{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T23:52:52Z","timestamp":1762300372673,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Schizophrenia has been associated with premorbid poor educational performance and low educational attainment (EA). However, some studies have found positive associations between psychotic disorders and excellent scholastic performance. In the present study, we examined the association between EA and several clinical and nonclinical characteristics in psychiatric patients diagnosed with psychotic or bipolar disorders. Data were obtained from the files of 1132 patients who entered a major Mexico City psychiatric hospital during the years 2009\u20132010 for the treatment of psychotic symptoms and who were subsequently diagnosed with schizophrenia, bipolar, schizoaffective, or another psychotic disorder. Chi-squared tests, t-tests, and Cox regression analysis were applied to explore associations between EA and factors including gender, familial history of mental illness, premorbid personality characteristics, age of symptom onset, diagnosis, civil status, and current employment. Family history of mental illness decreased the hazard of having lower EA (B = \u22120.137, p = 0.025, ExpB = 0.872, 95% CI = 0.774\u20130.983), while a schizophrenia diagnosis independently increased it (B = 0.201, p = 0.004, ExpB = 1.223, 95% CI = 1.068\u20131.401). In male patients (but not in females), family history of mental illness was significantly associated with higher EA, while in female patients, premorbid schizoid-like personality characteristics were associated with lower EA. For both genders, lower EA was associated with having more children and being employed in manual labor, while higher EA was associated with professional employment. Conclusions: Compared with bipolar disorder, a schizophrenia diagnosis is associated with lower EA; however, familial history of mental illness and premorbid schizoid-like characteristics independently favor higher and lower EA in males and females, respectively. Since lower EA is generally associated with a lower economic status, special preventative attention should be given to students at high risk for schizophrenia, particularly those displaying a schizoid-like personality.<\/jats:p>","DOI":"10.3390\/brainsci13060881","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T04:40:51Z","timestamp":1685508051000},"page":"881","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of Educational Attainment in a Mexican Psychiatric Patient Population with Bipolar or Psychotic Disorders"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-6133","authenticated-orcid":false,"given":"Hugo","family":"Cano-Ramirez","sequence":"first","affiliation":[{"name":"Center for Investigation in Reproduction, Autonomous University of Tlaxcala-CINVESTAV, Tlaxcala 90000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina","family":"Diaz-Castro","sequence":"additional","affiliation":[{"name":"Department of Epidemiological and Psychosocial Investigation, National Institute of Psychiatry Ram\u00f3n de la Fuente Mu\u00f1iz, Mexico City 14370, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt Leroy","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Center for Investigation in Reproduction, Autonomous University of Tlaxcala-CINVESTAV, Tlaxcala 90000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1377\/hlthaff.2018.05246","article-title":"Measuring the Lifetime Costs of Serious Mental Illness and the Mitigating Effects of Educational Attainment","volume":"38","author":"Seabury","year":"2019","journal-title":"Health Aff."},{"key":"ref_2","first-page":"357","article-title":"Global economic burden of schizophrenia: A systematic review","volume":"12","author":"Chong","year":"2016","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.eurpsy.2017.10.008","article-title":"Direct healthcare cost of schizophrenia\u2014European overview","volume":"48","author":"Millier","year":"2018","journal-title":"Eur. Psychiatry"},{"key":"ref_4","first-page":"168","article-title":"Risk factors for schizophrenia. Follow-up data from the Northern Finland 1966 Birth Cohort Study","volume":"5","author":"Isohanni","year":"2006","journal-title":"World Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1093\/schbul\/sbv027","article-title":"Early Childhood IQ Trajectories in Individuals Later Developing Schizophrenia and Affective Psychoses in the New England Family Studies","volume":"41","author":"Buka","year":"2015","journal-title":"Schizophr. Bull."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1093\/oxfordjournals.schbul.a006949","article-title":"School performance as a premorbid marker for schizophrenia: A twin study","volume":"28","author":"Sitskoorn","year":"2002","journal-title":"Schizophr. Bull."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1001\/2013.jamapsychiatry.43","article-title":"Decline in cognitive performance between ages 13 and 18 years and the risk for psychosis in adulthood: A Swedish longitudinal cohort study in males","volume":"70","author":"MacCabe","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1017\/S0033291720002354","article-title":"Academic achievement and schizophrenia: A systematic meta-analysis","volume":"50","author":"Dickson","year":"2020","journal-title":"Psychol. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jad.2006.01.025","article-title":"Reduced educational attainment in bipolar disorder","volume":"92","author":"Glahn","year":"2006","journal-title":"J. Affect. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1038\/s41398-019-0547-x","article-title":"The genetic relationship between educational attainment and cognitive performance in major psychiatric disorders","volume":"9","author":"Comes","year":"2019","journal-title":"Transl. Psychiatry"},{"key":"ref_11","first-page":"654","article-title":"Identification of Gene Loci that Overlap between Schizophrenia and Educational Attainment","volume":"43","author":"Wang","year":"2017","journal-title":"Schizophr. Bull."