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Stanley Zammit, MRCPsych; Peter Allebeck, MD; Anthony S. David, PhD; Christina Dalman, MD; Tomas Hemmingsson, PhD; Ingvar Lundberg, MD; Glyn Lewis, PhD

Arch Gen Psychiatry. 2004;61:354-360.

Context  Longitudinal studies indicate that a lower IQ score increases risk of schizophrenia. Preliminary evidence suggests there is no such effect for nonpsychotic bipolar disorder. To our knowledge, there are no prior population-based, longitudinal studies of premorbid IQ score and risk of developing severe depression requiring hospital admission.

Objectives  To investigate the association between premorbid IQ score and risk of developing schizophrenia, other nonaffective psychoses, bipolar disorder, and severe depression and to investigate effects of confounding and examine possible causal pathways by which IQ may alter these risks.

Design  Historical cohort study, using record linkage for hospital admissions during a 27-year follow-up period.

Setting  Survey of Swedish conscripts (1969-1970).

Participants  Population-based sample of 50 087 male subjects. Data were available on IQ score at conscription and on other social and psychological characteristics.

Main Outcome Measures  International Classification of Diseases, Eighth Revision or Ninth Revision diagnoses of schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses.

Results  There was no association between premorbid IQ score and risk of bipolar disorder. Lower IQ was associated with increased risk of schizophrenia, severe depression, and other nonaffective psychoses. Risk of schizophrenia was increased in subjects with average IQ compared with those with high scores, indicating that risk is spread across the whole IQ range.

Conclusions  Lower IQ score was associated with increased risk for schizophrenia, severe depression, and other nonaffective psychoses, but not bipolar disorder. This finding indicates that at least some aspects of the neurodevelopmental etiology of bipolar disorder may differ from these other disorders.

From the Department of Psychological Medicine, University of Wales College of Medicine, Cardiff (Dr Zammit); Department of Social Medicine, Gothenburg University, Gothenburg, Sweden (Dr Allebeck); Institute of Psychiatry, King's College, London, England (Dr David); Department of Psychiatric Epidemiology, Stockholm Centre of Public Health, Stockholm, Sweden (Dr Dalman); Department of Public Health Sciences, Karolinska Institute, Stockholm (Drs Hemmingsson and Lundberg); and Division of Psychiatry, University of Bristol, Bristol, England (Dr Lewis).

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