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Schizophrenia Research 165 (2015) 12

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Schizophrenia Research
journal homepage: www.elsevier.com/locate/schres

Is childhood cat ownership a risk factor for schizophrenia later in life?


E. Fuller Torrey a,, Wendy Simmons a, Robert H. Yolken b
a
b

Stanley Medical Research Institute, United States


Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University, School of Medicine, United States

a r t i c l e

i n f o

Article history:
Received 29 January 2015
Received in revised form 26 February 2015
Accepted 2 March 2015
Available online 17 April 2015
Keywords:
Schizophrenia
Bipolar disorder
Cat contact
Toxoplasmosis
Toxoplasma gondii

a b s t r a c t
Two previous studies suggested that childhood cat ownership is a possible risk factor for later developing
schizophrenia or other serious mental illness. We therefore used an earlier, large NAMI questionnaire to try
and replicate this nding. The results were the same, suggesting that cat ownership in childhood is signicantly
more common in families in which the child later becomes seriously mentally ill. If true, an explanatory
mechanism may be Toxoplasma gondii. We urge our colleagues to try and replicate these ndings to clarify
whether childhood cat ownership is truly a risk factor for later schizophrenia.
2015 Elsevier B.V. All rights reserved.

1. Introduction
In 1995 a study suggested that cat ownership during childhood
might be a risk factor for later developing schizophrenia (Torrey and
Yolken, 1995). The data came from a 1992 questionnaire lled out by
165 members of the National Alliance for the Mentally Ill (NAMI). At
that time, NAMI had approximately 170,000 members and consisted
almost exclusively of families in which a family member had been diagnosed with schizophrenia or schizoaffective disorder (approximately
two-thirds) or bipolar disorder or severe depression, usually with psychotic features (approximately one-third) (Steinwachs et al., 1992).
The question asked whether at any time between the affected family
member's birth and age 10 there was a cat living in the house; 84/165
(50.9%) of the cases and 65/165 (39.4%) of the controls responded yes.
The controls were obtained by having a family friend, whose child had
not developed any mental illness, ll out an identical questionnaire.
The cat question was part of two pages of questions covering
breastfeeding, developmental milestones, coordination, rheumatoid arthritis, and multiple sclerosis. Although the cat question was statistically
signicant by itself [chi square = 4.4, p .036; odds ratio (OR) = 1.60
(1.002.53), mean (95% condence interval)], it was not signicant
following the application of the Bonferroni correction for the number
of questions asked.
Based on these initial ndings, a 1997 follow-up survey was undertaken (Torrey, et al., 2000). Trained interviewers at the Survey Research
Center, University of Maryland, carried out a 20 minute telephone
interview with subjects randomly selected from the NAMI membership
Corresponding author. Tel.: +1 301 571 2078.
E-mail address: torreyf@stanleyresearch.org (E. Fuller Torrey).

http://dx.doi.org/10.1016/j.schres.2015.03.036
0920-9964/ 2015 Elsevier B.V. All rights reserved.

list; the refusal rate was 9%. Two controls for each case from families
without any serious mental illness were selected from the same
telephone exchange as the subjects and matched for age, sex and socioeconomic status; the refusal rate was 28%. The interview focused on the
perinatal and preadolescent childhood periods and included 19 major
variables, many of which included subsets, asking about the mother's
pregnancy, miscarriages/stillbirths, delivery, breast-feeding, developmental milestones and place of residence as well as exposure to dogs,
cats, other pets, and farm animals. Regarding family ownership of a
cat between the affected person's birth and age 13, 136/262 (51.9%) of
cases and 220/522 (42.1%) of controls responded yes [chi square =
6.7, p .01; OR = 1.48 (1.092.02)]. Dog ownership was more common
among the controls (78.8%) than among the cases (73.1%) although the
difference was not statistically signicant (p = .09).
Based on these two studies, we decided to analyze cat ownership
from a large unpublished NAMI survey carried out in 1982, 10 years before any data on cat ownership and mental illness had been published.
The issue is potentially important since cats are carriers, and the
denitive hosts, of Toxoplasma gondii. This parasite has been linked to
schizophrenia in a meta-analysis of 38 studies of T. gondii antibodies
(pooled OR = 2.71) (Torrey et al. 2012). In addition, T. gondii has been
shown to produce dopamine, thought to be increased in schizophrenia
(Gaskell, et al., 2009). There are also other reasons to suspect that
T. gondii may play a role in some cases of schizophrenia (Torrey and
Yolken, 2003; Yolken et al., 2009).
2. Materials and methods
At the NAMI annual convention in 1982, participants whose family
member was diagnosed with schizophrenia or schizoaffective disorder

E. Fuller Torrey et al. / Schizophrenia Research 165 (2015) 12

Table 1
Cat ownership in NAMI families and controls.

