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Academic achievement and schizophrenia: a systematic meta-analysis

Published online by Cambridge University Press:  20 July 2020

Hannah Dickson Open the ORCID record for Hannah Dickson [Opens in a new window] ,
Emily P. Hedges Open the ORCID record for Emily P. Hedges [Opens in a new window] ,
Shin Y. Ma ,
Alexis E. Cullen ,
James H. MacCabe ,
Matthew J. Kempton ,
Johnny Downs  and
Kristin R. Laurens
Hannah Dickson*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Emily P. Hedges
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Shin Y. Ma
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Alexis E. Cullen
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
James H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Matthew J. Kempton
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Johnny Downs
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Kristin R. Laurens
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Queensland University of Technology (QUT), School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia School of Psychiatry, University of New South Wales, NSW, Australia
*
Author for correspondence: Hannah Dickson, E-mail: hannah.dickson@kcl.ac.uk
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Abstract

Background

Cognitive impairments in childhood are associated with increased risk of schizophrenia in later life, but the extent to which poor academic achievement is associated with the disorder is unclear.

Methods

Major databases were searched for articles published in English up to 31 December 2019. We conducted random-effects meta-analyses to: (1) compare general academic and mathematics achievement in youth who later developed schizophrenia and those who did not; (2) to examine the association between education level achieved and adult-onset schizophrenia; and, (3) compare general academic achievement in youth at-risk for schizophrenia and typically developing peers. Meta-regression models examined the effects of type of academic assessment, educational system, age at assessment, measurement of educational level attained, school leaving age, and study quality on academic achievement and education level among individuals with schizophrenia.

Results

Meta-analyses, comprising data of over four million individuals, found that: (1) by age 16 years, those who later developed schizophrenia had poorer general academic (Cohen's d = −0.29, p ⩽ 0.0001) and mathematics achievement (d = −0.23, p = 0.01) than those who did not; (2) individuals with schizophrenia were less likely to enter higher education (odds ratio = 0.49, p ⩽ 0.0001); and, (3) youth reporting psychotic-like experiences and youth with a family history of schizophrenia had lower general academic achievement (d = −0.54, p ⩽ 0.0001; d = −0.39, p ⩽ 0.0001, respectively). Meta-regression analyses determined no effect modifiers.

Discussion

Despite significant heterogeneity across studies, various routinely collected indices of academic achievement can identify premorbid cognitive dysfunction among individuals who are vulnerable for schizophrenia, potentially aiding the early identification of risk in the population.

Keywords

Academic attainmentadolescencechildhoodcognitionpsychosisscholastic achievement
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 12 , September 2020 , pp. 1949 - 1965
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Joint first authors.

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