Patients with schizophrenia face more educational obstacles in higher-income nations
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Despite advances in treatment, patients with schizophrenia have faced obstacles in obtaining an education, with the largest gap occurring in high-income countries, according to a study published in Lancet Psychiatry.
“Mental health problems, particularly those that present early in life, are associated with disruption in schooling,” Nicolas A. Crossley, PhD, of the department of psychiatry at the Pontifical Catholic University of Chile, and colleagues wrote. “Among them, schizophrenia has some of the poorest educational outcomes.”
Crossley and fellow researchers sought to examine the trajectories of educational attainment in those with schizophrenia as well as in a cohort of healthy controls through a systematic review and meta-analysis.
From an initial reference point of 32,593 studies published after January 1970, and accessed through PubMed and PsycINFO, the authors culminated 3,321 studies (39% from the United States) for inclusion. From those, 318,632 patients (mean age 37.1, 35% female) with schizophrenia born between 1913 and 1998 and their specific number of years of education were analyzed, along with 138,675 healthy controls. The researchers estimated birth dates of participants from their mean age and publication date, and meta-analyzed these data using random-effects models, focusing on educational attainment, the education gap and changes over time.
Results showed that patients’ educational attainment increased with passage of time, mirroring the control group. However, patients with schizophrenia in high-income countries had 19 months less education than controls (–1.59 years; 95% CI, –1.66 to –1.53), which is equivalent to a Cohen's d of –0.56 (95% CI, –0.58 to –0.54) and implies an odds ratio of 2.58 for not completing 12 years of education for patients compared with controls.
The gap remained stable throughout the decades, although the rate of change in number of total years of education in time was not significant (annual change, 0.0047 years; 95% CI, –0.0005 to 0.0099). For patients in low-income and middle-income countries, the education gap was significantly smaller than in high-income countries (0.72 years; 95% CI, 0.85 to 0.59), but the gap widened over the years, approaching that of high-income countries (annual change, –0.024 years; 95% CI, –0.037 to –0.011).
“Educational efforts targeted specifically at people with schizophrenia need to be developed, deployed, reevaluated and increased,” Crossley and colleagues wrote.