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Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden
Open accessAbstract
IMPORTANCE: Depression is a common cause of morbidity and disability worldwide. Parental depression is associated with early-life child neurodevelopmental, behavioral, emotional, mental, and social problems. More studies are needed to explore the link between parental depression and long-term child outcomes. OBJECTIVE: To examine the associations of parental depression with child school performance at the end of compulsory education (approximately age 16 years). DESIGN, SETTING, AND PARTICIPANTS: Parental depression diagnoses (based on the International Classification of Diseases, Eighth Revision [ICD-8], International Classification of Diseases, Ninth Revision [ICD-9], and the International Statistical Classification of Diseases, 10th Revision [ICD-10]) in inpatient records from 1969 onward, outpatient records beginning in 2001, and school grades at the end of compulsory education were collected for all children born from 1984 to 1994 in Sweden. The final analytic sample size was 1,124,162 biological children. We examined the associations of parental depression during different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years, as well as any time before the child's final year of compulsory schooling) with the final school grades. Linear regression models adjusted for various child and parent characteristics. The dates of the analysis were January to November 2015. MAIN OUTCOME AND MEASURE: Decile of school grades at the end of compulsory education (range, 1-10, with 1 being the lowest and 10 being the highest). RESULTS: The study cohort comprised 1,124,162 children, of whom 48.9% were female. Maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance. After covariate adjustment, these associations decreased to -0.45 (95% CI, -0.48 to -0.42) and -0.40 (-0.43 to -0.37) lower deciles, respectively. These effect sizes are similarly as large as the observed difference in school performance between the lowest and highest quintiles of family income but approximately one-third of the observed difference between maternal education of 9 or less vs more than 12 years. Both maternal depression and paternal depression at different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years) generally were associated with worse school performance. Child sex modified the associations of maternal depression with school performance such that maternal depression had a larger negative influence on child school performance for girls compared with boys. CONCLUSIONS AND RELEVANCE: Diagnoses of parental depression throughout a child's life were associated with worse school performance at age 16 years. Our results suggest that diagnoses of parental depression may have a far-reaching effect on an important aspect of child development, with implications for future life course outcomes.
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“While there are a number of criticisms about the accuracy of disability weights 215-217 it is doubtlessly true that depression is a highly burdensome condition and other studies have confirmed that the disability is experienced as one of the most severe of all health conditions.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [217]
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“, 2005), child health problems (Ferro & Speechley, 2009; Schwebel & Brezausek, 2008), and poor school performance (Shen et al., 2016).”
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“…achieving an education, while adjusting for education as an intermediate variable will then bias the results towards null Other studies such as Shen et al. (2016) have adjusted for many intermediate factors, such as parents’ employment status and income level, but being mindful of the causal…”
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“The finding documenting a significant link between parents’ symptoms of depression and children’s academic attainment is consistent with previous studies (Murray et al., 2010; Pearson et al., 2016; Shen et al., 2016).”
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“…al. 2007; Forget-Dubois et al. 2007), and that early exposure to parental psychiatric disorders is associated with poor long-term academic outcomes (Pearson et al. 2016; Shen et al. 2016), our findings suggest that support during the transition to formal schooling is much needed for these children.”
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Guideline No. 454: Identification and Treatment of Perinatal Mood and Anxiety Disorders
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“Most studies reporting on the impacts of maternal and paternal mental health problems on the educational outcomes of the offspring focus on the associated effects during the perinatal period (Billings and Moos, 1983; Hay et al., 2001; Paget et al., 2018; Ranning et al., 2018; Shen et al., 2016), with one study reporti…”
BackgroundInfluentialPostpartum and Paternal Postnatal Depression
Gedzyk‐Nieman, S. A. (2021) · Nursing Clinics of North America · doi:10.1016/j.cnur.2021.04.001 · Cited by 24
Prevalence of mental illness within families in a regional child-focussed mental health service
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“The impact of parental mental illness on children has been well documented (Beardslee et al. 1998; Hanington et al. 2011; Nicholson et al. 2004; Reupert & Maybery 2009; Reupert et al. 2012; & Shen et al. 2016).”
