Birth Rank Research Articles

Birth order and mental illness

The conventional strategy in studies of birth order in psychiatric patients is to compare the birth rank distribution of a patient sample with an expected, hypothetical distribution, using the Greenwood Yule method, or a derivation of it. All such methods are based upon the assumption that within a given sample of subjects one can expect to find an even birth rank distribution. Previous writers have suggested reasons for believing this assumption to be incorrect in a contemporary population. The present study demonstrates that, in a random population sample drawn from the North Eastern Region of Scotland, the birth rank distribution within sibships is not an even one. In fact the distribution within this population sample was significantly deviant from the ‘expected’ one calculated by the Greenwood Yule method. It is concluded, therefore, that henceforth, the practice of calculating expected birth rank distributions should be abandoned in favour of making direct comparisons between patient and general population samples. - The present study is the report of such a comparison. The patient sample comprised a large series of referrals to psychiatric services of the North Eastern Region of Scotland, which were included in the regional psychiatric case register. The general population control sample was obtained by a postal survey carried out in seven general practices in the same region. The patients were divided into five diagnostic groups: depressives, neurotics other than depressive, psychotics other than depressive, alcoholics and personality disorders. It had been previously shown that the birth rank distribution of the population sample varied according to decade of birth. As there was considerable variation in the decade of birth distribution within the five diagnostic groups it was necessary to calculate, for each diagnosis separately, decade-of-birth based expected birth rank distributions. - The findings of the study were largely negative and suggest that birth order is not a factor in the aetiology of mental illness. It is proposed that the positive associations reported in previous birth order studies were due to the failure of investigators to appreciate the extent to which the general population birth rank distribution deviates from the ‘expected’ even one suggested by Greenwood and Yule. - The relationship between birth rank distribution and decade of birth has also, hitherto, been underestimated.

The impact of coping styles on the control of juvenile diabetes.

The relevance of psychosocial factors to the control of diabetes has been referred to in the literature, and previous studies have shown a particular relationship between family behavior and degree of control.This study of twenty-one children from the U.S.C. Pediatric Diabetes Clinic was undertaken to evaluate the extent to which specific variables correlate with control of diabetes. Statistically, no correlation was found between degree of control and: age of onset, duration of illness, number of siblings, intactness of family, degree of family psychopathology, intelligence of child and parents, knowledge about diabetes, birth rank or ethnic and social class. Positive correlation existed between family history of diabetes and good control. Children who appeared to be in the midst of an “adolescent growth spurt” clustered in the group with fair or poor control.Clinical observations of individual patients and their families suggest that the reactions to the onset of diabetes did influence the styles of coping with fears, anxieties and guilt. Case examples are given. The relation of psychologic and neurophysiologic mechanisms is discussed.

Malignant trophoblastic disorders: Epidemiologic aspects and relationship to hydatidiform mole

Records of all women with newly diagnosed choriocarcinoma and chorioadenoma destruens in Israel between 1950 and 1965 were reviewed. The mean annual incidence of all malignant trophoblastic disorders was 1:15,000 live births in Jewish women. Incidence was highest beyond the age of 40. There was no difference among ethnic groups in the incidence per live births except for a higher incidence among European-born women above the age of 45; birth rank had no effect. There was a secular decrease in incidence of choriocarcinoma from 1:11,700 in 1950 to 1954 to 1:40,000 in 1960 to 1965. Similarly, the risk to develop malignant trophoblastic disorders in women who previously had a hydatidiform mole declined with chronologic time period. The maximal estimate of the risk was 21.8 per cent for 1950 to 1954 and 4.4 per cent for the period from 1960 to 1965. This decline most probably reflects earlier and better recognition and therapy of hydatidiform mole.

Birth rank and mental illness.

