Objective: The purpose of this study was to evaluate the independent associations between DSM-IV psychiatric disorders and the failure to complete college among college entrants. Methods: Data were from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 15,800 adults, aged 22 years and older, who at least entered college. Diagnoses were made with the NESARC survey instrument, the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV Version. The large sample permitted analysis of multiple psychiatric disorders in the same multivariable logistic regression models. Given the frequent comorbidity of these disorders, this approach is an important step toward disentangling the independent roles of disorders in postsecondary educational outcomes. Results: Evaluation of the independent associations between specific psychiatric disorders and postsecondary educational attainment showed that five diagnoses were positively and significantly associated with the failure to graduate from college. Four were axis I diagnoses: bipolar I disorder, marijuana use disorder, amphetamine use disorder, and cocaine use disorder. One was an axis II diagnosis: antisocial personality disorder. Conclusions: This study provides new data on DSM-IV diagnoses associated with the failure to complete postsecondary education. The findings suggest that psychiatric factors play a significant role in college academic performance, and the benefits of prevention, detection, and treatment of psychiatric illness may therefore include higher college graduation rates. (Psychiatric Services 61:399-404, 2010)

Mental disorders among college students appear to be increasing and may lead to substantial economic and functional impairment over time. About 90% of campus directors of counseling centers report an increase in psychological problems among their students (1), and the proportion of students with a previous diagnosis of depression increased from 10% to 15% between 2000 and 2005 (2). The first onset of most mental disorders occurs before or during the typical college ages of 18 to 24 (3), and the many social, economic, and academic pressures of college may further exacerbate these mental problems (4). Despite increased awareness about the prevalence of psychiatric disorders among college students, little is known about the impact of these disorders on the central educational mission of colleges: to provide knowledge and skills. The link between mental health and academic success in college is important to understand not only from the perspective of the institutions' objectives but also from a broader societal perspective. Over two-thirds of high school graduates attend postsecondary education (5), but only about half of college enrollees complete their degree (6). College completion has a beneficial effect on economic well-being through increased future earnings (7,8) and on physical health through lower mortality rates and better self-reported health (9,10). Mental illness may play an important role in this poor overall graduation rate and the resulting loss of societal human capital.

Much of the evidence regarding the connection between mental health and academic outcomes for college students is based on small clinical samples. These studies primarily focused on depression (11,12,13) and indicate that measures of poor mental health are associated with worse academic outcomes. Two other studies examined nationally representative data from the National Comorbidity Survey (NCS) and the NCS-Replication (NCS-R), respectively. Using the NCS, Kessler and colleagues (14) found that failure to graduate from college was positively associated with several categories of mental disorders, but they did not examine specific DSM disorders. Breslau and colleagues (15) examined the impact of specific disorders on educational attainment but were unable to determine whether co-occurring disorders, such as substance use disorders, explained the impact of mood and anxiety disorders on outcomes. Improving our understanding of how co-occurring conditions affect educational attainment among students may help in prioritizing strategies in college mental health to improve care for the student population.

In this study we evaluated the association between psychiatric disorders, such as bipolar I disorder, and the failure to complete college among college entrants. We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which were collected by the National Institute on Alcohol Abuse and Alcoholism in 2001-2002. The sample we derived from the NESARC data included 15,800 adults, aged 22 years and older, who had at least entered college.

To our knowledge, this analysis used the largest available sample to analyze the relationship between psychiatric diagnoses and attainment of college education among college entrants. This large sample permitted the first analysis of a sample with multiple psychiatric disorders in the same regression models. Given the frequent comorbidity of the disorders included in this study, this approach is an important step toward disentangling the independent roles of disorders in educational outcomes.