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Hope, H. F., Osam, C. S., Kontopantelis, E., Hughes, S., Munford, L. A., Ashcroft, D. M., Pierce, M., & Abel, K. M. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2021.65 · Cited by 22
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“Our results however are consistent with a large-scale study that found that 16 years-old girls performed worse than boys at school in the context of MDS [23].”
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“Mental health problems in mothers of young children have also been associated with poorer school performance, stunting and under-weight, and higher psychological problems in their children (Bennett et al., 2016; Closa-Monasterolo et al., 2017; Shen et al., 2016).”
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“depression, and risk for school failure has proposed social pathways, in addition to adverse effects on neurodevelopment and shared genetic liability, as possible mechanisms [32].”
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School performance in children born after ICSI
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“This allowed comparison between birth cohorts without interference from changes in grading system (Lambe et al., 2006; Svensson et al., 2011; Ahlsson et al., 2015; Shen et al., 2016).”
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“…studies have reported both paternal and maternal alcohol abuse to equally increase the risk of adverse outcomes in children (McGrath et al., 1999; Shen et al., 2016; Sipilä et al., 2011; Torvik et al., 2011), while others have indicated that either maternal (Jääskeläinen et al., 2020) or…”
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“It is well established that children of parents with mental illness have an increased risk of developing their own mental health problems [3] and they also have an increased risk of experiencing other negative outcomes, such as poor physical health [4] and difficulties with academic performance [5].”
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“The Shen et al. (2016) study from Sweden had sufficiently large samples of fathers and was longitudinal and did show both a maternal and paternal depression effect on child’s school performance.”
BackgroundCourse of major depressive disorder after pregnancy and the postpartum period
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“Children with depressed mothers are at higher risk for attachment problems, behavioral problems, poor cognitive functioning, worse academic performance, and psychopathology (Goodman et al., 2011; Murray et al., 2011; Shen et al., 2016).”
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“One study revealed an association between parental depressive disorders at any point in children's lives from the postnatal period to age 16 and children's lower school performance at age 16 (Shen et al., 2016).”
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“Although less empirical attention has been devoted to effect of paternal PPD on child development, it has been reported that P-PPD is associated with a behavioural and mental health problems in offspring (Brophy et al., 2021; Gutierrez-Galve et al., 2019; Pilowsky et al., 2014; Shen et al., 2016).”
InfluentialAhun, M. N., Psychogiou, L., Guay, F., Boivin, M., Tremblay, R. E., & Côté, S. M. (2020) · Psychological Medicine · doi:10.1017/s0033291720004298 · Cited by 10
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“32,33 In addition to maternal, infant, and family health, PPND has a significant impact on the world economy as it threatens the workforce and increases healthcare costs.”
BackgroundCharacterization of Depressive Symptom Trajectories in Women between Childbirth and Diagnosis
Chechko, N., Stickel, S., Losse, E. M., Shymanskaya, A., & Habel, U. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12040538 · Cited by 12
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“Parents’ psychiatric morbidities, such depression 21 and other serious mental illnesses (SMIs), 22 are negatively associated with child school outcomes.”
BackgroundPostpartum Paternal Depression: Its Impact on Family and Child Development
DEMİRCİ, Ö., & İnan, E. (2023) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1153712 · Cited by 9
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Fetal sex-specific epigenetic associations with prenatal maternal depressive symptoms
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“…the frontal cortex (BA9), anterior cingulate cortex (BA24), the basal ganglia, and notably nucleus accumbens, as well as the hippocampus and amygdala (Figure 4B; Akil et al., 2018; Drysdale et al., 2017; Hamilton et al., 2013; Otte et al., 2016; Schmaal et al., 2016; Siddiqi et al., 2021).”
