Psychotic boys performing well in school are at increased risk of suicidal ideation.

AIM: This study investigated how the level of school performance is associated with suicidal behavior and psychiatric disorders among adolescent psychiatric inpatients aged 12-17 years.

METHODS: Data were collected from 508 adolescents (300 girls, 208 boys; age 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. Information on the adolescents' school performance, suicidal ideation, suicide attempts and self-mutilation as well as psychiatric DSM-IV diagnoses was obtained using the Schedule for Affective Disorder and Schizophrenia for School-Age Children.

RESULTS: An elevated risk of suicidal ideation (OR = 3.6, 95% CI 1.3-10.2, P = 0.017) and of psychotic disorders (OR = 3.2, 95% CI 1.0-10.0, P = 0.048) was observed among male adolescents performing well in school. In addition, adolescents with poor school performance had an increased likelihood of substance-related disorder both in boys (OR = 2.6, 95% CI 1.1-6.1, P = 0.027) and girls (OR = 2.5, 95% CI 1.2-5.1, P = 0.011).

CONCLUSIONS: Our findings indicate that psychotic inpatient male adolescents performing well in school are at an elevated risk of suicidal ideation. Although good school performance is often considered a marker of high intelligence and good general ability, symptoms of major psychiatric disorders and suicidality need to be taken very seriously among adolescents performing well in school.