PURPOSE: We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic. METHODS: Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics. RESULTS: We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates. CONCLUSIONS: Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.

2nd Faculty of Medicine Charles University Prague Prague Czech Republic

3rd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Psychiatry Faculty of Medicine University Hospital in Pilsen Charles University Prague Prague Czech Republic

Faculty of Science Charles University Prague Prague Czech Republic

National Institute of Mental Health Topolová 748 250 67 Klecany Czech Republic

See more in PubMed

Winkler P, Formanek T, Mlada K, Cermakova P (2018) The CZEch Mental health Study (CZEMS): study rationale, design, and methods. Int J Methods Psychiatric Res 27(3):e1728. https://doi.org/10.1002/mpr.1728 DOI

Kagstrom A, Alexova A, Tuskova E, Csajbók Z, Schomerus G, Formanek T, Mladá K, Winkler P, Cermakova P (2019) The treatment gap for mental disorders and associated factors in the Czech Republic. Eur Psychiatry 59:37–43 DOI

Formanek T, Kagstrom A, Cermakova P, Csemy L, Mlada K, Winkler P (2019) Prevalence of mental disorders and associated disability: Results from the cross-sectional CZEch mental health Study (CZEMS). Eur Psychiatry 60:1–6. https://doi.org/10.1016/j.eurpsy.2019.05.001 PubMed DOI

Horackova K, Kopecek M, Machu V, Kagstrom A, Aarsland D, Motlova LB, Cermakova P (2019) Prevalence of late-life depression and gap in mental health service use across European regions. Eur Psychiatry 57:19–25. https://doi.org/10.1016/j.eurpsy.2018.12.002 PubMed DOI

Seblova D, Brayne C, Machu V, Kuklova M, Kopecek M, Cermakova P (2019) Changes in Cognitive Impairment in the Czech Republic. J Alzheimer's Dis. https://doi.org/10.3233/jad-190688 DOI

Kucera M, Wolfová K, Cermakova P (2020) Changes in depressive symptoms of older adults in the Czech Republic. J Affect Disord 261:139–144. https://doi.org/10.1016/j.jad.2019.10.016 PubMed DOI

Lee S, Tsang A, Breslau J, Aguilar-Gaxiola S, Angermeyer M, Borges G, Bromet E, Bruffaerts R, De Girolamo G, Fayyad J (2009) Mental disorders and termination of education in high-income and low-and middle-income countries: epidemiological study. Br J Psychiatry 194(5):411–417 DOI

Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS (1982) Tambs K (2008) Does a higher educational level protect against anxiety and depression? The HUNT study. Soc Sci Med 66(6):1334–1345. https://doi.org/10.1016/j.socscimed.2007.12.019 DOI

McFarland MJ (1982) Wagner BG (2015) Does a college education reduce depressive symptoms in American young adults? Soc Sci Med 146:75–84. https://doi.org/10.1016/j.socscimed.2015.09.029 DOI

Barr PB, Salvatore JE, Maes H, Aliev F, Latvala A, Viken R, Rose RJ, Kaprio J, Dick DM (2016) Education and alcohol use: a study of gene-environment interaction in young adulthood. Soc Sci Med (1982) 162:158–167. https://doi.org/10.1016/j.socscimed.2016.06.031 DOI

Grant JD, Scherrer JF, Lynskey MT, Agrawal A, Duncan AE, Haber JR, Heath AC, Bucholz KK (2012) Associations of alcohol, nicotine, cannabis, and drug use/dependence with educational attainment: evidence from cotwin-control analyses. Alcohol Clin Exp Res 36(8):1412–1420. https://doi.org/10.1111/j.1530-0277.2012.01752.x PubMed DOI PMC

Thompson K, Leadbeater B, Ames M, Merrin GJ (2019) Associations between marijuana use trajectories and educational and occupational success in young adulthood. Prev Sci 20(2):257–269 DOI

Chevalier A, Feinstein L (2007) Sheepskin or Prozac: the causal effect of education on mental health.

