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

BackgroundDepression 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. MethodsWe 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). ResultsA 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. ConclusionsReceiving 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.