{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:23:34Z","timestamp":1790835814099,"version":"4.1.0"},"reference-count":45,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2018,3,13]],"date-time":"2018-03-13T00:00:00Z","timestamp":1520899200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Acta Neuropsychiatr."],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0924270818000030_abs1\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"S0924270818000030_abs2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"S0924270818000030_abs3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>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\u20132.04) and for BD-I (aHR=1.57, 95% CI: 1.13\u20132.19)]. Also, having low exam grades in mathematics was associated with increased risk of both BD (aHR=2.41, 95% CI: 1.27\u20134.59) and BD-I (aHR=2.71, 95% CI: 1.41\u20135.21). Females with very high exam grades in Danish (percentile group&gt;97.7) had a significantly increased risk of BD-I (aHR=2.49, 95% CI: 1.19\u20135.23).<\/jats:p><\/jats:sec><jats:sec id=\"S0924270818000030_abs4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>The potential to develop BD seems to affect the school results of individuals negatively even before BD is diagnosed \u2013 with females having the potential to develop BD-I as a possible exception.<\/jats:p><\/jats:sec>","DOI":"10.1017\/neu.2018.3","type":"journal-article","created":{"date-parts":[[2018,3,13]],"date-time":"2018-03-13T05:01:27Z","timestamp":1520917287000},"page":"209-217","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":11,"title":["The association between school exam grades and subsequent development of bipolar disorder"],"prefix":"10.1017","volume":"30","author":[{"given":"Steffie Damgaard","family":"Pedersen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8032-6208","authenticated-orcid":false,"given":"S\u00f8ren Dinesen","family":"\u00d8stergaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liselotte","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,3,13]]},"reference":[{"key":"S0924270818000030_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.0053"},{"key":"S0924270818000030_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2007.04.013"},{"key":"S0924270818000030_ref31","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2015-206329"},{"key":"S0924270818000030_ref6","doi-asserted-by":"publisher","DOI":"10.1521\/jaap.1.1985.13.2.191"},{"key":"S0924270818000030_ref16","doi-asserted-by":"crossref","unstructured":"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. 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