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Academic performance, externalizing disorders and depression: 26,000 adolescents followed into adulthood

Journal article
Authors A. S. Wallin
I. Koupil
Jan-Eric Gustafsson
S. Zammit
P. Allebeck
D. Falkstedt
Published in Social Psychiatry and Psychiatric Epidemiology
Volume 54
Issue 8
Pages 977-986
ISSN 0933-7954
Publication year 2019
Published at Department of Education and Special Education
Pages 977-986
Language en
Links dx.doi.org/10.1007/s00127-019-01668...
Keywords Academic performance, Depression, Externalizing disorders, Cohort study, Life course studies, school performance, relative changes, achievement, pathways, psychopathology, intelligence, childhood, suicide, health, risk, Psychiatry
Subject categories Public Health, Global Health, Social Medicine and Epidemiology, Psychiatry

Abstract

BackgroundThe incidence of major depression among adults has been shown to be socially differentiated, and there are reasons to seek explanations for this before adulthood. In this cohort study, we examined whether academic performance in adolescence predicts depression in adulthood, and the extent to which externalizing disorders explain this association.MethodsWe followed 26,766 Swedish women and men born 1967-1982 from the last year of compulsory school, at age about 16, up to 48years of age. We investigated the association between grade point average (GPA, standardized by gender) and first diagnosis of depression in national registers of in- or out-patient psychiatric care. We used Cox proportional hazards models, adjusting for lifetime externalizing diagnoses and potential confounders including childhood socioeconomic position and IQ.ResultsDuring follow-up, 7.0% of the women and 4.4% of the men were diagnosed with depression. A GPA in the lowest quartile, compared with the highest, was associated with an increased risk in both women (hazard ratio 95% confidence interval 1.7, 1.3-2.1) and men (2.9, 2.2-3.9) in models controlling for potential confounders. Additional control for externalizing disorders attenuated the associations, particularly in women.ConclusionsThe findings suggest that poor academic performance is associated with depression in young adulthood and that the association is partly explained by externalizing disorders. Our results indicate the importance of early detection and management of externalizing disorders among children and adolescents.

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