Changes in the association between educational achievement, attainment and subsequent mental health: A survival analysis of 21 Swedish graduation cohorts.

Background: Low academic achievement and low educational attainment in adolescence is associated with higher risks of internalizing disorders later in life. However, less is known regarding if these associations vary over time across cohorts. The aim of this study was to investigate temporal changes in the association between academic achievement or educational attainment and subsequent inpatient treatment for internalizing disorders among Swedish youths.

Methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 (N = 2 252 703) were used. Students were followed for a maximum of 8 years using discrete time proportional hazard models. Internalized disorders were measured by specialized inpatient psychiatric care for depression or anxiety disorders. Academic achievement was measured by grades at the end of compulsory school, and educational attainment by completion of upper secondary school.

Results: The positive association between inpatient treatment for internalizing disorders and both low compulsory school achievement and non-completion of upper secondary school became stronger in more recent cohorts. The results were completely driven by girls and native-born youth.

Conclusions: Low compulsory school achievements and failure to complete upper secondary school has become more important risk factors for inpatient treatment for internalizing disorders, particularly in native-born youth and girls. More research is needed to establish whether youth with internalizing disorders increasingly fail in school or whether low achievement has become more harmful for mental health.