People who develop mental health disorders in childhood or adolescence are less likely to complete their education than mentally healthy people, and this association is true for patients living in both high- and middle- or low-income countries, research shows.

A small number of previous studies have indicated that the early-onset of mental health disorders may increase the risk for early termination of education, which as been linked to adverse life-course consequences, such as poor health, low standards of living, and reduced social mobility.

However, Sing Lee (Prince of Wales Hospital, Shatin, Hong Kong, China) and team explain that “to date, studies of mental disorders and subsequent educational attainment have been limited to the USA and New Zealand.”

To investigate further, the researchers studied data from the World Mental Health Survey Initiative, which is a World Health Organization project that aims to obtain accurate cross-national information about the prevalence, risk factors, impairment, pattern of treatment and societal cost of mental disorders in both high-income and low- and middle-income (LAMI) countries.

Data from a total of 41,688 individuals with and without DSM??”IV mental disorders from nine high-income and seven LAMI countries were included in the analysis.

The researchers found that, overall, respondents with one or more prior mental disorders of any type were more likely to terminate secondary education and tertiary education before completion than mentally healthy respondents.

In high income countries, all mental health disorders were associated with an increased risk of education termination. Disorders associated with the greatest risk for premature termination of secondary education included drug abuse and dependence (OR=3.5??”3.9) and conduct disorders (OR=3.6), followed by mood disorders and anxiety disorders, at ORs of 1.4 and 1.3, respectively. Disorders associated with the greatest risk for non-completion of tertiary education included impulse control and substance use disorders, each at ORs of 1.4, followed by bipolar disorder, at an OR of 1.3.

In LAMI countries, drug dependence and conduct disorders were similarly associated with the greatest risk for non-completion of secondary education, at ORs of 3.2 and 3.0, respectively, followed by bipolar disorder, oppositional defiant disorder, and alcohol abuse, at ORs of 1.8, 1.6, and 1.6, respectively. Among those who entered tertiary education in LAMI countries, no disorder was significantly associated with non-completion of education.

Writing in the British Journal of Psychiatry, Lee and team summarize: “Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.”

They conclude: “Our findings suggest that few countries, whether they be high-income or LAMI, can afford to forgo the opportunity to develop early interventions and treatments for mental disorders in order to minimize their costly burden for society and vulnerable citizens.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Older bipolar disorder patients have inferior frontal lobe gray matter volume deficits, including in areas associated with the anterior limbic network, US researchers have discovered.

Although structural magnetic resonance imaging (MRI) studies have revealed inconsistent results in the assessment of volumetric changes in bipolar disorder patients, several investigations have indicated that regional abnormalities are present in such patients, predominantly in the frontal and temporal lobes.

John Beyer and colleagues from Duke University Medical Center in Durham, North Carolina administered structured clinical interviews and performed MRI scanning on 56 bipolar disorder patients with an average age of 60.5 years and 43 healthy individuals with an average age of 58.1 years. The cerebrum was divided into 16 units using image parcellation.

There were no significant differences between patients and controls in terms of age, gender, or race, the team notes in the International Journal of Geriatric Psychiatry. There were also no differences in total gray matter volume between patients and controls.

However, analysis revealed a significant bilateral difference in gray matter volume in patients versus controls in the anterior half of the brain, particularly in the anterior??”inferior brain regions. This difference remained significant even after controlling for age and gender.

Again, no overall total white matter volume differences were observed between patients and controls. Some differences were found in anterior brain regions, but these did not remain after taking into account age and gender.

“Our observation of decreased gray matter volume in the inferior frontal areas of the brain suggests that these areas may play a primary role in the mood and cognitive symptoms of bipolar disorder, and complements previous structural neuroimaging studies that suggest an underlying neuropathology in the anterior limbic network,” the researchers conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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