BackgroundThe association between parental internalizing disorders and child school performance
Nordmo, M., Kleppestø, T. H., Sunde, H. F., Flatø, M., Demange, P., & Torvik, F. A. (2023) · npj Science of Learning · doi:10.1038/s41539-023-00182-x · Cited by 8
“The impact of parental mental disorders on child development has been studied extensively 2 – 4 , with a subset of studies focusing on children ’ s school outcomes 5 – 8 .”
InfluentialKim, S.-I., Kim, S. M., Park, S. J., Song, J., Lee, J., Kim, K. H., & Park, S. M. (2024) · BMC Public Health · doi:10.1186/s12889-024-18337-9 · Cited by 7
“Consequently, the deterioration of the economic situation for parents with depression can make it difficult for their children to find employment themselves or access educational opportunities, which may negatively impact their mental health and academic performance [56].”
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Effect of gestational age on special education: a population-based matched cohort analysis
de Baat, T., Ravelli, A. C. J., Aarnoudse-Moens, C. S. H., Abu–Hanna, A., & Leemhuis, A. G. (2025) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2025-328599 · Cited by 6
Effect of Maternal Depression on the Participation of Children With Leukemia in Life Activities
Khazaeli, K., Khazaeli, Z., Jalili, N., & Gharebaghy, S. (2021) · فصلنامه علمی پژوهشی توانبخشی · doi:10.32598/rj.22.2.3240.1 · Cited by 6
“Previous studies have shown the vital role of parents in children’s participation and achievement in education [33-39].”
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“Indeed, the results of some studies suggest a poorer cognitive development in boys [43,44], while others suggest that this effect is more significant in girls [45].”
Axinn, W. G., Banchoff, E., Ghimire, D. J., & Scott, K. M. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116745 · Cited by 5
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Ethische Betrachtungen zur Elternschaft psychisch Erkrankter
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“Koplow (2002) and Shen et al. (2016) recommended that effective teacher-learner interactions encourage greater confidence and classroom engagement.”
Hsu, H.-W., Huang, J., Au, H., Lin, C.-L., Chen, Y., Chen, Y., Chao, H. J., Lo, Y., Lin, W., & Chen, Y. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.054 · Cited by 4
Question 10: Could the Burden of Care with Cystic Fibrosis Impact on Educational Outcomes?
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Neurobehavioral Follow-Up of Children Exposed to Selective Serotonin Reuptake Inhibitors in Utero
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Okuyama, K., Lönn, S. L., Khoshnood, A., Assari, S., Sundquist, J., & Sundquist, K. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1521387 · Cited by 4
Emotional Problems in Children of Mothers who had Depression: A Cross-Sectional Study
Kallapiran, K., & Jayanthini, V. (2021) · Indian Journal of Psychological Medicine · doi:10.1177/0253717621991210 · Cited by 4
Cremaschi, A., Iorio, M. D., Chong, Y. S., Broekman, B. F. P., Meaney, M. J., & Kee, M. Z. L. (2021) · Statistics in Medicine · doi:10.1002/sim.9167 · Cited by 4
Prevention of Childhood Adversities and Children’s Common Mental Disorders and School Grades
Pierce, M., Bai, Y., Nevriana, A., Dalman, C., Hope, H. F., Kosidou, K., Ohlis, A., Wicks, S., & Abel, K. M. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.36408 · Cited by 5
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Yao, H., Guan, L., Zhou, T., Zhang, C., Pan, Y., Han, J., He, R., Chang, Z., Du, C., Wu, T., et al. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12950 · Cited by 3
Rimmington, D., Roberts, R., Sawyer, A. C. P., & Sved‐Williams, A. (2024) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-024-00250-7 · Cited by 6
“Where parents face challenges due to mental health disorders children are also reported to experience poorer outcomes including higher rates of mental illness [11] as well as higher rates of neurodevelopmental issues [12], and functional impairment in schooling and academic achievement [13].”
