Malnutrition in early life and adult mental health: Evidence from a natural experiment

• Authors: Cheng Huang, George Washington University; Michael Phillips, Emory University; Yali Zhang, Beijing Hui Long Guan Hospital; Jingxuan Zhang, Shandong Provincial Mental Health Center; Qichang Shi, Li Tong De Hospital; Zhiqiang Song, 3rd Peoples Hospital; Zhijie Ding, Tianshui City Psychiatric Hosptial; Shutao Pang, Qingdao Mental Health Center; Reynaldo Martorell, Emory University
• Journal Title: Social Science and Medicine
• Volume: Volume 97
• Publisher: Elsevier | 2013-11-01, Pages 259-266
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.socscimed.2012.09.051
• Subjects: Health Sciences, Public Health; Health Sciences, Nutrition
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Social Sciences, Biomedical; Biomedical Social Sciences; Famine; Mental health; Selection effect; Natural selection in utero; China; Life course; 1959-1961 CHINESE FAMINE; LONG-TERM HEALTH; SEX-RATIO; GREAT LEAP; PRENATAL EXPOSURE; DUTCH FAMINE; NEURODEVELOPMENTAL DISORDERS; ECONOMIC CONSEQUENCES; CHILD UNDERNUTRITION; IN-UTERO

Abstract

As natural experiments, famines provide a unique opportunity to test the health consequences of nutritional deprivation during the critical period of early life. Using data on 4972 Chinese born between 1956 and 1963 who participated in a large mental health epidemiology survey conducted between 2001 and 2005, we investigated the potential impact of exposure to the 1959-1961 Chinese Famine in utero and during the early postnatal life on adult mental illness. The risk of mental illness was assessed with the 12-item General Health Questionnaire (GHQ-12) and eight other risk factors, and the famine impact on adult mental illness was estimated by difference-in-difference models. Results show that compared with unexposed women born in 1963, women born during the famine years (1959-1961) had higher GHQ scores (increased by 0.95 points; CI: 0.26, 1.65) and increased risk of mental illness (OR=2.80; CI: 1.23, 6.39); those born in 1959 were the most affected and had GHQ scores 1.52 points higher (CI: 0.42, 2.63) and an OR for mental illness of 4.99 (CI: 1.68, 14.84). Compared to men in the 1963 birth cohort, men born during the famine had lower GHQ scores (decreased by 0.89 points; CI:-1.59,-0.20) and a nonsignificant decrease in the risk of mental illness (OR=0.60; CI: 0.26, 1.40). We speculate that the long-term consequences of early-life famine exposure include both the selection of the hardiest and the enduring deleterious effects of famine on those who survive. The greater biological vulnerability and stronger natural selection in utero of male versus female fetuses during severe famine may result in a stronger selection effect among men than women, obscuring the deleterious impact of famine exposure on the risk of mental illness in men later in life.