The relationship of school performance and mental health: Educational achievement as indicator of psychopathology

In this thesis we explored the relationship between poor educational achievement and psychopathology. Examining the association between educational achievement and mental health problems and development of psychiatric disorders is important to investigate the potential value of educational achievement as an indicator of individuals and groups at risk. Knowledge generated by such studies may increase our understanding of the etiology of psychopathology. The results from the first part of the thesis suggest that poor educational achievement at secondary school can be used as an indicator of mental health problems in adolescents. We hypothesized that poor educational achievement would act as an independent risk factor for psychopathology but we did not find evidence that it is a risk factor by itself, instead our data indicated that poor educational achievement indexes a range of other risk factors, in particular socio-demographic factors and adverse life events. The results are consistent with a model whereby poor educational achievement acts differently in subgroups of pupils with different levels of achievement; for instance we found that it was a stronger indicator in pupils starting in higher tracks than pupils starting in lower tracks at secondary school. These findings also suggest that not the level of performance is informative, but rather the decline in education or shortfall in expected performance. In the second part of the thesis we investigated the specificity of poor educational achievement and showed that poor educational achievementfrom primary school onwards is specifically related to schizophrenia and not to other psychiatric disorders such as bipolar disorder or depressive disorder. In addition, this pattern of early poor educational achievement appears to be intrinsic to the illness since it is not found in siblings. The finding that educational impairment occurs from early age onwards in schizophrenia is interesting because it supports a neurodevelopmental model in which deficits in cognition are observed many years before illness onset. We also examined an estimate of cognitive achievement and educational achievement in an at-risk population of offspring of bipolar parents. In this study, the results suggest that cognitive development was worse in bipolar offspring who develop psychopathology at a young age (<16 years), as compared to offspring who develop psychopathology later in life and compared to those who develop no psychopathology. This effect was not reflected in poor educational achievement but these results were hampered by incomplete data. Our finding may indicate that the offspring who develop psychopathology early in life may be at particularly high genetic liability and vulnerable to both psychiatric symptoms and cognitive impairment. Further longitudinal studies are needed to investigate the course of cognitive and educational development in bipolar offspring. Final conclusion This thesis shows that poor educational achievement has some albeit limited value as a marker for psychosocial problems in adolescents and for groups at risk for developing severe psychopathology, in particular schizophrenia. Since poor educational achievement is an easily available, unbiased and non-invasive marker it may be worthwhile to further investigate possibilities for contribution to early identification and treatment of mental health problems including schizophrenia.