BackgroundFerede, Y. A., Zeleke, A. M., Assefa, G. W., Nigate, G. K., & Tassew, W. C. (2025) · AJOG Global Reports · doi:10.1016/j.xagr.2025.100475 · Cited by 3
Christiansen, H., & Paul, J. L. (2020) · Praxis der Kinderpsychologie und Kinderpsychiatrie · doi:10.13109/prkk.2020.69.5.443 · Cited by 2
Paternal Prenatal and Postpartum Depression
Paulson, J. F., Ellis, K. T., & Alexander, R. L. (2020) · Springer eBooks · doi:10.1007/978-3-030-51027-5_15 · Cited by 3
Li, B., Almquist, Y. B., Liu, C., & Berg, L. (2023) · SSM - Population Health · doi:10.1016/j.ssmph.2023.101357 · Cited by 2
“These challenges put children at higher risk of negative social outcomes, such as school dropout (Shen et al., 2016) and teenage pregnancy (Anda et al.”
BackgroundSchool performances in children with cataract: results from a population-based cohort study
Al‐Bakri, M., Skovgaard, A. M., Bach‐Holm, D., Larsen, D. A., Siersma, V., & Kessel, L. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072984 · Cited by 4
Elternschaft und psychische Erkrankungen
Koopmann, A., Hoell, A., Meyer‐Lindenberg, A., Kiefer, F., Banaschewski, T., Haege, A., Herpertz, S. C., Neukel, C., Poustka, L., Link, T., et al. (2024) · Der Nervenarzt · doi:10.1007/s00115-024-01781-8 · Cited by 2
“Die psychosozialen Folgen für Kinder aus den betroffenen Familien reichen von fehlender emotionaler Zuwendung durch die Eltern bis hin zu Parentifizierung [3], geringerem schulischem Erfolg [4] und ei-nererschwertensozialenIntegrationin die Gleichaltrigengruppe [5].”
Anxious Dads and Depressed Moms: Child Disability and the Mental Health of Parents
Asuman, D., Ásgeirsdóttir, T. L., & Jarl, J. (2025) · Health Economics · doi:10.1002/hec.4962 · Cited by 2
“A growing body of evidence shows negative consequences of poor mental health, including lower educational attainment (H. Shen et al. 2016; Ranning et al. 2018; Paget et al. 2018) and labor‐market outcomes (Banerjee et al. 2017; Mousteri et al. 2019; Y. Shen 2023; Wang et al. 2023).”
Editorial: Intergenerational impacts of perinatal mental health
Christoforou, A., Duman, E. A., & Caparrós-González, R. A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1542112 · Cited by 2
Metadata
- Authors
- Shen, H., Magnusson, C., Rai, D., Lundberg, M., Lê-Scherban, F., Dalman, C., & Lee, B. K.
- Affiliations
- Drexel University (US)
- Region Stockholm (SE)
- University of Bristol (GB)
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
- Karolinska Institutet (SE)
- Corresponding author
- Lee, Brian K.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2016-03-01
- Volume
- 73
- Issue
- 3
- Pages
- 239
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2260664678
- Cited by
- 144
- References
- 68
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 18 · 2023: 16 · 2022: 14 · 2021: 19 · 2020: 19 · 2019: 11 · 2018: 7 · 2017: 12 · 2016: 5
- FWCI
- 15.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- Vetenskapsrådet
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Family Support in Illness
- Keywords
- parental depression, maternal depression, paternal depression, academic performance, compulsory education, family environment, socioeconomic deprivation, birth cohort, Sweden, child mental health, child behavior problems, child emotional problems, child social problems
- MeSH terms
- Adolescent, Adolescent Behavior, Adult, Child, Child, Preschool, Depression, Fathers, Female, Humans, Infant, Learning, Male, Middle Aged, Mothers, Parents, Sex Factors, Sweden, Time Factors, Confounding Factors, Epidemiologic
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