Skip to main content
    • Aa
    • Aa

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

  • J. H. MacCabe (a1), M. P. Lambe (a2), S. Cnattingius (a2), A. Torrång (a2), C. Björk (a2), P. C. Sham (a1), A. S David (a1), R. M. Murray (a1) and C. M. Hultman (a2)...

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.


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.


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.


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

Corresponding author
*Address for correspondence: Dr J. H. MacCabe, Department of Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

H Arvidsson , BG Ericson (2005). The development of psychiatric care after the mental health care reform in Sweden. A case register study. Nordic Journal of Psychiatry 59, 186192.

M Cannon , P Jones , MO Huttunen , A Tanskanen , T Huttunen , S Rabe-Hesketh , RM Murray (1999). School performance in Finnish children and later development of schizophrenia: a population-based longitudinal study. Archives of General Psychiatry 56, 457463.

M Cannon , PB Jones , RM Murray (2002). Obstetric complications and schizophrenia: historical and meta-analytic review. American Journal of Psychiatry 159, 10801092.

TD Cannon , CE Bearden , JM Hollister , IM Rosso , LE Sanchez , T Hadley (2000). Childhood cognitive functioning in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophrenia Bulletin 26, 379393.

E Cantor-Graae , JP Selten (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.

C Dalman , J Broms , J Cullberg , P Allebeck (2002). Young cases of schizophrenia identified in a national inpatient register – are the diagnoses valid? Social Psychiatry and Psychiatric Epidemiology 37, 527531.

IJ Deary , P Strand , P Smith , C Fernandes (2007). Intelligence and educational achievement. Intelligence 35, 1321.

B Ekholm , A Ekholm , R Adolfsson , M Vares , U Osby , GC Sedvall , EG Jonsson (2005). Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nordic Journal of Psychiatry 59, 457464.

I Isohanni , MR Jarvelin , P Jones , J Jokelainen , M Isohanni (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, 1726.

I Isohanni , MR Jarvelin , P Nieminen , P Jones , P Rantakallio , J Jokelainen , M Isohanni (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, 967974.

DA Lawlor , H Clark , G Ronalds , DA Leon (2006). Season of birth and childhood intelligence: findings from the Aberdeen Children of the 1950s cohort study. British Journal of Educational Psychology 76, 481499.

JH MacCabe , RM Murray (2004). Intellectual functioning in schizophrenia: a marker of neurodevelopmental damage? Journal of Intellectual Disability Research 48, 519523.

D Malaspina , A Reichenberg , M Weiser , S Fennig , M Davidson , S Harlap , R Wolitzky , J Rabinowitz , E Susser , HY Knobler (2005). Paternal age and intelligence: implications for age-related genomic changes in male germ cells. Psychiatric Genetics 15, 117125.

TD Matte , M Bresnahan , MD Begg , E Susser (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, 310314.

J McGrath , J Welham , M Pemberton (1995). Month of birth, hemisphere of birth and schizophrenia. British Journal of Psychiatry 167, 783785.

KM Perreira , KM Harris , D Lee (2006). Making it in America: high school completion by immigrant and native youth. Demography 43, 511536.

A Reichenberg , M Weiser , J Rabinowitz , A Caspi , J Schmeidler , M Mark , Z Kaplan , M Davidson (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, 20272035.

D Schoenfeld (1982). Partial residuals for the proportional hazards regression model. Biometrika 69, 239241.

A Sipos , F Rasmussen , G Harrison , P Tynelius , G Lewis , DA Leon , D Gunnell (2004). Paternal age and schizophrenia: a population based cohort study. British Medical Journal 329, 1070.

S Wicks , A Hjern , D Gunnell , G Lewis , C Dalman (2005). Social adversity in childhood and the risk of developing psychosis: a national cohort study. American Journal of Psychiatry 162, 16521657.

S Zammit , P Allebeck , AS David , C Dalman , T Hemmingsson , I Lundberg , G Lewis (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, 354360.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 8
Total number of PDF views: 25 *
Loading metrics...

Abstract views

Total abstract views: 152 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th May 2017. This data will be updated every 24 hours.