Superior Academic Performance Linked to Increased Risk for Bipolar Disorder

psychologybipolar academic performance Superior Academic Performance Linked to Increased Risk for Bipolar DisorderStudents who at the age of 16 years excel at school, particularly in creative subjects, are almost 4 times more likely to develop bipolar disorder during the next decade than teenagers with average grades, a new study has found.

This finding supports the hypothesis that creative individuals are more susceptible to bipolar disorder, lead author James H. MacCabe, PhD, Senior Institute of Psychiatry, King’s College, London, United Kingdom, told Medscape Psychiatry. “This is an idea that a lot of people believe, although until this study, there hasn’t been very strong evidence,” said Dr. MacCabe.

However, the investigators also found a relationship, albeit a weaker one, between students who do poorly in school and the later development of bipolar disorder.

The study is published in the February issue of the British Journal of Psychiatry.

Healthy Cohort at Baseline

For the study, researchers followed up 713,876 children who were in the Swedish national school register from 1988 to 1997. The researchers excluded students who developed a psychiatric disorder before or within 1 year after completion of their national examination, which all Swedish children must sit the year they turn 16 years old.

“We didn’t want to risk that we were capturing people who were already ill and whose school performance might have been affected by their illness,” said Dr. MacCabe. “We wanted to get people when they were still well and then follow them up.”

From the national examination, students receive grades ranging from A to E in each of 16 compulsory subjects, which are converted into grade point averages. In this study, grade point average scores ranged from 1.0 to 5.0, with means of 3.11 for boys and 3.39 for girls.

Researchers followed up the subjects until December 31, 2003. The mean follow-up period was 9.48 years, by which time the mean age of the study group was 26.48 years.

During the follow-up period, 280 young people developed bipolar disorder, with a mean age at onset of 20.79 years. There were roughly an equal number of men and women who developed the disorder. Information on bipolar disorder diagnoses came from the Swedish hospital discharge register that contains details of all psychiatric hospitalizations.

Association Stronger in Boys

Students in the highest academic category — with grades of 2 or more standard deviations above the mean — had a significantly higher risk for bipolar disorder (hazard ratio, 3.79) compared with those with average scores.

“Basically, these students who got mainly A grades and a few B’s thrown in had a 4-fold increased risk of subsequently developing bipolar disorder,” said Dr. MacCabe.

At the other end of the academic scale, those in the lowest grade category were also more likely to develop bipolar disorder than those with average scores (hazard ratio, 1.86).

“The people who were 2 standard deviations below the mean, so mostly D and E grade students, were about twice as likely to get bipolar disorder,” said Dr. MacCabe. Adjusting for parental education and socioeconomic status did not fully explain these relationships, he added.

Although there were more girls than boys in the top academic category, the relationship between scholastic achievement and bipolar disorder appeared to be stronger in boys than girls. The study authors noted, too, that most of the eminent creative historical figures with probable bipolar disorder were male.

“The men in this top category were a more extreme group in that they were doing much better [academically] than their peers,” said Dr. MacCabe. “Perhaps the more extreme, the more different you are than your peers in terms of school performance, the higher your risk.”

Students who at the age of 16 years excel at school, particularly in creative subjects, are almost 4 times more likely to develop bipolar disorder during the next decade than teenagers with average grades, a new study has found.

This finding supports the hypothesis that creative individuals are more susceptible to bipolar disorder, lead author James H. MacCabe, PhD, Senior Institute of Psychiatry, King’s College, London, United Kingdom, told Medscape Psychiatry. “This is an idea that a lot of people believe, although until this study, there hasn’t been very strong evidence,” said Dr. MacCabe.

However, the investigators also found a relationship, albeit a weaker one, between students who do poorly in school and the later development of bipolar disorder.

The study is published in the February issue of the British Journal of Psychiatry.

Healthy Cohort at Baseline

For the study, researchers followed up 713,876 children who were in the Swedish national school register from 1988 to 1997. The researchers excluded students who developed a psychiatric disorder before or within 1 year after completion of their national examination, which all Swedish children must sit the year they turn 16 years old.

“We didn’t want to risk that we were capturing people who were already ill and whose school performance might have been affected by their illness,” said Dr. MacCabe. “We wanted to get people when they were still well and then follow them up.”

From the national examination, students receive grades ranging from A to E in each of 16 compulsory subjects, which are converted into grade point averages. In this study, grade point average scores ranged from 1.0 to 5.0, with means of 3.11 for boys and 3.39 for girls.

Researchers followed up the subjects until December 31, 2003. The mean follow-up period was 9.48 years, by which time the mean age of the study group was 26.48 years.

During the follow-up period, 280 young people developed bipolar disorder, with a mean age at onset of 20.79 years. There were roughly an equal number of men and women who developed the disorder. Information on bipolar disorder diagnoses came from the Swedish hospital discharge register that contains details of all psychiatric hospitalizations.

Association Stronger in Boys

Students in the highest academic category — with grades of 2 or more standard deviations above the mean — had a significantly higher risk for bipolar disorder (hazard ratio, 3.79) compared with those with average scores.

“Basically, these students who got mainly A grades and a few B’s thrown in had a 4-fold increased risk of subsequently developing bipolar disorder,” said Dr. MacCabe.

At the other end of the academic scale, those in the lowest grade category were also more likely to develop bipolar disorder than those with average scores (hazard ratio, 1.86).

“The people who were 2 standard deviations below the mean, so mostly D and E grade students, were about twice as likely to get bipolar disorder,” said Dr. MacCabe. Adjusting for parental education and socioeconomic status did not fully explain these relationships, he added.

Although there were more girls than boys in the top academic category, the relationship between scholastic achievement and bipolar disorder appeared to be stronger in boys than girls. The study authors noted, too, that most of the eminent creative historical figures with probable bipolar disorder were male.

“The men in this top category were a more extreme group in that they were doing much better [academically] than their peers,” said Dr. MacCabe. “Perhaps the more extreme, the more different you are than your peers in terms of school performance, the higher your risk.”

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