Image © Smith NR, Marshall L, Albakri M, et al. BMJ Open

Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study.

July 2021

Growing evidence of the prevalence of poor child and adolescent mental health has led to this issue becoming a key policy priority in the UK. Mental ill-health in children and young people in England increases age with around 14.4% of 11–16 years experiencing a mental disorder compared with 5.5% in their preschool counterparts aged 2–4 years.¹ With 75% of adult mental health problems (excluding dementia) starting by the age of 18,² adolescence is a key period in the development of long-lasting mental health difficulties. The UK government’s Future in Mind report² presented an important economic case for investment in early prevention of mental ill-health to mitigate against the costs of longer term support for health needs. However, this argument neglects the impact that early life mental health potentially has on other early life outcomes fundamental in determining life chances, such as educational attainment. Educational outcomes are closely associated with later-life chances with well-established links to employment, income, housing and offending as well as physical health and on-going mental health disorders. If poor mental health diminishes the capacity for individuals to fulfil their academic potential, mental health itself is likely to be a driver of educational inequality and consequent on-going social inequality.

On the other hand, the association between mental health and educational outcomes might not be direct, but rather incorporate the influence of confounding factors. A range of demographic and socioeconomic factors, such as gender, ethnicity, socioeconomic disadvantage and maternal education and parental health,⁴–⁶ have known relationships with educational attainment and must be accounted for when assessing the impact of poor mental health. Similarly, the home environment and specifically parental interest in schooling have been associated with higher attainment,⁷ as have positive environmental ‘school effects’,⁸ whereas lower attainment has been associated with absence from school¹ or poor classroom behaviours.⁹ What is less clear is the extent to which differential exposure to these factors also under- pins disparities in mental health, and whether resulting differences in mental health might influence differences in attainment.International research has demonstrated numerous associations between mental health and educational attainment.¹⁰–¹² The evidence base for England is less well established, which is of particular relevance during a time of policy interest in boosting mental health provision in schools.¹³ There is some evidence of longitudinal associa- tions between psychological distress in early adolescence and achievement at General Certificate of Secondary Education (GCSE) in England.¹⁴ ¹⁵ Similarly, poor mental health between ages 13 and 15 has been shown to be associated with low GCSE attainment and later unemployment,⁹ demonstrating how the effects of poor early life mental health can extend into adulthood.¹⁶ Though many of these findings support the association between mental health and educational outcomes, they are often of low generalisability being based on regional data or nonprobability samples¹⁴ or unable to account for a range of potentially explanatory factors.¹⁵ There appears to be a strengthening of the relationship between adolescent mental health and educational outcomes in recent generations,¹⁷ so there is a pressing need for an up-to- date examination of nationally representative data for England.

Therefore, this study uses a novel and contemporary data linkage between the nationally representative UK Household Longitudinal Study (UKHLS) linked to objectively measured official education records, to test associations between poor mental health and poor educational attainment. The study is significant in estimating the extent to which mental health in early adolescence has an independent association with attainment at age 16 in England in males and females. Robust evidence of a causal relationship between poor mental health and lower academic attainment could be crucial in inspiring invest- ment in researching ‘what works’ in supporting children and adolescents’ mental health. Although schools already appreciate the importance of supporting pupils’ health and well-being,¹⁸ a proven link to academic outcomes could also encourage education and public health policy- makers to invest more in mental health.

¹ Digital  NHS Mental health of children and young people in England, 2017, 2018. Available: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017

² Department of Health. Future in mind - Promoting protecting and improving our children and young people’s mental health and wellbeing [Internet], 2015. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf

³ Chowdry  H, McBride  T. Disadvantage, Behaviour And Cognitive Outcomes:Longitudinal Analysis From Age 5 To 16. London, 2017.

⁴ Crawford  C, Greaves  E. Socio-economic, ethnic and gender differences in HE participation. [Internet]. Department for Business, Innovation and Skills, 2015. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/474273/BIS-15-85-socio-economic-ethnic-and-gender-differences.pdf

⁵ Lessof  C, Ross  A, Brind  R. Multiple disadvantage and KS4 attainment: evidence from LSYPE2. GOV.UK; 2019. https://www.gov.uk/government/publications/multiple-disadvantage-and-ks4-attainment-evidence-from-lsype2

⁶ Schoon  I. Planning for the future: changing education expectations in three British cohorts. Historical Social Research2010; 35.doi:10.2307/20762452

⁷ Flouri  E. Parental interest in children's education, children's self-esteem and locus of control, and later educational attainment: twenty-six year follow-up of the 1970 British birth cohort. Br J Educ Psychol2006; 55.doi:10.1348/000709905X52508 pmid:http://www.ncbi.nlm.nih.gov/pubmed/16573978

⁸ Sellström  E, Bremberg  S. Is there a "school effect" on pupil outcomes? a review of multilevel studies. J Epidemiol Community Health2006; 149–55.doi:10.1136/jech.2005.036707 pmid:16415266

⁹ Hale  DR, Viner  RM. How adolescent health influences education and employment: investigating longitudinal associations and mechanisms. J Epidemiol Community Health 2018;72:465–70.doi:10.1136/jech-2017-209605 pmid:http://www.ncbi.nlm.nih.gov/pubmed/29615474

¹⁰ Dalsgaard  S, McGrath  J, Østergaard  SD, et al. Association of mental disorder in childhood and adolescence with subsequent educational achievement. JAMA Psychiatry 2020;77:797–805.doi:10.1001/jamapsychiatry.2020.0217 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32211833

¹¹ Kessler  RC, Foster  CL, Saunders  WB, et al. Social consequences of psychiatric disorders, I: educational attainment. Am J Psychiatry1995;152:1026–32.doi:10.1176/ajp.152.7.1026 pmid:http://www.ncbi.nlm.nih.gov/pubmed/7793438

¹² Veldman  K, Bültmann  U, Stewart  RE, et al. Mental health problems and educational attainment in adolescence: 9-year follow-up of the trails study. PLoS One 2014;9:e101751. doi:10.1371/journal.pone.0101751 pmid:http://www.ncbi.nlm.nih.gov/pubmed/25047692

¹³ et alMarshall  L, RW, Dunatchik  A. Supporting mental health in schools and colleges, 2017ISBN 978-1-78105-757-5, DFE-RR697b. Available: https://www.gov.uk/government/publications/supporting-mental-health-in-schools-and-colleges

¹⁴ Rothon  C, Head  J, Clark  C, et al. The impact of psychological distress on the educational achievement of adolescents at the end of compulsory education. Soc Psychiatry Psychiatr Epidemiol2009;44:421–7.doi:10.1007/s00127-008-0452-8 pmid:http://www.ncbi.nlm.nih.gov/pubmed/18979222

¹⁵ Deighton  J, Humphrey  N, Belsky  J, et al. Longitudinal pathways between mental health difficulties and academic performance during middle childhood and early adolescence. Br J Dev Psychol2018;36:110–26.doi:10.1111/bjdp.12218 pmid:http://www.ncbi.nlm.nih.gov/pubmed/29150840

¹⁷ Sellers  R, Warne  N, Pickles  A, et al. Cross-Cohort change in adolescent outcomes for children with mental health problems. J Child Psychol Psychiatry2019;60:813–21.doi:10.1111/jcpp.13029 pmid:http://www.ncbi.nlm.nih.gov/pubmed/30989670\

¹⁸ et alMarshall  L, Wishart  R, Dunatchik  A. Supporting Mental Health in Schools and Colleges [Internet], 2017. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/634726/Supporting_Mental-Health_survey_report.pdf

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