Failing specific educational transitions predicted schizophrenia, bipolar disorder (BD), obsessive-compulsive disorder (OCD), major depression (MD), anorexia nervosa (AN), alcohol use disorder (AUD), and/or drug use disorder (DUD). These findings were published in Psychological Medicine.
Investigators from Lund University in Sweden sourced data for this study from population-based registers in Sweden. Educational data about grade point averages during transitions from early, intermediate, and upper compulsory education and to vocational or university education among individuals born in Sweden between 1972 and 1995 (N=1,997,910) were related with developing schizophrenia, BD, MD, AN, AUD, and/or DUD by 2018. In Sweden compulsory education starts at 7 years of age and lasts for 9 years.
Among the entire cohort, 64.2% resided in an urban area, 31.4% lived in an unstable home, 12.4% had parents with a low level of education, and 10.1% lived in a deprived area. Out of the 7 outcomes of interest, the highest rate was observed for MD (17.6%), followed by DUD (5.5%), AUD (3.8%), BD (1.5%), OCD (1.3%), AN (0.5%), and schizophrenia (0.2%).
In both MD and BD as well as AUD and DUD, the largest influences on risk were observed for individuals who completed basic high school but did not start upper high school compared with those who did start upper high school whereas the lowest impacts on MD, BD, AUD, and DUD risk were observed for individuals who finished upper vocational high school compared with precollege upper high school.
For OCD and schizophrenia outcomes, early educational transitions appeared to be more important. The greatest influences on risk were observed for those who did or did not complete basic high school, had delayed basic high school graduation compared with graduating on time, and completed basic high school but did not start upper high school compared with those who did start upper high school.
In general, educational transitions seemed to be the poorest predictor for AN risk and AN was the only outcome that had a protective effect, in which finishing upper vocational high school compared with precollege upper high school was associated with lower AN risk.
These trends may not be generalizable for areas outside Sweden.
Study authors concluded, “In this study of almost 2 million young people in Sweden, sorting young individuals by school performance reveals a robust relationship with risk for a range of psychiatric disorders. These results suggest that familial-genetic cognitive measures and educational measures collected on the basis of school performance and placement predict later psychiatric and behavioral disorders with a set of diagnosis-specific patterns and ranges of severity.”
This article originally appeared on Psychiatry Advisor
Kendler KS, Keefe RSE, Ohlsson H, Sundquist J, Sundquist K. Risk for psychiatric and substance use disorders as a function of transitions in Sweden’s public educational system: a national study. Psychol Med. 2023;1-8. doi:10.1017/S003329172300048X