Lifetime Poor Educational Attainment Associated With Diagnosis of Posttraumatic Stress Disorder

This study examines the extent that PTSD is associated with impaired educational performance over and above psychiatric comorbidity, familial factors, and general cognitive ability.

Lifetime academic failure was associated with posttraumatic stress disorder (PTSD). These findings, from a population-based cohort study, were published in JAMA Network Open.

Various Swedish nationwide databases were pooled for this analysis. A total of 2,244,193 individuals were assessed for diagnoses of PTSD and educational attainment.

Individuals were 51.3% men, 0.1% had a diagnosis of PTSD before secondary education (first educational milestone), 0.1% were diagnosed during upper secondary education (second milestone), 0.1% before starting university (third milestone), and 0.2% before finishing a university degree (fourth milestone).

Among the 4 cohorts of PTSD, on the basis of educational level at diagnosis, cases of PTSD were enriched among women (range, 77.2%-81.8%) compared with men (range, 48.3%-48.8%; all P <.001). Similarly, comorbid diagnoses of other psychiatric conditions were more common among those diagnosed with PTSD than the general population (range, 83.4%-85.1% vs 13.3%-14.0%; all P <.001) and cognition scores were lower among those with PTSD (mean, 3.9 vs 5.1; all P <.001).

Individuals diagnosed with PTSD during the first educational milestone had 82% lower odds of accessing upper secondary education (adjusted odds ratio [aOR], 0.18; 95% CI, 0.15-0.20). Those who were diagnosed during the first or second educational milestone had 87% lower odds of finishing upper secondary education (aOR, 0.13; 95% CI, 0.12-0.14). Individuals diagnosed through the third milestone had 68% lower odds of beginning a university degree (aOR, 0.32; 95% CI, 0.28-0.35). A PTSD diagnosis at any time point was associated with decreased odds of 73% for finishing a university degree (aOR, 0.27; 95% CI, 0.23-0.31).

Compared with their unaffected siblings, individuals with PTSD had decreased odds of achieving each educational milestone (aOR range, 0.22-0.53). When individuals with comorbid psychiatric disorders (neurodevelopmental, conduct, anxiety, affective, or eating) were excluded one at a time, PTSD remained associated with decreased educational attainment at all levels (aOR range, 0.13-0.38).

This study was limited by only including data from individuals seeking treatment for their symptoms of PTSD. However, previous research has indicated individuals often do not seek treatment for long periods of time after symptom onset.

These data indicated PTSD was associated with impaired educational attainment throughout their lifetime and indicated trauma-informed interventions may be needed in the school and university setting in order to decrease the long-term socioeconomic consequences from poor educational attainment.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Vilaplana-Pérez A, Sidorchuk A, Pérez-Vigil A, et al. Assessment of posttraumatic stress disorder and educational achievement in Sweden. JAMA Netw Open. Published online December 8, 2020. doi:10.1001/jamanetworkopen.2020.28477