Yonago Acta medica 1998;41:99–103

Japanese Schizophrenics and the Family
Ikuko Miyabayashi
Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori
University, Yonago 683-0826, Japan
Schizophrenia is a type of devastating psychiatric condition. Among various potential
causes, family environmental factors may play an important role. The purposes of thisstudy were to identify the pattterns of presentation of parental problems in Japaneseschizophrenics and to evaluate the significance of the problems. Thirty-fiveschizophrenics were selected from medical records in a mental hospital based on DSMIII criteria. An age and gender matched control group (n = 29) was selected at random.
A questionnaire form was used to collect data from both groups. The following patterns
were observed significantly more in the schizophrenic group than in the control group:i) absence of both parents, ii) the presence of problems in the social life of one or bothparents such as alcoholism, anti-social behavior or domestic violence and iii) a historyof serious illness or injury, e.g., that which requires hospitalization over 3 days time
involving problems derived from auto accidents (loss of limb) or congenital disease
suffered during the formative years of the patients. Family enviromental factors appear
to play a significant role in the development of schizophrenia in Japan. With changing
family structures in Japan, sound family enviroment should be emphasized for thewell-being of mental health in Japanese adolescent children.
Key words: family environment; schizophrenia

emotion has been investigated, and high expressed emotion in the family has been related
to the recurrence of schizophrenia (Brown et al.,1962, 1972; Leff and Vaughn, 1981; Vaughn,
1984; Leff et al., 1987, 1990; Tarrier et al., 1987,
1989; Barrelt et al., 1990). However, there has
been no study considering expressed emotion in
the development of schizophrenia.
In Japan, parental influences on schizophrenics have not been well studied (Okonogi et al.,1967). In Japanese families, a parent-childrelationship is close and continues until children leave their homes. The children are expected to respect their parents, and the parents
serve as a mirror for their children. Thus, research in effects of family environmental factors on development of schizophrenia is beneficial in Japan.
The purposes of this study were to identify

In Japan, as seen in other countries, schizophrenia is a major psychiatric condition. In 1990,
over 200,000 patients or approximately 63% of
the total number of hospitalized psychiatricpatients were due to schizophrenia (Japanese
Health and Welfare Statistics Association,1995). This was far more than the second highest cause (geropsychosis; 11.1%).
In the etiology of schizophrenia, the previous studies have focused on organic changes inthe brain (Asaka et al., 1981), genetic factors(Fukuda and Mitsuda, 1979), and effects ofchemical substances (Shimizu, 1979).
Effects of family environment have been
also studied. European researchers have recognized that parents may be important in the development of schizophrenia (Lidz and Lidz,
1949; Watt and Nicholi, 1979; Sham et al., 1992;
Noordsy et al., 1994). In addition, expressed

Abbreviation: DSM, diagnostic and statistical manual of mental disorders

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I. Miyabayashi

Table 1. Description of samples

Total
NumberMean age at present *Age range*
Mean age at onset** Year.
NA, not applicable.

35
32.9
21–49
18.8

Schizophrenic Group
Male
Female
16
31.6
21–42
19.1

19
34.2
24–49
18.4

patterns in the influence of parental problems
on hospitalized schizophrenics and to evaluate
the significance of the problems.

Materials and Methods
A schizophrenic group (n = 35; 16 males and 19
females) was selected based on medical recordsof hospitalized schizophrenic patients in a mental hospital in Kitakyushu city, Japan (Table 1).
The patient ages ranged from 21 to 49 years.
The first episode of schizophrenia was confirmed by the age of 24 years. Diagnosis of schizophrenia was based on DSM-III criteria at thetime of admission. At the time of this study,
DSM-IV criteria had not yet been available.
None of the patients had a schizophrenic parent.
An age- and gender-matched control group (n =29; 16 males and 13 females; age range of 24 to35) was selected at random from healthy individuals (Table 1).
A questionnaire was used to collect data on
various family environmental factors: i) age of
onset of schizophrenia, ii) loss of a parent or

Total

Control Group
Male

Female

29
28.9
24–35
NA

16
29.2
25–34
NA

13
28.6
24–35
NA

parents by the age of 24 due to death, separation, or divorce, iii) problems in the social lifeof a parent or parents such as alcholism, antisocial behavior or domestic violence, iv) number of family members, v) genetic factors ofmental disorders within first-degree relatives,vi) history of serious illness or injury, e.g., thatwhich requires hospitalization over 3 days time
involving problems derived from auto accidents(loss of limb) or congenital disease sufferedduring the formative years, vii) birth order andviii) other factors. For the control group, theauthor interviewed the individuals in order tofill out the questionnaires. A hospital psychiatrist reviewed the medical records to fill out
the questionnaire based on the patient’s medical
records.
A chi-squared test was used to find out thestatistical significance (P < 0.05) between the 2groups among the following factors: i) loss of aparent or parents by age of 24, ii) problems inthe social life of a parent or parents, iii) historyof serious illness of the child during the formative years and iv) birth order.

Table 2. Loss of a parent or parents by age 24
Lostparent(s)

Total
[35]

Schizophrenic group
Male
Female
[16]
[19]

Total
[29]

Control group
Male
[16]

Female[13]

Father4
0
4
2
1
1Mother
0
0
0
2
1
1
Both*
7*
2
5
0*
0
0
[ ], number of samples.
* Loss of both parents versus presence of at least one parent between the schizophrenia and control group:chi-squire with 1 degree of freedom, 6.51; P < 0.05.

