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School achievement as a predictor of depression and self-harm in adolescence: linked education and health record study

Rahman, Muhammad A., Todd, Charlotte, John, Ann, Tan, Jacinta, Kerr, Michael, Potter, Robert, Kennedy, Jonathan, Rice, Frances ORCID: and Brophy, Sinead 2018. School achievement as a predictor of depression and self-harm in adolescence: linked education and health record study. British Journal of Psychiatry 212 (04) , pp. 215-221. 10.1192/bjp.2017.69

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Background Mental disorders in children and adolescents have an impact on educational attainment. Aims To examine the temporal association between attainment in education and subsequent diagnosis of depression or self-harm in the teenage years. Method General practitioner, hospital and education records of young people in Wales between 1999 and 2014 were linked and analysed using Cox regression. Results Linked records were available for 652 903 young people and of these 33 498 (5.1%) developed depression and 15 946 (2.4%) self-harmed after the age of 12 but before the age of 20. Young people who developed depression over the study period were more likely to have achieved key stage 1 (age 7 years) but not key stage 2 (age 11) (hazard ratio (HR) = 0.79, 95% CI 0.74–0.84) milestones, indicating that they were declining in academic attainment during primary school. Conversely, those who self-harmed were achieving as well as those who did not self-harm in primary school, but showed a severe decline in their attainment during secondary school (HR = 0.72, 95% CI 0.68–0.78). Conclusions Long-term declining educational attainment in primary and secondary school was associated with development of depression in the teenage years. Self-harm was associated with declining educational attainment during secondary school only. Incorporating information on academic decline with other known risk factors for depression/self-harm (for example stressful life events, parental mental health problems) may improve risk profiling methods. Declaration of interest None.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Additional Information: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher: Cambridge University Press
ISSN: 0007-1250
Date of First Compliant Deposit: 21 March 2018
Date of Acceptance: 12 December 2017
Last Modified: 04 May 2023 22:26

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