The fertility and fecundity of patients with psychoses

Objective: Previous research has suggested that patients with schizophrenia have fewer offspring compared to the general population. Reduced fertility in a disorder with a strong genetic component and an apparently stable inc idence has implications for models of genetic transmission. There is also a need to obtain contemporary estimates of the prevalence of parenthood amon g subjects with psychotic disorders in order to inform service planning. Th e aim of this study was to determine the fertility and fecundity of a repre sentative sample of individuals with psychoses who were in contact with men tal health services, and to explore the interactions between age at first d iagnosis and fertility. Method: All clients of two community mental health clinics and an extended- care psychiatric hospital were surveyed. Data on diagnosis, age at first di agnosis, and the number and age of offspring were collected. Based on inter views with the proband and chart review, a genogram of the probands' family was drawn that identified sex, age, affected status and the number of offs pring for each patient and their siblings. Results: In total, 36% of all patients were parents. Most women with psycho ses (59%) were mothers. Patients with psychoses had fewer offspring compare d to their unaffected same-sex siblings. This was especially the case for m en with non-affective psychoses. Higher levels of fertility were associated with a later age at first diagnosis. Conclusion: The consistent finding of reduced 'reproductive fitness' in tho se with non-affective psychoses needs to be incorporated in the genetic epi demiology of these disorders. Despite this reduction in fertility and fecun dity, many patients with psychoses are parents. Services need to remain min dful of the special needs of these patients.