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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: james.maccabe@iop.kcl.ac.uk)
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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

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