Barry and Barry1 observed in a sample of American schizophrenics an over-representation of first borns in small sibships and later borns in large ones. On this evidence they hypothesized that the more severe pressure of parental expectation on first borns of small sibships and the relative parental rejection of later borns in large ones might contribute to the development of schizophrenia in adult life. Erlenmeyer-Kimling et al.2 reported that the same trend was observed about as frequently in studies of non-schizophrenics, and Price and Hare3 suggested reasons for such a trend being present in the British population as a whole and demonstrated it in a large sample of non-schizophrenic patients4. They noted that the extent of the deviation varied with year of birth. They later showed that the birth rank distribution of a large sample of British schizophrenics differed significantly from that of a sample of neurotics, having the same year of birth distribution and which they assumed to be representative of the general population5. In sibships of two to four there was a comparative excess of schizophrenics in the later birth ranks. Hinshelwood6 attempted to explain this finding by postulating that, in schizophrenia, there is a specific over-representation of the penultimate birth rank. To account for the vulnerability of the penultimate sibling he revived Adler's “dethroned monarch” theory, suggesting that an unwanted last child may be an especial trauma to its predecessor. He summed data of six previous studies (four American, one Canadian and one British), and demonstrated in the total sample an over-representation of the last-but-one position. Hare and Price7 considered this to be a chance effect of combining studies carried out at different times and in different countries. Hinshelwood should be further criticized for combining data on patients diagnosed as schizophrenic in America and Britian. A recent patient8 was videotaped and diagnosed as schizophrenic by 69% of American psychiatrists but only 2% of British ones. The latest study of Hare and Price5 is far from conclusive for, as Barry and Barry9 have correctly pointed out, a sample of neurotics, or of any other non-schizophrenic patients, may well differ from the general population by birth rank distribution.

Birth Order and Political Success: A Study of the 1970 Illinois General Elections

A questionnaire was used to obtain the birth order of all candidates for contested seats in the Illinois State Senate and General Assembly. It was hypothesized that firstborn and lastborn Ss would be more likely to enter political life and more likely to win their contests. Results indicated that no birth rank was overrepresented among these candidates but proportionally more firstborn and lastborn candidates won their contests than did middle-born candidates. Winners were more likely to return their questionnaires than were losers, and the data suggested that it might be possible crudely to predict election outcome on the basis of the proportion of questionnaires returned prior to the election.

Child Growth and Related Factors in a Rural Community in St. Vincent

A study was undertaken in the rural district of Belair St. Vincent West Indies in order to fill some of the existing gaps in knowledge of the growth of infants in the first 3 years of life from longitudinally collected data. The attempt was also made to elucidate the epidemiological aspects of infant and childhood malnutrition in St. Vincent by collecting and analyzing data on infant feeding practices and food habits and on some associated ecological factors. A total of 300 children were enrolled and the periods of follow-up ranged from a minimum of 1-1/2 years to a maximum of 3-3/4 years. Of the 300 children enrolled 21 died 25 left the district but 2 returned after a long absence and 24 defaulted. Malnutrition was reported as the primary cause of death in 8 cases gastroenteritis in 4 and respiratory infection in 5. Growth retardation most marked in the 6-18 months age group was of a similar pattern to that observed in other tropical developing countries. The duration of breastfeeding was the most important of the nutritional factors influencing growth. Children who were breastfed for longer than 9 months were heavier and grew better than those breastfed for shorter periods. Overcrowding among children under age 5 and a history of sibling deaths were significantly related to growth. Low maternal age and high birth rank revealed some relationship to poor growth. Civil status and educational level of mothers and the nuclear family size failed to influence growth significantly.

Mental illness in sibships of two and three.

A conspicuous deficiency of practically all birth order studies is the absence of a general population control group. Instead, a number of statistical methods of estimating the expected number of subjects in each sibling position have been used. These are based upon the assumption that for any given size of sibship there should be equal numbers of subjects in each birth rank. As Price and Hare (1969) have pointed out, there are a number of reasons why such as assumption is incorrect, and therefore why the conclusions based upon it are unreliable. Because, in most studies, only relatively small numbers of patients are available various methods of combining sibships of different sizes are adopted and the sexes of the siblings are ignored. To consider a sibling position irrespective of the size and composition of the sibship in which it occurs is unjustifiable. As birth order effects are relatively slight, large numbers of subjects are required to detect them. Unless a patient sample of several thousand is used the numbers in any sibship size are too small to permit analysis by birth rank. As sibship size is itself a possible variable, and as within each sibship the sexes of the siblings can be distributed in a variety of ways, birth order studies should ideally consider one sibship size at a time and should investigate sibling position by sex of sibling. Unfortunately, in sibships of four or more the numbers of combinations become so great as to render this approach impracticable.

