Background

Educational attainment is associated with wellbeing and health, but patients with schizophrenia achieve lower levels of education than people without. Several effective interventions can ameliorate this situation. However, the magnitude of the education gap in schizophrenia and its change over time are unclear. We aimed to reconstruct the trajectories of educational attainment in patients with schizophrenia and, if reported, their healthy comparator controls.

Methods

We did a systematic review and meta-analysis including all studies reporting on patients with schizophrenia (of mean age ≥18 years) and describing the number of years of education of the participants, with or without healthy controls. There were no other design constraints on studies. We excluded studies that included only patients with other schizophrenia spectrum disorders and studies that did not specify the number of years of education of the participants. 22 reviewers participated in retrieving data from a search in PubMed and PsycINFO (Jan 1, 1970, to Nov 24, 2020). We estimated the birth date of participants from their mean age and publication date, and meta-analysed these data using random-effects models, focusing on educational attainment, the education gap, and changes over time. The primary outcome was years of education. The protocol was registered on PROSPERO (CRD42020220546).

Findings

From 32 593 initial references, we included 3321 studies reporting on 318 632 patients alongside 138 675 healthy controls (170 941 women and 275 821 men from studies describing sex or gender; data on ethnicity were not collected). Patients’ educational attainment increased over time, mirroring that of controls. 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; p<0·0001), 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 (ie, not completing secondary education) for patients compared with controls. This gap remained stable throughout the decades; 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; p=0·078). For patients in low-income and middle-income countries, the education gap was significantly smaller than in high-income countries (smaller by 0·72 years, 0·85 to 0·59; p<0·0001), yet there was evidence that this gap was widening over the years, approaching that of high-income countries (annual change: –0·024 years, –0·037 to –0·011; p=0·0002).

Interpretation

Patients with schizophrenia have faced persistent inequality in educational attainment in the last century, despite advances in psychosocial and pharmacological treatment. Reducing this gap should become a priority to improve their functional outcomes.

Funding

Ciencia y Tecnología para el Desarrollo (CYTED) to the Latin American Network for the Study of Early Psychosis (ANDES).

中文翻译：

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根据过去 50 年已发表的研究，精神分裂症患者受教育程度的持久差距：系统回顾和荟萃分析

背景

受教育程度与福祉和健康相关，但精神分裂症患者的受教育程度低于非精神分裂症患者。一些有效的干预措施可以改善这种情况。然而，精神分裂症患者的教育差距的大小及其随时间的变化尚不清楚。我们的目的是重建精神分裂症患者的受教育程度轨迹，以及他们的健康对照对照（如果有报告）。

方法

我们进行了系统回顾和荟萃分析，包括所有报告精神分裂症患者（平均年龄≥18岁）的研究，并描述了参与者的受教育年限，无论是否有健康对照。研究没有其他设计限制。我们排除了仅包括其他精神分裂症谱系障碍患者的研究以及未具体说明参与者受教育年限的研究。22 位审稿人参与了 PubMed 和 PsycINFO 检索数据（1970 年 1 月 1 日至 2020 年 11 月 24 日）。我们根据参与者的平均年龄和出版日期估计了他们的出生日期，并使用随机效应模型对这些数据进行了荟萃分析，重点关注教育程度、教育差距和随时间的变化。主要成果是受教育年限。该协议已在 PROSPERO 上注册（CRD42020220546）。

发现

从 32 593 份初始参考文献中，我们纳入了 3321 项研究，报告了 318 632 名患者以及 138 675 名健康对照（来自描述性或性别的研究中的 170 941 名女性和 275 821 名男性；未收集种族数据）。患者的受教育程度随着时间的推移而提高，与对照组的情况一致。然而，高收入国家的精神分裂症患者的受教育程度比对照组少 19 个月（–1·59 岁，95% CI –1·66 至 –1·53；p<0·0001），这相当于 Cohen 的d 为 –0·56（95% CI –0·58 至 –0·54），意味着与对照组相比，患者未完成 12 年教育（即未完成中学教育）的优势比为 2·58。几十年来，这一差距一直保持稳定；总受教育年限随时间的变化率不显着（年变化：0·0047 年，95% CI –0·0005 至 0·0099；p=0·078）。对于低收入和中等收入国家的患者，教育差距显着小于高收入国家（缩小0·72岁，0·85至0·59；p<0·0001），但存在有证据表明，这一差距逐年扩大，接近高收入国家的差距（年变化：–0·024 年，–0·037 至–0·011；p=0·0002）。

解释

尽管心理社会和药物治疗取得了进步，但上个世纪精神分裂症患者在教育程度方面仍然面临着持续的不平等。缩小这一差距应成为改善其功能成果的首要任务。

资金

Ciencia y Tecnología para el Desarrollo (CYTED) 到拉丁美洲早期精神病研究网络 (ANDES)。