1992 questionnaire
1997 survey
1982 questionnaire

Cat in house, birth to age 10


Cat ownership, birth to age 13
Cat ownership, birth to age 13

Cases

Controls

84/165 (50.9%)
136/262 (51.9%)
1075/2125 (50.6%)

65/165 (39.4%)
220/522 (42.1%)
2065/4847 (42.6%)

p = .03; OR = 1.60 (1.002.53)


p = .01; OR = 1.48 (1.092.02)
p .0001; OR = 1.38 (1.251.53)

p values are derived from chi square, 2 tailed; ORs shown as mean (95% CI).

were asked to ll out a two-page questionnaire. Questions included


conditions of pregnancy, birth weight, childhood illnesses, smallpox
vaccination, seizures, age of rst referral, illnesses immediately preceding onset, family history of mental illness and rheumatoid arthritis, and
cat and dog ownership up to age 17. The question on pets included ages
of pet exposure, so it was possible to identify those exposed between
birth and age 13, thus making the data comparable to the 1997
telephone questionnaire. The 1982 questionnaire did not include controls. However, a 1991 survey of 55,143 households by the American
Veterinary Medical Association reported cat ownership among 10 different groups such as young singles, young couples, retired older couples,
etc. The group which was most similar to our study group was the
group of middle parents, dened as having multiple members, the
household head being younger than 45 years, and the youngest child
being 6 or over (American Veterinary Medical Association, 1991).

Even if this mode of transmission explains the ndings presented


here, it is somewhat surprising that this can be demonstrated by surveys
of cat ownership. Children could theoretically become infected by
playing in any infected public play area even if their family did not
own a cat. Alternately, neighborhood cats could infect the child's
home outside play area. It is also possible that exposure to cats provides
risk in terms of other infectious agents shed by cats or by allergic
exposures, since increased levels of childhood allergic reactions
have been associated with increased risk of schizophrenia in later life
(Khandaker et al., 2014; Zhang et al., 2014).
It is important to ascertain whether or not cat ownership in childhood is a risk factor for later schizophrenia since it is a risk factor
which could be minimized. We therefore urge our colleagues in other
countries to collect data on cat and other pet ownership, and a major
goal of this paper is to encourage such research.

3. Results

Funding source
The Stanley Medical Research Institute

There were 2125 useable 1982 questionnaires from NAMI families


who lived in 46 states and the District of Columbia. The number who
owned a cat when the affected person was between birth and 13 was
1075/2125 or 50.6%. This result is remarkably similar to those found in
1992 (50.9%) and 1997 (51.9%) (Table 1). Among the middle parents
control group from the 1991 AVMA survey, 2065/4087 (42.6%) owned a
cat, a result virtually identical to the controls in our 1997 survey
(Table 1). The difference between the rate of cat ownership in the
NAMI families and those in the AVMA survey is highly signicant [chi
square = 38.05, p b .0001; OR 1.38 (1.241.53)].

Contributors
E. Fuller Torrey, MD Stanley Medical Research Institute, United States
Wendy Simmons, MA Stanley Medical Research Institute, United States
Robert H. Yolken, MD Stanley Laboratory of Developmental Neurovirology Johns
Hopkins University, School of Medicine, United States
Conict of interest
The authors have declared that there is no conict of interest in relation to the subject
of the study.
Acknowledgements
We are grateful to the NAMI families who provided us with the information.

4. Discussion
References
Cat ownership in childhood has now been reported in three studies
to be signicantly more common in families in which the child is later
diagnosed with schizophrenia or another serious mental illness,
compared to families in which the child is not so diagnosed. Such a
nding, if conrmed in other groups, would suggest that cat exposure
in childhood is a risk factor for developing the disease.
Were NAMI members in the 1980s representative of families with a
member with schizophrenia? At that time, NAMI members tended to be
disproportionally middle and upper class socioeconomically. In addition, their affected family member tended to be more severely affected
than average, providing an incentive for the families to join the national
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survey was drawn from a random selection of the entire NAMI
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