Endocardial fibroelastosis: Family studies withspecial reference to counseling

Primary endocardial fibroelastosis of the left ventricle was studied in 119 families. Themale to female sex ratio was 0.63. The mean maternal age of 27.2 years (S.D. 5.6 years) and the mean paternal age of 31.1 years (S.D. 6.2 years) were normal. The mean birth rank was significantly higher for patients than for sibs. Nine families had multiple affected children, including 7 with 2 affected sibs and 2 with 3 affected sibs. The family data did not fit either the recessive or the multifactorial mode of inheritance. The sib incidence in the families of affected girls was 4.3 per cent and in the family of affected boys 2.9 per cent. After the birth of the first affected child the sibling incidence was 17.7 per cent (11/62), and after the second affected child, 33.3 per cent (2/6). The empiric risk figures for sib incidence found in this study may be useful in genetic counseling.

Birth Rank and Schizophrenia

HINSHELWOOD1 reported an association of schizophrenia with the last but one birth rank. Barry and Barry2 were not able to confirm this, but found that later birth ranks were associated with schizophrenia in families of five or more and especially from families of eight or more. They also drew attention to the contrary findings of Sundararaj and Rao in India3 and suggested an explanation in terms of different cultural stress for different birth ranks. Our own studies suggest there may be a single technical explanation for all these findings.

Sibship Size and Mental Illness

Though there have been many investigations concerned with sibling order and mental illness there have been relatively few concerned with sibship size. The abundance of sibling order studies is probably due to the widely accepted belief that in such studies comparison with general population data is not necessary. Expected numbers within each birth rank are estimated by the Greenwood-Yule method, proposed in 1914, by which it is assumed that for any given size of sibship siblings should be evenly distributed among birth ranks. In the present population, in which family size has in recent years been decreasing, this assumption is clearly invalid, for the younger members of the larger families of earlier years are more likely to be included in a contemporary sample, the older members by now having died. Other factors influencing sibling position have been more fully discussed by Price and Hare (1969). Thus comparison with general population figures is necessary in sibling order studies, and a report on such a comparison will be published separately by the author.

An investigation of the difference in measured intelligence between twins and single births.

SUMMARYMean V.R. (verbal reasoning) scores recorded in the eleven‐plus examination for Birmingham multiple births in the years 1950‐57 were 95‐7 for 2164 twins and 91‐6 for 33 triplets. The mean for 48,913 single children born in the years 1950‐54 was 100‐1.The low scores of twins are not explained by differences from single births in their distributions by maternal age and birth order or by birth weight and duration of gestation. They are also not accounted for by the increased risks associated with monozygosity (assessed by comparison of like‐ and unlike‐sex twins) or with delivery of the second twin. Taken together these observations, like the previous ones on single births, suggest that variation in experience before and during birth has little influence on measured intelligence and that the explanation of the large difference between twins and single children must be sought in the postnatal environment.There were 148 twins whose co‐twins were stillborn or died within 4 weeks after birth; their mean score was 98‐8, only a little lower than that of single births (99‐5) standardized to the maternal age and birth rank distribution of twins. From this evidence it is concluded that the handicapping of twins, reflected in their low verbal reasoning scores, is due to postnatal rather than prenatal influences.These conclusions are of course based on children who took the eleven‐plus examination and cannot be accepted without reservations for those who did not.

Birth rank in schizophrenia: with a consideration of the bias due to changes in birth-rate.