Ross CE (1982) Mirowsky J (2006) Sex differences in the effect of education on depression: resource multiplication or resource substitution? Soc Sci Med 63(5):1400–1413. https://doi.org/10.1016/j.socscimed.2006.03.013 DOI

Schaan B (2014) The interaction of family background and personal education on depressive symptoms in later life. Soc Sci Med (1982) 102:94–102. https://doi.org/10.1016/j.socscimed.2013.11.049 DOI

Breslau J, Lane M, Sampson N, Kessler RC (2008) Mental disorders and subsequent educational attainment in a US national sample. J Psychiatr Res 42(9):708–716 DOI

Ross CE, Wu C-l (1995) The Links Between Education and Health. Am Sociol Rev 60(5):719–745. https://doi.org/10.2307/2096319 DOI

Park C, Kang C (2008) Does education induce healthy lifestyle? J Health Econ 27(6):1516–1531. https://doi.org/10.1016/j.jhealeco.2008.07.005 PubMed DOI

Li J (1982) Powdthavee N (2015) Does more education lead to better health habits? Evidence from the school reforms in Australia. Soc Sci Med 127:83–91. https://doi.org/10.1016/j.socscimed.2014.07.021 DOI

Cohen AK, Syme SL (2013) Education: a missed opportunity for public health intervention. Am J Public Health 103(6):997–1001 DOI

Lustigova M, Dzurova D, Pikhart H, Kubinova R, Bobak M (2018) Cardiovascular health among the Czech population at the beginning of the 21st century: a 12-year follow-up study. J Epidemiol Community Health 72(5):442–448. https://doi.org/10.1136/jech-2017-209967 PubMed DOI PMC

Filer RK, Jurajda Š, Plánovský J (1999) Education and wages in the Czech and Slovak Republics during transition. Labour Econ 6(4):581–593 DOI

Walterová E (2006) Czech comparative education in the bipolar world. Eur Educ 38(3):48–59 DOI

Tung RL, Lazarova M (2006) Brain drain versus brain gain: an exploratory study of ex-host country nationals in Central and East Europe. Int J Hum Res Manage 17(11):1853–1872

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33 (quiz 34–57) PubMed

Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291(21):2581–2590. https://doi.org/10.1001/jama.291.21.2581 DOI

McGrath JJ, Charlson F, Whiteford HA (2016) Challenges and options for estimating the prevalence of schizophrenia, psychotic disorders, and bipolar disorders in population surveys.

Twomey CD, Baldwin DS, Hopfe M, Cieza A (2015) A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK. BMJ open 5(7):e007575 DOI

Andrade LH, Alonso J, Mneimneh Z, Wells J, Al-Hamzawi A, Borges G, Bromet E, Bruffaerts R, De Girolamo G, De Graaf R (2014) Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 44(6):1303–1317 DOI

Enache D, Fereshtehnejad SM, Kareholt I, Cermakova P, Garcia-Ptacek S, Johnell K, Religa D, Jelic V, Winblad B, Ballard C, Aarsland D, Fastbom J, Eriksdotter M (2016) Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry. Acta Psychiatr Scand 134(5):430–440. https://doi.org/10.1111/acps.12630 PubMed DOI

Cermakova P, Formanek T, Kagstrom A, Winkler P (2018) Socioeconomic position in childhood and cognitive aging in Europe. Neurology 91(17):e1602–e1610. https://doi.org/10.1212/wnl.0000000000006390 PubMed DOI PMC

Araya R, Lewis G, Rojas G, Fritsch R (2003) Education and income: which is more important for mental health? J Epidemiol Community Health 57(7):501–505. https://doi.org/10.1136/jech.57.7.501 PubMed DOI PMC

Kurtze N, Eikemo TA, Kamphuis CB (2013) Educational inequalities in general and mental health: differential contribution of physical activity, smoking, alcohol consumption and diet. Eur J Pub Health 23(2):223–229. https://doi.org/10.1093/eurpub/cks055 DOI

Paananen R, Ristikari T, Merikukka M, Gissler M (2013) Social determinants of mental health: a Finnish nationwide follow-up study on mental disorders. J Epidemiol Community Health 67(12):1025–1031. https://doi.org/10.1136/jech-2013-202768 PubMed DOI

Cutler DM, Huang W, Lleras-Muney A (2015) When does education matter? The protective effect of education for cohorts graduating in bad times. Soc Sci Med (1982) 127:63–73. https://doi.org/10.1016/j.socscimed.2014.07.056 DOI

Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112 DOI

Chang-Quan H, Zheng-Rong W, Yong-Hong L, Yi-Zhou X, Qing-Xiu L (2010) Education and risk for late life depression: a meta-analysis of published literature. Int J Psychiatry Med 40(1):109–124. https://doi.org/10.2190/PM.40.1.i PubMed DOI

Avendano M, de Coulon A, Nafilyan V (2017) Does more education always improve mental health? Evidence from a British compulsory schooling reform. HEDG, c/o Department of Economics, University of York, York

Bracke P, Pattyn E, von dem Knesebeck O (2013) Overeducation and depressive symptoms: diminishing mental health returns to education. Sociol Health Illn 35(8):1242–1259 DOI

