Hostname: page-component-745bb68f8f-v2bm5 Total loading time: 0 Render date: 2025-01-27T19:44:47.392Z Has data issue: false hasContentIssue false
  • English
  • Français

Scholastic achievement at age 16 and risk of schizophrenia and other psychoses: a national cohort study

Published online by Cambridge University Press:  08 November 2007

J. H. MacCabe ,
M. P. Lambe ,
S. Cnattingius ,
A. Torrång ,
C. Björk ,
P. C. Sham ,
A. S David ,
R. M. Murray  and
C. M. Hultman
J. H. MacCabe*
Affiliation:
Department of Psychiatry, Institute of Psychiatry, King's College London, London, UK
M. P. Lambe
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
S. Cnattingius
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
A. Torrång
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
C. Björk
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
P. C. Sham
Affiliation:
Department of Psychiatry, Institute of Psychiatry, King's College London, London, UK
A. S David
Affiliation:
Department of Psychiatry, Institute of Psychiatry, King's College London, London, UK
R. M. Murray
Affiliation:
Department of Psychiatry, Institute of Psychiatry, King's College London, London, UK
C. M. Hultman
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: Dr J. H. MacCabe, Department of Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is abundant evidence that schizophrenia is associated with cognitive deficits in childhood. However, previous studies investigating school performance have been inconclusive. Furthermore, there are several biological and social factors that could confound the association. We investigated whether school performance at age 16 is associated with risk of adult schizophrenia and other psychoses in a large national cohort, while controlling for multiple confounders.

Method

Using a national sample of 907 011 individuals born in Sweden between 1973 and 1983, we used Cox regression to assess whether scholastic achievement at age 15–16 predicted hospital admission for psychosis between ages 17 and 31, adjusting for potential confounders.

Results

Poor school performance was associated with increased rates of schizophrenia [hazard ratio (HR) 3.9, 95% confidence interval (CI) 2.8–5.3], schizo-affective disorder (HR 4.2, 95% CI 1.9–9.1) and other psychoses (HR 3.0, 95% CI 2.3–4.0). Receiving the lowest (E) grade was significantly associated with risk for schizophrenia and other psychoses in every school subject. There was no evidence of confounding by migrant status, low birthweight, hypoxia, parental education level or socio-economic group.

Conclusions

Poor school performance across all domains is strongly associated with risk for schizophrenia and other psychoses.

