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Academic decline in elementary school may lead to teenage depression

Findings published in The British Journal of Psychiatry showed that children whose grades declined throughout elementary and high school were more likely to develop depression in adolescence, and self-harm was only linked to declining grades during high school.

“The link between education and mental health is generally believed to be complex and reciprocal, with academic success giving a strong subjective sense of children feeling good about themselves and being linked to higher levels of well-being in adulthood and poor academic attainment been identified as co-occurring with symptoms,” Muhammad A. Rahman, PhD, of the FARR Institute, School of Medicine, Swansea University, U.K., and colleagues wrote. “However, studies exploring this issue have been limited in the extent to which they take coexisting problems into account and fewer studies have explored these associations over time.”

To determine the relationship between grades and subsequent depression diagnosis or self-harm in adolescence, the investigators examined general practice, hospital and educational records of Welsh youth aged 5 to 20 years between 1999 and 2014. Using diagnosis and symptom codes for depression and self-harm in those aged 12 years and older, researchers analyzed mental health outcomes, which were adjusted for confounders. Data were available for 652,903 young people, of which 33,498 developed depression and 15,946 experienced self-harm from age 12 to 20 years.

Youth who developed depression over the study period were more likely to have achieved key stage 1 milestones, which covers national tests in math and language at age 7 years, but not key stage 2 milestones, which covers national tests in math, language and science at age 11 years (HR = 0.79; 95% CI, 0.74-0.84). Researchers noted continued decline: those diagnosed with depression after age 14 years were 38% less likely to have achieved their key stage 3 milestones, which covers national tests at age 14 years, and 50% were less likely to have gotten their key stage 4 milestones, which covers tests at age 16 years, compared with those without depression. Additionally, individuals with depression in the months before or at the time of their tests were 40% less likely to achieve the key stage.

For young people who self-harmed in their teen years, grades did not decline in elementary school and instead showed improvement. They were less likely to score well on tests at age 7 (HR=1.17; 95% CI, 1.07-1.29), but scored as well as those who do not self-harm at age 11 years (HR = 1.03; 95% CI, 0.94-1.12). However, this population showed a severe decline in their attainment during high school and were 60% less likely to achieve their key stage 3 and key stage 4 milestones before record of self-harm compared with those who did not.

“Impaired academic performance precedes overt clinical symptoms of depression,” Rahman and colleagues wrote. “The findings from this study show that this decline may be seen as early as primary school and imply that preventing these children becoming disengaged from the educational system may be critical in modifying the development of mental disorder and, perhaps economic inactivity.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.