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The association between school exam grades and subsequent development of bipolar disorder

Published online by Cambridge University Press:  13 March 2018

Steffie Damgaard Pedersen ,
Søren Dinesen Østergaard Open the ORCID record for Søren Dinesen Østergaard [Opens in a new window]  and
Liselotte Petersen
Steffie Damgaard Pedersen
Affiliation:
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
Søren Dinesen Østergaard*
Affiliation:
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
Liselotte Petersen
Affiliation:
National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
*
Author for correspondence: Søren Dinesen Østergaard, Aarhus Institute of Advanced Studies, Aarhus University, Høegh-Guldbergs Gade 6B, 8000 Aarhus, Denmark Tel: +45 61282753; Fax: +45 78471609; E-mail: [email protected].
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Abstract

Objective

Prior studies have indicated that both high and low school grades are associated with development of bipolar disorder (BD), but these studies have not adjusted for parental history of mental disorder, which is a likely confounder. Furthermore, the association between school grades and bipolar I disorder (BD-I) has not been studied. Therefore, we aimed to study the association between school exam grades and subsequent development of BD and BD-I while adjusting for parental history of mental disorder.

Methods

We conducted a register-based nationwide cohort study following 505 688 individuals born in Denmark between 1987 and 1995. We investigated the association between school exam grades and development of BD or BD-I with a Cox model adjusting for family history of mental disorder and other potential confounders.

Results

During follow-up, 900 individuals were diagnosed with BD and 277 of these with BD-I. The risk for BD and BD-I was significantly increased for individuals not having completed the exams at term [adjusted hazard ratio (aHR) for BD (aHR=1.71, 95% CI: 1.43–2.04) and for BD-I (aHR=1.57, 95% CI: 1.13–2.19)]. Also, having low exam grades in mathematics was associated with increased risk of both BD (aHR=2.41, 95% CI: 1.27–4.59) and BD-I (aHR=2.71, 95% CI: 1.41–5.21). Females with very high exam grades in Danish (percentile group>97.7) had a significantly increased risk of BD-I (aHR=2.49, 95% CI: 1.19–5.23).

Conclusions

The potential to develop BD seems to affect the school results of individuals negatively even before BD is diagnosed – with females having the potential to develop BD-I as a possible exception.

Keywords

bipolar disordercohort studyepidemiologyregistersschool achievement
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 30 , Issue 4 , August 2018 , pp. 209 - 217
Copyright
© Scandinavian College of Neuropsychopharmacology 2018 

