.7)

5 (13.5)

5 (21.7)

1 (6.7)

2(11.1)

14(11.4)

*Birth order & depression (p-value<0.001)

RESULTS:

Table 3: Distribution of birth order and diagnosisGROUP II (N=47) GROUP III (N=110)

Birth order

Diagnosis n (%) Birth order

Diagnosis n (%)

1 Dissociation 8 (36.4) 2 Alcohol dependence

12 (66.7)

Last ADHD 4 (26.7) Last Comorbid mental illness

9 (28.1)

RESULTS: Table 4: Distribution of diagnosis and birth order

between gendersGroup Male (n=402) Female (n=282)

Birth order

Diagnosis (%) Birth order

Diagnosis (%)

I 4 Depression (53.3) 6 Depression (72.7)

II 1 Dissociative Disorder (26.7)

1 Dissociative Disorder (57.1)

III 2 Alcohol Dependence (70.6)

2 Cannabis Dependence (100)

RESULTS:Table 5: Effect of Birth Order on Psychopathology

Groups Mean square

df F Significance

I(N=527)

20.151 1 1.564 O.212

II(N=47) 8.167 1 0.452 0.505

III(N=110)

17.547 1 1.509 0.222

SUMMARY

Adults: All birth orders had depression as the most common diagnosis

A within group analysis of birth order and depression was statistically significant

(p <0.001) Substance abuse: Comorbid mental illness

was maximum among the last born

SUMMARY (CONTD….) Children: Dissociative disorder was more

predominant in the first born

Gender: Birth order (4) in males and (6) in females had a maximum risk for depression

FUTURE DIRECTIONSTrans-generational study ?

Nuclear family VS single child ?

A population based prospective study to examine birth order and development of temperament/ personality ?

THANK YOU!