Law May Prevent Discrimination Against People Genetically Predisposed to Mental Disorders

The Genetic Information Nondiscrimination Act (GINA), signed into law in May 2008, may help protect individuals with genetic indicators of mental illness, according to an article in the April issue of Psychiatric Services.

Study author Paul S. Appelbaum, MD, professor of psychiatry, medicine, and law, Department of Psychiatry, Columbia University, New York City, says the increasing use of tests that indicate genetic susceptibility for psychiatric disorders has generated growing concern that such information may be misused.

"[GINA] may turn out to be every bit as important in protecting persons from discrimination on the basis of propensity to develop a mental disorder as it is likely to be for general medical conditions," Dr. Appelbaum writes ...

Extreme Example

Hong Kong serves as an extreme example of how family history can limit opportunities. In that country, individuals with a first-degree relative with a "mental disorder of a hereditary nature" were excluded from jobs in fire, ambulance, or law enforcement services. The assumption was that individuals with mental disorders have higher rates of violence — not an established fact yet applied to first-degree relatives of affected persons. Challenges in the Hong Kong courts removed the ruling.

Looking at current genetic information on psychiatric disorders, Dr. Applebaum notes that test-based discrimination might be difficult, even without GINA. Genes currently associated with mental disease have poor predictive ability, and the development of mental disorders usually involves both genetic proclivity and environmental factors.

"Schizophrenia and bipolar disorder both have very high heritability," said Dr. Applebaum. "Alleles contributing to Alzheimer’s disease have been identified, although the ones so far identified appear to account for only a minority of cases. Most other psychiatric disorders that have been examined, including depression and OCD [obsessive-compulsive disorder], have shown some degree of heritability," he told Medscape Psychiatry.

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