Vreeker A, Boks MPM, Abramovic L, Verkooijen S, van Bergen AH, Hillegers MHJ, Spijker AT, Hoencamp E, Regeer EJ, Riemersma-Van der Lek RF, Stevens AWMM, Schulte PFJ, Vonk R, Hoekstra R, van Beveren NJM, Kupka RW, Brouwer RM, Bearden CE, MacCabe JH, Ophoff RA, Investigators G (2016) High educational performance is a distinctive feature of bipolar disorder: a study on cognition in bipolar disorder, schizophrenia patients, relatives and controls. Psychol Med 46(4):807–818. https://doi.org/10.1017/S0033291715002299 PubMed DOI

Grittner U, Kuntsche S, Gmel G, Bloomfield K (2012) Alcohol consumption and social inequality at the individual and country levels—results from an international study. Eur J Public Health 23(2):332–339 DOI

Rosoff DB, Clarke T, Adams MJ et al (2019) Educational attainment impacts drinking behaviors and risk for alcohol dependence: results from a two-sample Mendelian randomization study with ~780,000 participants. Mol Psychiatry. https://doi.org/10.1038/s41380-019-0535-9 PubMed DOI PMC

Kuntsche S, Knibbe RA (1982) Gmel G (2009) Social roles and alcohol consumption: a study of 10 industrialised countries. Soc Sci Med 68(7):1263–1270. https://doi.org/10.1016/j.socscimed.2009.01.018 DOI

Ashton K, Bellis MA, Davies AR, Hughes K, Winstock A (2017) Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings. BMJ open 7(10):e016089 DOI

Dzúrová D, Spilková J, Pikhart H (2010) Social inequalities in alcohol consumption in the Czech Republic: a multilevel analysis. Health Place 16(3):590–597 DOI

Chatterji P (2006) Does alcohol use during high school affect educational attainment?: Evidence from the National Education Longitudinal Study. Econ Educ Rev 25(5):482–497 DOI

Staff J, Patrick ME, Loken E, Maggs JL (2008) Teenage alcohol use and educational attainment. J Stud Alcohol Drugs 69(6):848–858 DOI

Coplan JD, Hodulik S, Mathew SJ, Mao X, Hof PR, Gorman JM, Shungu DC (2012) The relationship between Intelligence and Anxiety: an association with subcortical white matter metabolism. Front Evol Neurosci 3:8–8. https://doi.org/10.3389/fnevo.2011.00008 PubMed DOI PMC

Frank-Briggs AI, Alikor EAD (2010) Anxiety disorder amongst secondary school children in an Urban City in Nigeria. Int J Biomed Sci 6(3):246–251 PubMed PMC

Van Ameringen M, Mancini C, Farvolden P (2003) The impact of anxiety disorders on educational achievement. J Anxiety Disord 17(5):561–571 DOI

Melkevik O, Nilsen W, Evensen M, Reneflot A, Mykletun A (2016) Internalizing disorders as risk factors for early school leaving: a systematic review. Adolescent Res Rev 1(3):245–255. https://doi.org/10.1007/s40894-016-0024-1 DOI

Ross CE (1982) Mirowsky J (2011) The interaction of personal and parental education on health. Soc Sci Med 72(4):591–599. https://doi.org/10.1016/j.socscimed.2010.11.028 DOI

Organization WH, Unit WHOMoSA (2014) Global status report on alcohol and health, 2014. World Health Organization

Formanek T, Kagstrom A, Winkler P, Cermakova P (2019) Differences in cognitive performance and cognitive decline across European regions: a population-based prospective cohort study. Eur Psychiatry 58:80–86 DOI

Cermakova P, Pikhart H, Kubinova R, Bobak M (2020) Education as inefficient resource against depressive symptoms in the Czech Republic: cross-sectional analysis of the HAPIEE study. Eur J Public Health. https://doi.org/10.1093/eurpub/ckaa059

Tolonen H, Laatikainen T, Helakorpi S, Talala K, Martelin T, Prättälä R (2010) Marital status, educational level and household income explain part of the excess mortality of survey non-respondents. Eur J Epidemiol 25(2):69–76 DOI

OECD (2019) Education at a Glance 2019. https://doi.org/10.1787/f8d7880d-en

Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, Sartorius N, Van Voren R, Aizberg O, Bitter I (2017) A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry 4(8):634–642 DOI

The explanation of educational disparities in adiposity by lifestyle, socioeconomic and mental health mediators: a multiple mediation model

Educational attainment and anxiety in middle-aged and older Europeans

Educational attainment inequalities in depressive symptoms in more than 100,000 individuals in Europe