Early school performance predicts risk of schizophrenia

Poor academic achievement appears to be a precedent of adult-onset schizophrenia, according to the results of a systematic review and meta-analysis.

The meta-analysis included 22 studies evaluating the general academic performance—measured using objective scores on at least two core subjects (eg, literacy and mathematics) in achievement tests and national examinations—at age ≤16 years. Most studies obtained data on educational level attainment by self-report via structured interview or questionnaire. All studies had mixed-gender population samples, except for two, which included only men.

Pooled data from more than 4 million individuals showed that individuals who later developed schizophrenia had poorer general academic (p≤0.0001) and mathematics achievement (p=0.01) by age 16 years compared with those who had better performance.

The risk of adult-onset schizophrenia was also higher among people who did not enter higher education (odds ratio, 0.49; p≤0.0001).

Meanwhile, young people who reported psychotic-like experiences and those with a family history of schizophrenia had lower general academic achievement (p≤0.0001 for both). There were no effect modifiers detected on meta-regression analyses.

Despite the significant heterogeneity across studies and effect sizes being small to moderate in magnitude only, the study brings to the fore that youths at risk of schizophrenia are characterized by poorer general academic and mathematics achievement by age 16 years.

Additional research is needed to establish the feasibility of using academic achievement and other known antecedents of the disorder as a tool for identifying at-risk pupils and thereby facilitate early treatment and preventative interventions.