100Japanese Schizophrenics and the Family

Table 3. Presence of problems in the social life of a parent or parents
Problems
in

Total
[35]

Schizophrenic group
Male
Female[16][19]

Father3
2
1
Mother
10
4
6
Both
3
0
3
[ ], number of samples.
Chi-squire with 1 degree of freedom, 7.52; P < 0.01.

Total
[29]

Control group
Male
[16]

Female
[13]

2
1
1

1
0
1

1
1
0

had parents who had problems in their social
life (Table 3). A chi-squared test showed asignificance difference in the 2 groups (P <0.01).

Results

Loss of a parent or parents by age of 24
In the schizophrenia group, 4 patients had lost
fathers, and 7 patients had lost both parents(Table 2). In the control group, 2 had lost theirfathers and another 2 had lost their mothers. A
chi-squared test showed no statistical differencein the following comparisons: i) loss of at least
1 parent versus the presence of both parents, ii)
loss of father versus presence of father or bothparents, and iii) loss of mother versus presenceof mother or both parents. However, loss ofboth parents versus presence of at least 1 parent
showed a significant difference between theschizophrenia and control groups (P < 0.05).

History of serious illness
The data were available for 31 of 35 patients(Table 4). Fourteen patients and 5 control
individuals had a history of serious illness. The
difference was significant (P < 0.05).

Birth order
The data were available for 34 of 35 patients(Table 5). Thirteen patients and 16 control
indviduals were first-born children. No
statistically significant difference was foundbetween the 2 groups.

Problems in the social life of a parent orparents

Discussion

Sixteen patients (3 who lost fathers, 10 who lost
mothers, and 3 who lost both parents) and 4
control individuals (2 who lost fathers, 1 wholost his/her mother, and 1 who lost both parents)

In this study, the author attempted to review thesignificance of family environment in thedevelopment of schizophrenia in Japan. There
were 3 statistically significant findings in the

Table 4. Presence of history of serious illness
History ofseriousillness

Total
[35]

Schizophrenic group
Male
Female[16][19]

Positive
1477[ ], number of samples.
Chi-squire with 1 degree of freedom, 5.39; P < 0.05.

101

Total
[29]

Control group
Male
[16]

Female
[13]

5

1

4

I. Miyabayashi

Table 5. Birth order
Birth order
Total
[34]
First-born
13
Later-born
21[ ], number of samples.

Schizophrenic group
Male
Female
[16]
[18]
7
9

6
12

schizophrenic group: i) a high incidence of absence of both parents, ii) a high incidence ofpresence of problems in the social life of one orboth parents and iii) a high incidence of serious
illness during the formative years of schizophrenic patients. These significant findings
may be classified into primary and secondary
factors. The primary factors involved thechild’s own reactions to or recognition of specific problems such as loss of both parents, stressfrom parental maladjustment, and psychological trauma from serious illness. Secondary
factors could be economic hardship, disruptionof living conditions, and enforced morbidity
due to the primary factors. Lack of parental
guidance and care or the appearance of parental
over-protection could be secondary factors.
In this study, expressed emotion was notreviewed. Expressed emotion involves criteria
similar to those used in this study and includes
critical comments, hostility and emotional
overinvolvement (Brown et al., 1972). Expressed emotion is then classified into high andlow. A high expressed emotion in a family environment was associated with the recurrenceof schizophrenia (Brown et al., 1962, 1972;
Leff and Vaughn 1981; Vaughn, 1984; Leff etal., 1987, 1990; Tarrier et al., 1987, 1989;
Barrelt et al., 1990). It will be useful to apply
these criteria and relate to the family environmental etiology of schizophrenia.
One of the primary factors for the onset ofthe disease was the loss of both parents in theschizophrenic group. In Europe and the UnitedStates, Pollock et al. (1939), Lidz and Lidz
(1949), Lucas (1964), Watt and Nicholi (1979)
found the loss of a parent to be siginificant in
the development of schizophrenia in their research. Loss of both parents in the formative

Total
[ 29]

Control group
Male
[16]

Female
[13]

16
13

9
7

7
6

years of schizophrenic patients was not discussed. In this study, loss of only 1 parent was not asignificant factor. Loss of both parents was asignificant factor. It is difficult to explain the
difference in the results of this study and theprevious studies. However, this might be atleast in part due to a difference in family structures between Japan and Western countries.
Family environment has been changing inJapan. When this study was conducted in theearly 80’s, the divorce rate was low. Yet, in
Europe and the United States, broken family
enviroments were already present, and the term“single parent” was becoming popular. Currently in Japan, we see a similar trend in broken
family environments. Family support for asingle parent in Japan might not yet be common. A single parent was due to death of aparent. Now, divorce might be the most common cause of a single parent. Siblings may beraised separately due to divorce. It is necessary
to study the family environment again at thispoint and compare it with the results of earlier
studies in Europe, the United States and Japan.
Based on the results of this study, family
environmental factors are important in thedevelopment of schizophrenia in Japan, andfurther studies on the family enviroment are
warranted.

102

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(Received Dec. 19, 1997, Accepted Sept. 4, 1998)

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