Abstract

The current education policy in Finland tends to result in higher levels of education, and to avoid educational failures. The aim of the present study was to determine school predictors for later severe mental disorders requiring hospital treatment, and to determine whether or not severe mental disorders or smoking are associated with educational achievement.

Educational attainments were analysed in the Northern Finland 1966 Birth Cohort (n = 12 058 born alive) using school performance and attained level of education. Data was collected using questionnaires as well as from national registers. Data on psychiatric morbidity was gathered from the Finnish Hospital Discharge Register. The case notes of all potential subjects were examined. Up to the end of 1994, a total of 387 subjects had received a DSM-III-R psychiatric diagnosis categorized as follows: schizophrenia (n = 89), other psychoses (n = 55), and non-psychotic disorders (n = 243). Smoking habits were assessed at 14 and 31 years by postal questionnaires. The association between exposure, confounding and outcome variables were analysed by cross-tabulations. Regression models were fitted and adjusted for confounding.

Children not in their normal grade or not in normal school at the age of 14 years had a 2 to 8 times higher risk than those in the comparison category (with no psychiatric hospitalisation) to develop some form of mental disorders. Among adolescents with non-psychotic disorders, the means of school marks were lower than in the comparison category, but lower marks did not predict schizophrenia or other psychoses. 11% of the pre-schizophrenic boys had excellent mean school marks compared with only 3% of the comparison category (adjusted OR 3.8; 95% CI 1.6–9.3).

Over half of all those with a hospital-treated mental disorder progressed beyond basic education, but few completed their tertiary education. Early schizophrenia, (i.e. onset before 22 years of age) as well as non-psychotic cases had an approximately 3- to 6- fold adjusted odds for staying in the basic level. Persons with psychoses with an onset at age 23 or later performed nearly as well as the comparison group. Adult smoking (at age 31) and prolonged smoking (at ages 14 and 31) were associated with an approximately 2- to 6- fold, adjusted odds for educational underachievement, but not smoking only at the age of 14.

These results provide new information on the need for earlier therapeutic, rehabilitative and educational interventions directed at children with poor school performance as well as at mentally vulnerable and smoking young persons.