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References

1. Murray, CJ, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD Michaud, C et al. (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197–2223.Google Scholar
2. Kessing, LV, Hansen, MG Andersen, PK (2004) Course of illness in depressive and bipolar disorders. Naturalistic study, 1994-1999. Br J Psychiatry 185, 372–377.Google Scholar
3. Akiskal, HS Akiskal, KK (2007) In search of Aristotle: temperament, human nature, melancholia, creativity and eminence. J Affect Disord 100, 1–6.Google Scholar
4. Andreasen, NC Glick, ID (1988) Bipolar affective disorder and creativity: implications and clinical management. Compr Psychiatry 29, 207–217.Google Scholar
5. Andreasen, NC (2008) The relationship between creativity and mood disorders. Dialogues Clin Neurosci 10, 251–255.Google Scholar
6. Bond, AH (1985) Virginia Woolf: manic-depressive psychosis and genius. An illustration of separation-individuation theory. J Am Acad Psychoanal 13, 191–210.Google Scholar
7. Anderson, EW (1971) Strindberg’s illness. Psychol Med 1, 104–117.Google Scholar
8. Andreasen, NC (1987) Creativity and mental illness: prevalence rates in writers and their first-degree relatives. Am J Psychiatry 144, 1288–1292.Google Scholar
9. Post, F (1996) Verbal creativity, depression and alcoholism. An investigation of one hundred American and British writers. Br J Psychiatry 168, 545–555.Google Scholar
10. Post, F (1994) Creativity and psychopathology. A study of 291 world-famous men. Br J Psychiatry 165, 22–34.Google Scholar
11. Srivastava, S, Childers, ME, Baek, JH, Strong, CM, Hill, SJ, Warsett, KS, Wang, PW, Akiskal, HS, Akiskal, KK Ketter, TA (2010) Toward interaction of affective and cognitive contributors to creativity in bipolar disorders: a controlled study. J Affect Disord 125, 27–34.Google Scholar
12. Santosa, CM, Strong, CM, Nowakowska, C, Wang, PW, Rennicke, CM Ketter, TA (2007) Enhanced creativity in bipolar disorder patients: a controlled study. J Affect Disord 100, 31–39.Google Scholar
13. MacCabe, JH, Lambe, MP, Cnattingius, S, Sham, PC, David, AS, Reichenberg, A, Murray, RM Hultman, CM (2010) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. Br J Psychiatry 196, 109–115.Google Scholar
14. Kendler, KS, Ohlsson, H, Mezuk, B, Sundquist, K Sundquist, J (2016) A Swedish National Prospective and Co-relative Study of school achievement at age 16, and risk for schizophrenia, other nonaffective psychosis, and bipolar illness. Schizophr Bull 42, 77–86.Google Scholar
15. Kendler, KS, Ohlsson, H, Mezuk, B, Sundquist, JO Sundquist, K (2016) Observed cognitive performance and deviation from familial cognitive aptitude at age 16 years and ages 18 to 20 years and risk for schizophrenia and bipolar illness in a Swedish National Sample. JAMA Psychiatry 73, 465–471.Google Scholar
16. Kendler KS, Ohlsson H, Keefe RSE, Sundquist K and Sundquist J (2017) The joint impact of cognitive performance in adolescence and familial cognitive aptitude on risk for major psychiatric disorders: a delineation of four potential pathways to illness. Mol Psychiatry. Epub ahead of print.Google Scholar
17. Pedersen, CB (2011) The Danish Civil Registration System. Scand J Public Health 39, 22–25.Google Scholar
18. Munk-Jorgensen, P Ostergaard, SD (2011) Register-based studies of mental disorders. Scand J Public Health 39, 170–174.Google Scholar
19. Jensen, VM Rasmussen, AW (2011) Danish Education Registers. Scand J Public Health 39, 91–94.Google Scholar
20. The Danish Ministry of Education. The Student Counseling Act. Available at https://www.retsinformation.dk/Forms/R0710.aspx?id=132825. Accessed November 21, 2017.Google Scholar
21. Mors, O, Perto, GP Mortensen, PB (2011) The Danish Psychiatric Central Research Register. Scand J Public Health 39, 54–57.Google Scholar
22. Danish National Board of Health (1971) Classification of diseases: extended Danish-Latin version of the World Health Organization International Statistical Classification of Diseases and Related Health Problems, 8th Revision. Copenhagen. Denmark: Danish National Board of Health.Google Scholar
23. World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: WHO.Google Scholar
24. Kessing, L (1998) Validity of diagnoses and other clinical register data in patients with affective disorder. Eur Psychiatry 13, 392–398.Google Scholar
25. World Health Organization . ICD-11 draft. Available at https://gcp.network/en/. Accessed November 21, 2017.Google Scholar
26. Ostergaard, SD, Waltoft, BL, Mortensen, PB Mors, O (2013) Environmental and familial risk factors for psychotic and non-psychotic severe depression. J Affect Disord 147, 232–240.Google Scholar
27. Mathiasen, R, Hansen, BM, Andersen, AM, Forman, JL Greisen, G (2010) Gestational age and basic school achievements: a national follow-up study in Denmark. Pediatrics 126, e1553–e1561.Google Scholar
28. Schoenfeld, D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69, 239–241.Google Scholar
29. Koenen, KC, Moffitt, TE, Roberts, AL, Martin, LT, Kubzansky, L, Harrington, H, Poulton, R Caspi, A (2009) Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 166, 50–57.Google Scholar
30. Kutcher, S, Robertson, HA Bird, D (1998) Premorbid functioning in adolescent onset bipolar I disorder: a preliminary report from an ongoing study. J Affect Disord 51, 137–144.Google Scholar
31. Björkenstam, E, Dalman, C, Vinnerljung, B, Weitoft, GR, Walder, DJ Burstrom, B (2016) Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County. J Epidemiol Community Health 70, 473–480.Google Scholar
32. Duffy, A, Alda, M, Hajek, T, Sherry, SB Grof, P (2010) Early stages in the development of bipolar disorder. J Affect Disord 121, 127–135.Google Scholar
33. Tundo, A, Musetti, L, Benedetti, A, Berti, B, Massimetti, G Dell’Osso, L (2015) Onset polarity and illness course in bipolar I and II disorders: the predictive role of broadly defined mixed states. Compr Psychiatry 63, 15–21.Google Scholar
34. Baldessarini, RJ, Tondo, L Visioli, C (2014) First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand 129, 383–392.Google Scholar
35. Goldberg, JF Harrow, M (2011) A 15-year prospective follow-up of bipolar affective disorders: comparisons with unipolar nonpsychotic depression. Bipolar Disord 13, 155–163.Google Scholar
36. Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DA, Leon, AC, Rice, JA Keller, MB (2002) The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 59, 530–537.Google Scholar
37. Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Leon, AC, Solomon, DA, Coryell, W, Maser, JD Keller, MB (2005) Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry 62, 1322–1330.Google Scholar
38. Kupka, RW, Altshuler, LL, Nolen, WA, Suppes, T, Luckenbaugh, DA, Leverich, GS, Frye, MA, Keck, PE Jr, McElroy, SL, Grunze, H Post, RM (2007) Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder. Bipolar Disord 9, 531–535.Google Scholar
39. Jonsson, U, Bohman, H, Hjern, A, von Knorring, L, Olsson, G von Knorring, AL (2010) Subsequent higher education after adolescent depression: a 15-year follow-up register study. Eur Psychiatry 25, 396–401.Google Scholar
40. Hysenbegasi, A, Hass, SL Rowland, CR (2005) The impact of depression on the academic productivity of university students. J Ment Health Policy Econ 8, 145–151.Google Scholar
41. Carvalho, AF, McIntyre, RS, Dimelis, D, Gonda, X, Berk, M, Nunes-Neto, PR, Cha, DS, Hyphantis, TN, Angst, J Fountoulakis, KN (2014) Predominant polarity as a course specifier for bipolar disorder: a systematic review. J Affect Disord 163, 56–64.Google Scholar
42. Kim, BN Kwon, SM (2017) The link between hypomania risk and creativity: the role of heightened behavioral activation system (BAS) sensitivity. J Affect Disord 215, 9–14.Google Scholar
43. McCraw, S, Parker, G, Fletcher, K Friend, P (2013) Self-reported creativity in bipolar disorder: prevalence, types and associated outcomes in mania versus hypomania. J Affect Disord 151, 831–836.Google Scholar
44. Bock, C, Bukh, JD, Vinberg, M, Gether, U Kessing, LV (2009) Validity of the diagnosis of a single depressive episode in a case register. Clin Pract Epidemiol Ment Health 5, 4.Google Scholar
45. Uggerby, P, Ostergaard, SD, Roge, R, Correll, CU Nielsen, J (2013) The validity of the schizophrenia diagnosis in the Danish Psychiatric Central Research Register is good. Dan Med J 60, A4578.Google Scholar
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