Delayed school progression and mental health problems in adolescence:A population-based study in 10,803 adolescents

Background Accumulating evidence suggests that several adult mental disorders, particularly psychoses, are preceded by impairments in cognitive function, reflected in scholastic underachievement. This study investigates the association between scholastic underachievement and general mental health problems in adolescence, using delay in school progression as a marker of poor scholastic performance.MethodCross-sectional secondary school survey comprising 10,803 adolescents. Participants completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health problems. The association of delayed school progression with the SDQ was investigated using logistic regression with SDQ as outcome and delayed school progression as primary exposure of interest while adjusting for socio-demographic characteristics, adverse life events, school-related factors, risk taking behaviour, healthy lifestyle and physical health.ResultsUnadjusted analysis showed an association between delayed school progression and total mental health problems (OR 1.83, 95% CI 1.27 - 2.63) in adolescents. After adjusting for other risk factors (socio-demographic factors and life events) in a logistic regression model the association between delayed school progression en mental health problems was attenuated (OR 1.33, 95% CI 0.86 - 2.05).ConclusionDelayed school progression is associated with general mental health problems in adolescence, but this relationship is heavily confounded by other factors. A causal relationship between impaired cognitive function such as poor scholastic performance and general mental health at adolescence is less likely and delayed school progression may merely be considered an indicator of risk for mental health problems.</p

Educational Level, Underachievement, and General Mental Health Problems in 10,866 Adolescents

Objective Previous research suggests that cognitive functioning is associated with the risk of several adult psychiatric disorders. In this study we investigated whether adolescents who perform worse than expected at secondary school are at a higher risk for general mental health problems. Methods In a cross-sectional survey comprising 10,866 Dutch adolescents aged 13 to 16 years, underachievement at secondary school was defined as the discrepancy between predicted school grade and actual grade 1 or 3 years later. Mental health problems were assessed using the Strengths and Difficulties Questionnaire. We investigated the association of underachievement with mental health problems using logistic regression, adjusting for potential confounders. Results Underachievement was associated with general psychopathology in pupils aged 13 to 14 years (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.47–2.37) and in pupils aged 15 to 16 years (OR, 2.05; 95% CI, 1.67–2.52) in a multivariate analysis including sociodemographic factors. The association between underachievement and mental health problems was attenuated when school factors such as teacher advice and interaction between underachievement and teacher advice were added, but underachievement remained significantly associated with mental health problems in adolescents in the higher educational tracks (pupils aged 13–14 years: OR, 2.22; 95% CI, 1.07–4.60 and OR, 2.41; 95% CI, 1.10–5.30, age 15–16 years: OR, 2.63; 95% CI, 1.38–5.03). In the multivariate analysis including the interaction between underachievement and teacher advice, a significant interaction effect occurs between underachievement and teacher advice in the higher tracks. Values of OR and CI are given for each significant interaction term. In the younger age group (pupils aged 13-14 years) this results in 2 sets of OR and CI. This association was most pronounced for the hyperactivity subscale of the Strengths and Difficulties Questionnaire. Conclusions Underachievement at secondary school is associated with general mental health problems, especially with hyperactivity symptoms, in pupils who started at high educational tracks

Educational level, underachievement and general mental health problems in 10 866 adolescents