Studies of the relation between birth rank and schizophrenia (or any other disorder of adults) have hitherto been based on the assumption that, for a null hypothesis, cases will be randomly distributed among the birth ranks. In other words, if the distribution of cases is found to depart significantly from random (i.e. from equal numbers in each birth rank for each sibship size) then an association between birth rank and the disorder is held to have been demonstrated. However, we have recently shown, both from theoretical considerations (Price and Hare, 1969) and from the study of a large sample of psychiatric patients (Hare and Price, 1969b), that birth-rank distribution may depart very significantly from random because of bias arising from changes in the birth rate of the general population. The amount and direction of this bias will depend both on the changes in family size and on the number of families being started during the period of time when the patients (or any other population sample) and their siblings were born. The amount of bias is thus likely to be different in geographically different populations or in the same population at different periods of time.

Birth rank bias due to changes in birth rate.

Birth rank bias due to changes in birth rate.

Race, sex, ordinal position of birth, and self-disclosure in high school students.

The Jourard and Lasakow (1958) Self-disclosure Questionnaire was administered to 120 high school students in order to examine relationships of birth order, race, and sex to self-disclosure. Results indicated that later borns disclosed more than firstborns, whites disclosed more than Negroes, and mother was the favorite target person. Further, firstborn Negroes disclosed less than any other group, females disclosed most to mother and female friend while males disclosed least to female friend, firstborns disclosed most to mother, and whites disclosed more to father than Negroes. Results were discussed in relation to possible child-rearing practices affecting the meaningfulness of interpersonal relationships established by the various birth ranks.

Birth order and family size: bias caused by changes in birth rate.

In a previous paper (Price and Hare, 1969) we drew attention to some types of bias which may complicate the search for a useful association between disease and birth order. In particular, we considered biases occurring in a sample of adult patients where the patients' mothers have all passed their reproductive period and where, therefore, the sibships of the patients are complete. In such a sample, the recognized methods of searching for an association between disease and birth order are based on the assumption, that, for a null hypothesis, the sample will be randomly distributed among the birth ranks for each sibship size. But in fact the distribution may be non-random, and there are two main causes for this. These are (i) changes in the birth rate of the population, and (ii) changes in the birth rank distribution of the patients between birth and the age-range from which the sample is selected (e.g. differential rates of mortality or migration). The principal aim in the present paper is to illustrate the bias arising from the first of these causes.

Determinants of rural-urban migration in Ghana

Abstract In the 39 years between the 1921 and 1960 censuses, urban population in Ghana multiplied by nine while the population of the whole country only trebled. The major factor in urban growth was rural-urban migration and the reproduction of the migrants. In 1963 a survey consisting of a systematic sample of households in 45 rural centres, randomly chosen in Local Authority Areas selected in accord with the regional rural population distribution, reconstituted the rural population so as to include current migrants in the towns as well as those remaining in rural areas. For analysis 13,748 respondents were divided into 14 categories by ruralurban migration behaviour. At the same time a survey of urban population provided a check on rural-urban migration data. study of the propensity to migrate from rural to urban areas shows that this increases with the closeness of the rural area to a large town, the population size of the rural centre, the economic well-being of the rural household, the number of relatives already in the urban area, the individual's level of education, larger family size and probably lower birth rank, as well as exhibiting specific age and sex patterns. It is shown that only a minor role is played by occupation, conjugal condition and number of dependants. Various interrelations between these factors are discussed, and attention is given to the special importance of education in partially or wholly determining some of the other factors. Census data are used to demonstrate the effect of rural-urban migration in concentrating persons with certain characteristics in the urban areas.

Stillbirth and birth order.

