IQ and risk for schizophrenia: a population-based cohort study
A. S. DAVID a1 , A. MALMBERG a1 , L. BRANDT a1 , P. ALLEBECK a1 and G. LEWIS a1
a1 Department of Psychological Medicine, King's College School of Medicine and Dentistry, London, Department of Psychiatry, University of Oxford and Department of Psychological Medicine, University of Wales College of Medicine, Cardiff; and Karolinska Institute, Department of Community Medicine, Huddinge University Hospital, Department of Social Medicine, University of Göteborg and Vasa Hospital, Gothenburg, Sweden
Background. This study aimed to quantify the association between low IQ and the later development of psychosis in a population-based cohort study of 18-year-old conscripts.
Methods. Fifty thousand males conscripted into the Swedish army in 1969–1970 were followed by means of the Swedish National Register of Psychiatric Care up to 1983. Tests of verbal and visuospatial abilities, general and mechanical knowledge and several psychosocial variables were recorded at conscription.
Results. One hundred and ninety-five subjects were admitted to hospital with schizophrenia and 192 with a non-schizophrenic psychosis on ICD-8 criteria. The distribution of scores in those later diagnosed as suffering from schizophrenia was shifted in a downward direction, with a linear relationship between low IQ and risk. This remained after adjustment for potential confounders. The risk for non-schizophrenic disorders was also higher in those with lower IQ but the effect was less marked and non-linear. Only poorer performance on the verbal tasks and mechanical knowledge test conferred a significantly increased risk for schizophrenia after taking into account general intellectual ability. Low IQ at conscription was not related to age of onset.
Conclusions. The results confirm the importance of low intellectual ability as a risk factor for schizophrenia and other psychoses. This is unlikely to be due to prodromal decline or known confounders. The association could be directly causal with cognitive impairment leading to false beliefs and perceptions, or could be indirect with any factors causing lower IQ, such as abnormal brain development increasing the risk for schizophrenia.
Address for correspondence: Professor Anthony S. David, Department of Psychological Medicine, Institute of Psychiatry, Denmark Hill, London SE5 8AF.