The longitudinal course of educational attainment among children and adolescents with depression
: Analysis of an existing data linkage

Student thesis: Doctoral ThesisDoctor of Philosophy



Previous research suggests that depression is associated with lower educational attainment. However, many studies rely on questionnaire measures of depression symptoms rather than indicators of clinical depression diagnosis, and there is mixed evidence on effect modifiers of this association. Additionally, compulsory education in England spans ages 5 to 16 years, over which time attainment can change substantially, but there is little understanding of how depression is associated with such changes in attainment over time.


In this thesis, I aimed to fill these gaps in the literature, by providing a robust estimate of the association between a clinical diagnosis of depression and subsequent attainment, understanding the role of effect modifiers, and exploring the association between depression and longitudinal trajectories of attainment over time.


To investigate these issues, I leveraged routinely collected administrative data from an existing data linkage between the National Pupil Database (NPD) and the South London and Maudsley NHS Foundation Trust (SLaM) Clinical Record Interactive Search (CRIS). CRIS extracts data from SLaM electronic health records and removes personal identifiers, so that the resulting pseudonymised data can be safely accessed by researchers. The NPD contains pupil- and school-level data for all pupils in England’s state schools. As a result of this linkage, I had access to educational records data for 276,655 pupils, some of whom had been referred to SLaM Child and Adolescent Mental Health Services (CAMHS). In a series of retrospective cohort studies, I used various statistical techniques including regression modelling, mixed modelling, and structural equation modelling to explore associations between receiving a depression diagnosis from SLaM CAMHS and performance on statutory tests in School Years 2, 6 and 11.


My findings supported an association between receiving a depression diagnosis and lower subsequent educational attainment in Year 11, and this relationship was not modified by gender, ethnicity, or socioeconomic status. I also found that among pupils who received a depression diagnosis before age 18 years, attainment showed a pattern of stability between Years 2 and 6 followed by a substantial decline in Year 11, relative to a local reference population. Again, this pattern was consistent across multiple different sociodemographic groups. Finally, I found that in a community sample, pupils’ attainment could be broadly summarised as following one of five trajectories: average/high-stable (the predominant trajectory), low-improving, average modest declining, average-steep declining, and low-stable. Again, pupils who received a depression diagnosis before age 18 years were more likely to occupy either the modestly declining or steeply declining trajectory. Furthermore, the risk associated with belonging to the steeply declining trajectory was greater than the risk associated with belonging to the modestly declining trajectory.


This thesis addresses key gaps in the literature relating to depression and educational attainment, an important and topical area in light of the significant policy attention that school-based mental health is currently attracting. It also demonstrates how a large and novel administrative data linkage can be effectively used for conducting longitudinal and cross-disciplinary research. These findings highlight the importance of providing effective mental health and educational support to children and adolescents with depression.

Date of Award1 Jul 2022
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJohnny Downs (Supervisor) & Robert Stewart (Supervisor)

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