History

The New England Family Study (NEFS) is a long running investigation aimed at identifying risk factors of several medical issues of adulthood that may have genetic and early developmental childhood origins.  The primary goal of the NEFS is to improve understanding of the effects of pregnancy, in-utero exposures, and birth complications on a wide range of adult health outcomes, and ultimately, to expand on identification and detection of risk factors that may help prevent and treat some of the illnesses that impact individuals and society.


The New England Family Study involves a number of adult follow-up investigations of participants in the Providence RI and Boston MA sites of the Collaborative Perinatal Project.  This work began through a collaboration between Brown University Psychology Professor, Lewis P. Lipsitt, Ph.D., who had directed the childhood assessments in Providence, Brown psychiatrist / epidemiologist, Dr. Ming T. Tsuang and Harvard doctoral student Stephen Buka who co-designed and directed these initial follow-up efforts (Buka, Lipsitt, Tsuang, 1988). 


At the heart of their initial study was the seminal work of Pasamanick et al. who proposed “…a continuum of reproductive casualty extending from death [which] might descend in severity through cerebral palsy, epilepsy, mental deficiency, and perhaps even to behavior disorder” (Pasamanick, Rogers, Lilienfeld, 1956).  The first major study (the “Providence 1000”) selected from the Providence site 500 infants born with moderate perinatal complications, and 500 matched comparison subjects, and interviewed these children as adults at mean age 23 years utilizing standardized diagnostic assessments (Buka, Tsuang, Lipsitt, 1993).  The generally null results indicated no elevated risk for psychiatric disorder in relation to perinatal complications, with two exceptions.  Infants born with conditions suggestive of chronic fetal hypoxia were at marginally elevated risk for both cognitive impairment and psychotic disorders, including schizophrenia.  These initial findings led to a considerable body of work over the next 25 years, with major collaborators including Stephen Buka, Jill Goldstein,and Larry Seidman (Buka et al.,1999). Their research on how perinatal complications, infections during pregnancy and family history contribute to the development of schizophrenia and other severe mental disorders include both a ‘high-risk’ study of over 700 original CPP parents (referred to as Generation 1 or G1) with a history of psychiatric treatment and matched unaffected comparison parents, and a nested case-control study of approximately 200 CPP offspring (Generation 2 or G2) diagnosed with schizophrenia, bipolar disorder and other psychoses, their unaffected siblings and matched unaffected controls (Buka et al, 2013).  The case-control component of the schizophrenia work resulted in the first uses of stored maternal serum samples relative to adult outcomes, including the initial serologically-based finding of elevated maternal antibodies and cytokine levels (Buka et al, 2001a, b) in relation to subsequent psychosis.  These schizophrenia projects now include over 1000 CPP cohort members with and without psychotic disorders and incorporate detailed clinical diagnostic, neuropsychological, structural and functional imaging procedures and more (Thermenos et al., 2005; Goldstein et al., 2010; Seidman et al., 2013).


Studies have extended beyond psychotic disorders, and what is now known as the “New England Family Study” involves the follow-up and assessment of three generation pedigrees of members of both the Providence and Boston sites of the CPP, most investigating the role of prenatal and early life risk conditions for later psychopathology and comorbid conditions, embedded within informative family designs.   Among the hundreds of publications resulting from this work include novel investigations of the consequences resulting from maternal smoking during pregnancy using discordant sibling designs including nicotine dependence, other forms of substance abuse, and comorbid medical conditions.  Recent work has moved from neuropsychiatric outcomes to physical conditions, with a particular emphasis on adult risks for cardiovascular disease.  Other major projects have included investigations of the stability and sequelae of childhood learning disorders, attention deficit disorders, social determinants of depression and other psychiatric disorders, and more.