Objective Previous research suggests that cognitive functioning is associated with the risk of several adult psychiatric disorders. In this study we investigated whether adolescents who perform worse than expected at secondary school are at a higher risk for general mental health problems. Methods In a cross-sectional survey comprising 10,866 Dutch adolescents aged 13 to 16 years, underachievement at secondary school was defined as the discrepancy between predicted school grade and actual grade 1 or 3 years later. Mental health problems were assessed using the Strengths and Difficulties Questionnaire. We investigated the association of underachievement with mental health problems using logistic regression, adjusting for potential confounders. Results Underachievement was associated with general psychopathology in pupils aged 13 to 14 years (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.47–2.37) and in pupils aged 15 to 16 years (OR, 2.05; 95% CI, 1.67–2.52) in a multivariate analysis including sociodemographic factors. The association between underachievement and mental health problems was attenuated when school factors such as teacher advice and interaction between underachievement and teacher advice were added, but underachievement remained significantly associated with mental health problems in adolescents in the higher educational tracks (pupils aged 13–14 years: OR, 2.22; 95% CI, 1.07–4.60 and OR, 2.41; 95% CI, 1.10–5.30, age 15–16 years: OR, 2.63; 95% CI, 1.38–5.03). In the multivariate analysis including the interaction between underachievement and teacher advice, a significant interaction effect occurs between underachievement and teacher advice in the higher tracks. Values of OR and CI are given for each significant interaction term. In the younger age group (pupils aged 13-14 years) this results in 2 sets of OR and CI. This association was most pronounced for the hyperactivity subscale of the Strengths and Difficulties Questionnaire. Conclusions Underachievement at secondary school is associated with general mental health problems, especially with hyperactivity symptoms, in pupils who started at high educational tracks

Sleep Disturbances, Psychosocial Difficulties and Health Risk Behaviour in 16,781 Dutch Adolescents

Objective To investigate the prevalence of adolescent sleep disturbances and their relation with psychosocial difficulties and health risk behaviours we analysed data of a province-wide health survey (n=16,781). Methods Psychosocial difficulties were measured with the Strength and Difficulties Questionnaire. Additional assessments included self-reported sleep disturbances, suicidality and health risk behaviours including current use of tobacco, alcohol and drugs, physical inactivity and compulsive use of multimedia. We used multi-level analyses to investigate the relations including differences between boys and girls, as well as the mediating role of emotional problems. Results Just under 20 % of adolescents reported sleep disturbances in the previous month. These sleep disturbances were associated with psychosocial problems (OR: 6.42, p<0.001), suicidality (OR: 3.90 - 4.14, p<0.001) and all health risk behaviours (OR: 1.62-2.66, p<0.001) but not with physical inactivity. We found moderation by gender for the relations between sleep and suicide attempts (OR: 0.38, p<0.002) and sleep and cannabis use (OR: 0.52, p=0.002), indicating attenuated relations in girls compared to boys. Emotional problems partially mediated the relations between sleep disturbances and multimedia use. Conclusions The current study reiterates the high prevalence of sleep disturbances during adolescence. These sleep disturbances were strongly related to psychosocial problems and a wide range of health risk behaviours. Although the direction of causality cannot be inferred, the current study emphasizes the need for awareness of impaired sleep in adolescents. Moreover, the gender differences in associated suicide attempts and cannabis use call for further research into tailored intervention strategies

Sleep Disturbances, Psychosocial Difficulties and Health Risk Behaviour in 16,781 Dutch Adolescents

Objective To investigate the prevalence of adolescent sleep disturbances and their relation with psychosocial difficulties and health risk behaviours we analysed data of a province-wide health survey (n=16,781). Methods Psychosocial difficulties were measured with the Strength and Difficulties Questionnaire. Additional assessments included self-reported sleep disturbances, suicidality and health risk behaviours including current use of tobacco, alcohol and drugs, physical inactivity and compulsive use of multimedia. We used multi-level analyses to investigate the relations including differences between boys and girls, as well as the mediating role of emotional problems. Results Just under 20 % of adolescents reported sleep disturbances in the previous month. These sleep disturbances were associated with psychosocial problems (OR: 6.42, p<0.001), suicidality (OR: 3.90 - 4.14, p<0.001) and all health risk behaviours (OR: 1.62-2.66, p<0.001) but not with physical inactivity. We found moderation by gender for the relations between sleep and suicide attempts (OR: 0.38, p<0.002) and sleep and cannabis use (OR: 0.52, p=0.002), indicating attenuated relations in girls compared to boys. Emotional problems partially mediated the relations between sleep disturbances and multimedia use. Conclusions The current study reiterates the high prevalence of sleep disturbances during adolescence. These sleep disturbances were strongly related to psychosocial problems and a wide range of health risk behaviours. Although the direction of causality cannot be inferred, the current study emphasizes the need for awareness of impaired sleep in adolescents. Moreover, the gender differences in associated suicide attempts and cannabis use call for further research into tailored intervention strategies