Article open access publication

Heritability of Schizophrenia and Schizophrenia Spectrum Based on the Nationwide Danish Twin Register

Biological Psychiatry, Elsevier, ISSN 1873-2402

Volume 83, 6, 2018

DOI:10.1016/j.biopsych.2017.08.017, Dimensions: pub.1091413297, PMID: 28987712,


Hilker, Rikke * (1) (2) (3)
Helenius, Dorte (4) (5)
Werge, Thomas M. (1) (4) (5)
Nordentoft, Merete (1) (3) (5) (7)
Glenthøj, Birte (1) (2) (3)

* Corresponding author



  1. (1) CINS–Lundbeck Foundation Center of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Glostrup, Denmark
  2. (2) Rigshospitalet, grid.475435.4, Capital Region
  3. (3) University of Copenhagen, grid.5254.6, KU
  4. (4) Mental Health Centre Sct Hans, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
  5. (5) iPSYCH–Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
  6. (6) University of Southern Denmark, grid.10825.3e, SDU
  7. (7) Mental Health Services, grid.466916.a, Central Denmark Region






BACKGROUND: Twin studies have provided evidence that both genetic and environmental factors contribute to schizophrenia (SZ) risk. Heritability estimates of SZ in twin samples have varied methodologically. This study provides updated heritability estimates based on nationwide twin data and an improved statistical methodology. METHODS: Combining two nationwide registers, the Danish Twin Register and the Danish Psychiatric Research Register, we identified a sample of twins born between 1951 and 2000 (N = 31,524 twin pairs). Twins were followed until June 1, 2011. Liability threshold models adjusting for censoring with inverse probability weighting were used to estimate probandwise concordance rates and heritability of the diagnoses of SZ and SZ spectrum disorders. RESULTS: The probandwise concordance rate of SZ is 33% in monozygotic twins and 7% in dizygotic twins. We estimated the heritability of SZ to be 79%. When expanding illness outcome to include SZ spectrum disorders, the heritability estimate was almost similar (73%). CONCLUSIONS: The key strength of this study is the application of a novel statistical method accounting for censoring in the follow-up period to a nationwide twin sample. The estimated 79% heritability of SZ is congruent with previous reports and indicates a substantial genetic risk. The high genetic risk also applies to a broader phenotype of SZ spectrum disorders. The low concordance rate of 33% in monozygotic twins demonstrates that illness vulnerability is not solely indicated by genetic factors.


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