Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study
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Background: Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries. Aims: To examine the association between early-onset mental disorder and subsequent termination of education. Method: Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM–IV mental disorders and subsequent non-attainment of educational milestones. Results: In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4–15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education. Conclusions: Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.
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Early-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 [22]
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 [22]
In the WMH study, PARP estimates ranged from 0 to 11.37 for non-completion of high school, −0.05 to 4.65 for non-entry into college, and 0 to 2.64 for non-completion of college.
“in which PARP estimates ranged from 0 to 11.37 for non-completion of high school, −0.05 to 4.65 for non-entry into college, and 0 to 2.64 for non-completion of college [10]”
From Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up (2015) · cites this paper as [10]
The PARP estimates obtained in this study are in line with those for a similar range of mental disorders in a study based on data from 9 of the countries participating in the World Mental Health (WMH) survey.
“Despite the fact that the associations found here are weaker than in previous NCS analyses, the PARP estimates obtained here are in line with those for a similar range of mental disorders in a study based on data from 9 of the countries participating in the World Mental Health (WMH) survey [10]”
From Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up (2015) · cites this paper as [10]
Results of prior studies on associations of child and adolescent mental disorders with subsequent educational attainment have been inconsistent.
“Results have been inconsistent, with the majority of studies, but not all [9], finding significant gross associations of childhood and adolescent mental disorders with low levels of educational attainment and some finding that significant gross associations are explained by childhood adversities that preceded onset of the disorders [11,22].”
From Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up (2015) · cites this paper as [10]
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- Authors
- Lee, S., Tsang, A., Breslau, J., Aguilar-Gaxiola, S., Angermeyer, M., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., Fayyad, J., Gureje, O., Haro, J. M., Kawakami, N., Levinson, D., Browne, M. A. O., Ormel, J., Posada-Villa, J., Williams, D. R., & Kessler, R. C.
- Affiliations
- Prince of Wales Hospital (CN)
- Chinese University of Hong Kong (HK)
- Leipzig University (DE)
- Universidad Autónoma Metropolitana (MX)
- Stony Brook University (US)
- Universitair Ziekenhuis Leuven (BE)
- Saint George Hospital (LB)
- University College Hospital, Ibadan (NG)
- Instituto de Salud Carlos III (ES)
- The University of Tokyo (JP)
- Israel Ministry of Health (IL)
- Monash University (AU)
- University Medical Center Groningen (NL)
- Universidad Colegio Mayor de Cundinamarca (CO)
- Harvard University (US)
- Corresponding author
- Lee, S.
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2009-05
- Volume
- 194
- Issue
- 5
- Pages
- 411-417
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC2801820
- OpenAlex
- W2032483008
- Cited by
- 168
- References
- 35
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 12 · 2023: 9 · 2022: 9 · 2021: 14 · 2020: 14 · 2019: 10 · 2018: 10 · 2017: 9 · 2016: 12 · 2015: 9 · 2014: 17 · 2013: 9 · 2012: 8
- FWCI
- 10.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- World Health Organization
- Shire
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, R01MH059575, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R01-TW006481, R03TW006481)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Education › Educational Outcomes and Influences
- Keywords
- mental illness, educational attainment, school dropout, substance use disorders, anxiety disorders, mood disorders, impulse control disorders, secondary education, low- and middle-income countries, high-income countries, World Mental Health Survey Initiative
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Educational Status, Epidemiologic Methods, Humans, Schools, Student Dropouts, Universities, Cost of Illness, Age of Onset, Diagnostic and Statistical Manual of Mental Disorders
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