SUMMARY AND CONCLUSIONS1. Some stillbirth sibships are characterized by positive birth‐order effects, and among them some are probably of the sort illustrated by Fig. 1; other stillbirth sibships are characterized by negative order effects, and among them some are probably of the sort illustrated by Fig. 2.2. The ‘strength’ of these two opposing effects was roughly equal in the sample tested, so there was no over‐all trend of stillbirths with birth order within sibships.3. There seem to be a few sibships in which a curvilinear effect is present, with higher risks of stillbirth at the beginning and at the end of the same sibship.4. Lastly, it seems possible (though no direct evidence on this point has been presented in this paper) that many stillbirths belong to sibships which do not exemplify any appreciable maternal age or order effect.5. It seems likely that the positive and negative effects are related to specific pathological causes of stillbirth.6. It seems possible that the occasional sibship seeming to show higher risks at both ends is due to the co‐existence in a single woman of a propensity to bear two types of stillbirth—one type characterized by a positive effect, and the other by a negative effect.7. The stillbirth ratio declines from the 1st to the 2nd and 3rd birth ranks, and thereafter increases.8. The initial drop is due to a genuine negative birth order (or maternal age) effect.9. The subsequent rise seems to be not primarily due to secular changes within individual women (either as a result of maternal age or birth order) but to an association of fertility with proneness to stillbirth. The cause may thus be social rather than biological.10. The cause of this association is not that a stillbirth is likely to occasion reproductive compensation. (Indeed in this sample, at all the birth ranks up to the ninth, a stillbirth promoted birth limitation instead.)11. The association of fertility with a propensity to stillbirth may be mediated by social class or by duration of marriage, but it is not clear that the underlying cause of this association has been uncovered.12. One recommendation would follow from this work if its findings should be confirmed: stillbirth‐prone women on the average have more pregnancies than other women. This fact is a major cause of the variation of stillbirths rate with birth rank. This being so, workers using multivariate analysis may feel the need to scrutinize the assumptions implicit in their models.

A search for sub-clinical rickets in Glasgow children.

Two random samples of Glasgow children aged 12 to 24 months were examined for clinical, biochemical and radiological evidence of subclinical rickets. No cases of florid rickets were discovered. One-third of the first sample studied (202 children) were estimated to be receiving less than 100 i.u. of vitamin D daily from all sources except sunshine. A poor dietary intake was most prevalent in the higher birth ranks and in social classes II and III (non-manual). The mean serum alkaline phosphatase level was 20 K.A. units per 100 ml. (S.D. 8 units) and 11 per cent had levels of 25 K.A. units per 100 ml. or above. No reason, either dietary or clinical, was found which would account for these high levels. Bone changes were observed in the wrist X-rays of about 9 per cent of children. They disappeared gradually with vitamin D therapy and there is some correlation with a raised alkaline phosphatase level and with tallness. They may be due to a relative insufficiency of vitamin D. Serum alkaline phosphatase estimations and wrist radiography do not appear to be useful methods for estimating the prevalence of hypovitaminosis D in the community or as screening procedures in the detection of individual cases of subclinical rickets.

Induction of oestrus and ovulation in Romney ewe hoggets with a progestagen

Abstract Ninety-six Romney ewe hoggets from a group of 236 hoggets of known history were treated with intra-vaginal sponges containing 20 mg or 60 mg methyl-acetoxy-progesterone (MAP) for 14 days near the onset of the breeding season. Observations were made for oestrus in all hoggets and for ovulations in a sample of animals from each group. After treatment the amount of MAP “absorbed” from each sponge was chemically determined. The effects of sire, birth rank of hoggets, dose level of MAP, and occurrence of oestrus on the amount of MAP “absorbed” were estimated. The incidence of oestrus within seven days of sponge withdrawal was 62%, and its occurrence was similar for both dose levels of MAP. The numbers of ovulations in treated hoggets were normal.

Statistical Analysis Of 750 Cleft Lip And Palate Patients

Summary1. 750 cleft lip and palate cases have been analysed.2. Clefts which involve the prepalate and palate proper, are seen most commonly.3. MF. ratiois 4: 3.4. There is a positive family history in 12.19.5. Left sided clefts of the prepalate are found in 50% of cases.6. There was a history of consanguinity in over 50% of 250 cases.7. Maternal age and birth rank are not of much significance.8. Middle ear disease was found in only 9% of cases and the reason for this is offered.