Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time
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We examined the joint predictive effects of childhood and adolescent onset psychiatric and substance use disorders on failure to graduate high school (HS) on time. Structured diagnostic interviews were conducted with a US national sample of adults (18 and over). The analysis sample included respondents with at least 8 years of education who were born in the US or arrived in the US prior to age 13 (N=29,662). Psychiatric disorders, substance use and substance use disorders were examined as predictors of termination or interruption of educational progress prior to HS graduation, with statistical adjustment for demographic characteristics and childhood adversities. Failure to graduate HS on time was more common among respondents with any of the psychiatric and substance use disorders examined, ranging from 18.1% (specific phobia) to 33.2% (ADHD-combined type), compared with respondents with no disorder (15.2%). After adjustment for co-occurring disorders, significant associations with failure to graduate on time remained only for conduct disorder (OR=1.89, 95%CI 1.57–2.26) and the three ADHD subtypes (Inattentive OR=1.78, 95%CI 1.44–2.20, Hyperactive-Impulsive OR=1.38, 95%CI 1.14–1.67, and Combined OR=2.06, 95%CI 1.66–2.56). Adjusting for prior disorders, tobacco use was associated with failure to graduate on time (OR=1.97, 95%CI 1.80–2.16). Among substance users, substance use disorders were not associated with on time graduation. The findings suggest that the adverse impact of childhood and adolescent onset psychiatric disorders on HS graduation is largely accounted for by problems of conduct and inattention. Adjusting for these disorders, smoking remains strongly associated with failure to graduate HS on time.
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A US sample of almost 30,000 adults found that those with ADHD were twice as likely not to have graduated high school on time, after adjusting for other psychiatric disorders.
“A study of a U.S. sample of almost 30,000 adults found that those with ADHD were twice as likely not to have graduated from high school on time, after adjusting other psychiatric disorders”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Breslau et al., 2011
The Results (page not available) describe a U.S. analysis sample of 29,662 adults and report an association between ADHD and failure to graduate high school on time after adjustment for co-occurring disorders. But the adjusted odds ratios differ by ADHD subtype—1.38, 1.78, and 2.06—so saying that people with ADHD were uniformly twice as likely overstates the finding. The paper reports odds, rather than a doubling of probability. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEarly-onset major depressive disorder predicts later difficulties in role transitions, such as lower educational attainment, higher risk of teen childbearing, marital disruption, and unstable employment.
“Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment.”
From The Costs of Depression (2012) · cites this paper as [20]
Early-onset mental disorders are associated with ending education, with disruptive behavior disorders and bipolar disorder showing the strongest associations, and major depressive disorder associated with roughly 60% higher odds of failing to complete secondary school in high-income countries.
“Several studies show early-onset mental disorders associated termination of education.19–26 While disruptive behavior disorders and bipolar disorder tend to have the strongest associations in these studies, MDD also is significantly associated with a roughly 60% elevated odds of failure to complete secondary school than otherwise comparable youth in high income countries.”
From The Costs of Depression (2012) · cites this paper as [20]
One of the most consistently documented mechanisms is the association of depression with non-adherence to treatment regimens.
“One of the most consistently documented is the association of depression with non-adherence to treatment regimens. 191,192”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [191]
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- Authors
- Breslau, J., Miller, E., Joanie Chung, W.-J., & Schweitzer, J. B.
- Affiliations
- University of California, Davis (US)
- Corresponding author
- Breslau, Joshua
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 45
- Issue
- 3
- Pages
- 295-301
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC2962709
- OpenAlex
- W2108566322
- Semantic Scholar
- 1777a005a6a3ed9318d1add822da1806fe1196eb
- Cited by
- 183
- References
- 39
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 7 · 2023: 16 · 2022: 18 · 2021: 23 · 2020: 10 · 2019: 14 · 2018: 12 · 2017: 9 · 2016: 16 · 2015: 9 · 2014: 11 · 2013: 6 · 2012: 9
- FWCI
- 9.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of California, Davis
- National Institute of Mental Health (K01-MH66057, K01MH066057)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD051958)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Education › Educational Outcomes and Influences
- Keywords
- child psychopathology, substance use disorders, tobacco use, high school graduation, educational attainment, conduct disorder, attention deficit hyperactivity disorder, inattention, smoking, co-occurring disorders, childhood adversity
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Mental Disorders, Developmental Disabilities, Educational Status, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Psychiatric Status Rating Scales, Schools, Prevalence, Age of Onset, Substance-Related Disorders, Young Adult
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