Keywords

Bipolar disordercohort studycognitive functionepidemiologyschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1133 - 1140
Copyright
Copyright © 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arvidsson, H, Ericson, BG (2005). The development of psychiatric care after the mental health care reform in Sweden. A case register study. Nordic Journal of Psychiatry 59, 186–192.CrossRefGoogle ScholarPubMed
Barnett, JH, Salmond, CH, Jones, PB, Sahakian, BJ (2006). Cognitive reserve in neuropsychiatry. Psychological Medicine 36, 1053–1064.Google Scholar
Björklund, A, Lindahl, M, Sund, K (2003). Family background and school performance during a turbulent era of school reforms. Swedish Economic Policy Review 10, 111–136.Google Scholar
Cannon, M, Jones, P, Huttunen, MO, Tanskanen, A, Huttunen, T, Rabe-Hesketh, S, Murray, RM (1999). School performance in Finnish children and later development of schizophrenia: a population-based longitudinal study. Archives of General Psychiatry 56, 457–463.Google Scholar
Cannon, M, Jones, PB, Murray, RM (2002). Obstetric complications and schizophrenia: historical and meta-analytic review. American Journal of Psychiatry 159, 1080–1092.CrossRefGoogle ScholarPubMed
Cannon, TD, Bearden, CE, Hollister, JM, Rosso, IM, Sanchez, LE, Hadley, T (2000). Childhood cognitive functioning in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophrenia Bulletin 26, 379–393.Google Scholar
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.CrossRefGoogle ScholarPubMed
Cnattingius, S, Ericson, A, Gunnarskog, J, Kallen, B (1990). A quality study of a medical birth registry. Scandinavian Journal of Social Medicine 18, 143–148.Google Scholar
Dalman, C, Broms, J, Cullberg, J, Allebeck, P (2002). Young cases of schizophrenia identified in a national inpatient register – are the diagnoses valid? Social Psychiatry and Psychiatric Epidemiology 37, 527–531.Google Scholar
Davidson, M, Reichenberg, A, Rabinowitz, J, Weiser, M, Kaplan, Z, Mark, M (1999). Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. American Journal of Psychiatry 156, 1328–1335.Google Scholar
Deary, IJ, Strand, P, Smith, P, Fernandes, C (2007). Intelligence and educational achievement. Intelligence 35, 13–21.Google Scholar
Ekholm, B, Ekholm, A, Adolfsson, R, Vares, M, Osby, U, Sedvall, GC, Jonsson, EG (2005). Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nordic Journal of Psychiatry 59, 457–464.CrossRefGoogle ScholarPubMed
Isohanni, I, Jarvelin, MR, Jones, P, Jokelainen, J, Isohanni, M (1999). Can excellent school performance be a precursor of schizophrenia? A 28-year follow-up in the Northern Finland 1966 birth cohort. Acta Psychiatrica Scandinavica 100, 17–26.CrossRefGoogle ScholarPubMed
Isohanni, I, Jarvelin, MR, Nieminen, P, Jones, P, Rantakallio, P, Jokelainen, J, Isohanni, M (1998). School performance as a predictor of psychiatric hospitalization in adult life. A 28-year follow-up in the Northern Finland 1966 Birth Cohort. Psychological Medicine 28, 967–974.Google Scholar
Jones, PB, Done, DJ (1997). From birth to onset: a developmental perspective of schizophrenia in two national birth cohorts. In Neurodevelopment and Adult Psychopathology (ed. Keshavan, M. S. and Murray, R. M.), pp. 119–136. Cambridge University Press: Cambridge.Google Scholar
Lawlor, DA, Clark, H, Ronalds, G, Leon, DA (2006). Season of birth and childhood intelligence: findings from the Aberdeen Children of the 1950s cohort study. British Journal of Educational Psychology 76, 481–499.Google Scholar
MacCabe, JH, Murray, RM (2004). Intellectual functioning in schizophrenia: a marker of neurodevelopmental damage? Journal of Intellectual Disability Research 48, 519–523.CrossRefGoogle ScholarPubMed
Malaspina, D, Reichenberg, A, Weiser, M, Fennig, S, Davidson, M, Harlap, S, Wolitzky, R, Rabinowitz, J, Susser, E, Knobler, HY (2005). Paternal age and intelligence: implications for age-related genomic changes in male germ cells. Psychiatric Genetics 15, 117–125.CrossRefGoogle ScholarPubMed
Matte, TD, Bresnahan, M, Begg, MD, Susser, E (2001). Influence of variation in birth weight within normal range and within sibships on IQ at age 7 years: cohort study. British Medical Journal 323, 310–314.Google Scholar
McGrath, J, Welham, J, Pemberton, M (1995). Month of birth, hemisphere of birth and schizophrenia. British Journal of Psychiatry 167, 783–785.Google Scholar
Perreira, KM, Harris, KM, Lee, D (2006). Making it in America: high school completion by immigrant and native youth. Demography 43, 511–536.Google Scholar
Reichenberg, A, Weiser, M, Rabinowitz, J, Caspi, A, Schmeidler, J, Mark, M, Kaplan, Z, Davidson, M (2002). A population-based cohort study of premorbid intellectual, language, and behavioral functioning in patients with schizophrenia, schizoaffective disorder, and nonpsychotic bipolar disorder. American Journal of Psychiatry 159, 2027–2035.Google Scholar
Schoenfeld, D (1982). Partial residuals for the proportional hazards regression model. Biometrika 69, 239–241.Google Scholar
Sipos, A, Rasmussen, F, Harrison, G, Tynelius, P, Lewis, G, Leon, DA, Gunnell, D (2004). Paternal age and schizophrenia: a population based cohort study. British Medical Journal 329, 1070.Google Scholar
WHO (1992). International Statistical Classification of Diseases and Related Health Problems, 3 vols. World Health Organization: Geneva.Google Scholar
Wicks, S, Hjern, A, Gunnell, D, Lewis, G, Dalman, C (2005). Social adversity in childhood and the risk of developing psychosis: a national cohort study. American Journal of Psychiatry 162, 1652–1657.Google Scholar
Zammit, S, Allebeck, P, David, AS, Dalman, C, Hemmingsson, T, Lundberg, I, Lewis, G (2004). A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of General Psychiatry 61, 354–360.Google Scholar