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1038\/nature17671","article-title":"Genome-wide association study identifies 74 loci associated with educational attainment","volume":"533","author":"Okbay","year":"2016","journal-title":"Nature"},{"key":"ref_13","first-page":"468","article-title":"Intelligence decline across major depressive disorder, bipolar disorder, and schizophrenia","volume":"27","author":"Ohi","year":"2021","journal-title":"CNS Spectr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1038\/mp.2015.225","article-title":"Shared genetic aetiology between cognitive functions and physical and mental health in UK Biobank (N = 112,151) and 24 GWAS consortia","volume":"21","author":"Hagenaars","year":"2016","journal-title":"Mol. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S2215-0366(22)00121-3","article-title":"The enduring gap in educational attainment in schizophrenia according to the past 50 years of published research: A systematic review and meta-analysis","volume":"9","author":"Crossley","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1192\/bjp.184.4.327","article-title":"Psychosis and academic performance","volume":"184","author":"Karlsson","year":"2004","journal-title":"Br. J. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1192\/bjp.bp.108.060368","article-title":"Excellent school performance at age 16 and risk of adult bipolar disorder: National cohort study","volume":"196","author":"MacCabe","year":"2010","journal-title":"Br. J. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1017\/S0033291715002299","article-title":"High educational performance is a distinctive feature of bipolar disorder: A study on cognition in bipolar disorder, schizophrenia patients, relatives and controls","volume":"46","author":"Vreeker","year":"2016","journal-title":"Psychol. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1017\/S0033291710001820","article-title":"Intellectual functioning and the long-term course of schizophrenia-spectrum illness","volume":"41","author":"Carter","year":"2011","journal-title":"Psychol. Med."},{"key":"ref_20","first-page":"77","article-title":"A Swedish National Prospective and Co-relative Study of School Achievement at Age 16, and Risk for Schizophrenia, Other Nonaffective Psychosis, and Bipolar Illness","volume":"42","author":"Kendler","year":"2016","journal-title":"Schizophr. Bull."},{"key":"ref_21","unstructured":"Secretar\u00eda Educaci\u00f3n P\u00fablica (SEP) (2012). Reporte de la Encuesta Nacional de Deserci\u00f3n Escolar en la Educaci\u00f3n Media Superior, Secretar\u00eda de Educaci\u00f3n P\u00fablica."},{"key":"ref_22","unstructured":"Secretar\u00eda Educaci\u00f3n P\u00fablica (SEP) (2008). Reporte CS03b Nivel Educativo Alcanzado por la Poblaci\u00f3n, Secretar\u00eda de Educaci\u00f3n P\u00fablica."},{"key":"ref_23","first-page":"611","article-title":"Schizotypy, creativity and mating success in humans","volume":"273","author":"Nettle","year":"2006","journal-title":"Proc. Biol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jpsychires.2005.01.005","article-title":"Creativity in familial bipolar disorder","volume":"39","author":"Simeonova","year":"2005","journal-title":"J. Psychiatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jad.2006.10.013","article-title":"Enhanced creativity in bipolar dis-order patients: A controlled study","volume":"100","author":"Santosa","year":"2007","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1192\/bjp.bp.110.085316","article-title":"Creativity and mental disorder: Family study of 300,000 people with severe mental disorder","volume":"199","author":"Kyaga","year":"2011","journal-title":"Br. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S427","DOI":"10.1093\/schbul\/sbu195","article-title":"Schizotypy as an organizing framework for social and affective sci-ences","volume":"41","author":"Cohen","year":"2015","journal-title":"Schizophr. Bull."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1192\/bjp.2020.160","article-title":"Educational attainment trajectories among children and adolescents with depression, and the role of sociodemographic characteristics: Longitudinal data-linkage study","volume":"218","author":"Wickersham","year":"2021","journal-title":"Br. J. Psychiatry"},{"key":"ref_29","first-page":"495","article-title":"Review on vocational predictors: A systematic review of pre-dictors of vocational outcomes among individuals with schizophrenia: An update since 1998. Aust","volume":"44","author":"Tsang","year":"2010","journal-title":"N. Z. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.schres.2003.08.009","article-title":"Gender and procreation among patients with schizophrenia","volume":"68","author":"Bhatia","year":"2004","journal-title":"Schizophr. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/0165025415616199","article-title":"Growth Trajectories of Mexican-Origin Ado-lescent Mothers\u2019 Educational Expectations","volume":"41","author":"Bravo","year":"2017","journal-title":"Int. J. Behav. Dev."},{"key":"ref_32","first-page":"29","article-title":"El rezago educativo en M\u00e9xico: Dimensiones de un enemigo silencioso y modelo propuesto para entender las causas de su propagaci\u00f3n","volume":"27","year":"2005","journal-title":"Rev. Interam. Educ. Adultos"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"469580211060797","DOI":"10.1177\/00469580211060797","article-title":"Family History of Psychiatric Disor-ders and Clinical Factors Associated with a Schizophrenia Diagnosis","volume":"58","author":"Hoffman","year":"2021","journal-title":"Inquiry"},{"key":"ref_34","first-page":"916198","article-title":"Gender differences in schizophrenia and first-episode psychosis: A com-prehensive literature review","volume":"2012","author":"Ochoa","year":"2012","journal-title":"Schizophr. Res. Treat."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4529","DOI":"10.1038\/s41380-020-00969-z","article-title":"Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings","volume":"26","author":"Velthorst","year":"2021","journal-title":"Mol. Psychiatry"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/6\/881\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:45:14Z","timestamp":1760125514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/6\/881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,30]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["brainsci13060881"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13060881","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2023,5,30]]}}}