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Association between depression diagnosis and educational attainment trajectories: an historical cohort study using linked data

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Original languageEnglish
JournalJournal of Child Psychology and Psychiatry
Early online date30 Jan 2023
Accepted/In press9 Dec 2022
E-pub ahead of print30 Jan 2023

Bibliographical note

Funding Information: This paper represents independent research funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (NIHR‐INF‐0690). A.W. is also supported by ADR UK (Administrative Data Research UK), an Economic and Social Research Council (ESRC) investment (part of UK Research and Innovation) (ES/W002531/1). R.S. is part‐funded by: (a) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London; (b) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust; (c) the DATAMIND HDR UK Mental Health Data Hub (MRC grant MR/W014386). R.S. has received research support in the last 3 years from Janssen, GSK and Takeda. J.D. is supported by NIHR Clinician Science Fellowship award (CS‐2018‐18‐ST2‐014) and has received support from a Medical Research Council (MRC) Clinical Research Training Fellowship (MR/L017105/1) and Psychiatry Research Trust Peggy Pollak Research Fellowship in Developmental Psychiatry. CRIS is supported by the NIHR Biomedical Research Centre for Mental Health BRC Nucleus at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London jointly funded by the Guy's and St Thomas' Trustees and the South London and Maudsley Trustees. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The remaining authors have declared that they have no competing or potential conflicts of interest. Publisher Copyright: © 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.


King's Authors


Background: Depression symptoms are thought to be associated with lower educational attainment, but patterns of change in attainment among those who receive a clinical diagnosis of depression at any point during childhood and adolescence remain unclear. Methods: We conducted a secondary analysis of an existing data linkage between a national educational dataset (National Pupil Database) and pseudonymised electronic health records (Clinical Record Interactive Search) from a large mental healthcare provider in London, United Kingdom (2007 to 2013). A cohort of 222,027 pupils were included. We used Growth Mixture Modelling (GMM) and stakeholder input to estimate trajectories of standardised educational attainment over School Years 2, 6 and 11. Multinomial logistic regression analyses were then used to investigate the association between resulting educational attainment trajectory membership (outcome) and depression diagnosis any time before age 18 (exposure). Results: A five-trajectory GMM solution for attainment was derived: (1) average/high-stable, (2) average-modest declining, (3) average-steep declining, (4) low-improving and (5) low-stable. After adjusting for clinical and sociodemographic covariates, having a depression diagnosis before age 18 was associated with occupying the average-modest declining trajectory (RRR = 2.80, 95% CI 2.36–3.32, p <.001) or the average-steep declining trajectory (RRR = 3.54, 95% CI 3.10–4.04, p <.001), as compared to the average/high-stable trajectory. Conclusions: Receiving a diagnosis of depression before age 18 was associated with a relative decline in attainment throughout school. While these findings cannot support a causal direction, they nonetheless suggest a need for timely mental health and educational support among pupils struggling with depression.

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