The potential to develop bipolar (BP) disorder can negatively affect school test scores in certain students even before the condition is diagnosed, according to results published in Acta Neuropsychiatrica.

The study included individuals born in Denmark between 1987 and 1995 (n=505,688). The researchers used a Cox model to investigate the association between school exam grades and the development of BP or BP I, adjusting for family history of mental disorder and other potential confounders.

During the follow-up period, 900 participants were diagnosed with BP disorder (277 with BP I disorder).

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The risk for developing BP disorder was significantly increased in participants who did not complete­ the exams at term (BP disorder adjusted hazard ratio [aHR], 1.71; 95% CI, 1.43-2.04; BP 1 disorder aHR, 1.57; 95% CI, 1.13-2.19).

Receiving low exam grades in mathematics was associated with an increased risk for developing BP disorder (aHR, 2.41; 95% CI, 1.27–4.59) and BP I disorder (aHR, 2.71; 95% CI, 1.41-5.21).

Female participants who had high exam grades in Danish (percentile group >97.7) had a significantly increased risk for developing BP I disorder (aHR, 2.49; 95% CI, 1.19-5.23).

The study researchers note that BP II disorder outcomes were not examined due to lack of easily identifiable data using the 10th revision of the International Classification of Disease coding system.

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Taken together, these findings suggest that the risk for developing BP disorder or BP I disorder is increased in students with incomplete or no exams reported at term. In addition, low mathematics grades may also be associated with an increased risk.


Pedersen SD, Ostergaard SD, Peterson L. The association between school exam grades and subsequent development of bipolar disorder [published online March 13, 2018]. Acta Neuropsychiatr. doi:10.1017/neu.2018.3