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      The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving

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          Abstract

          Background

          Most psychiatric disorders present symptom patterns that cause severe impairment on the emotional, cognitive and social level. Thus, adolescents who suffer from a mental disorder risk finding themselves in a downward spiral caused by the reciprocal association of psychological symptoms and negative school experiences that may culminate in early school leaving. In addition to previous collective work that mainly focused on school refusing behaviour among children and was presented as an expert’s opinion, the following systematic review fills the knowledge gap by providing a structured overview of the bidirectional association between mental health and secondary school dropout based on a sound methodology and with a particular focus on mediating factors.

          Methods

          Four electronic databases were searched from January 1990 until June 2014. Selected references were assessed for study details, main results, mediating factors and methodological limitations. Standardized risk of bias assessment was conducted.

          Results

          Mood and anxiety disorders seemed to have a less consequential direct effect on early school leaving than substance use and disruptive behaviour disorders. The association between externalizing disorders and educational attainment was even stronger when the disorder occurred early in life. On the other hand, internalizing disorders were reported to develop as a consequence of school dropout. Only few studies had addressed gender differences, with discrepant results. Socio-economic background, academic achievement and family support were identified as significant mediating factors of the association between mental disorders and subsequent educational attainment.

          Conclusions

          Findings suggested a strong association between mental health and education, in both directions. However, most studies focused on mediating factors that could not be targeted by intervention programs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12888-014-0237-4) contains supplementary material, which is available to authorized users.

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          Most cited references69

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          Social consequences of psychiatric disorders, I: Educational attainment.

          This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.
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            High School Dropouts: A Review of Issues and Evidence

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              Low Socioeconomic Status and Mental Disorders: A Longitudinal Study of Selection and Causation during Young Adulthood

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                Author and article information

                Contributors
                pascale.esch@crp-sante.lu
                valery.bocquet@crp-sante.lu
                charles.pull@crp-sante.lu
                sophie.couffignal@crp-sante.lu
                torsten.lehnert@ffe.lu
                marc.graas@chnp.lu
                laurence.fond-harmant@crp-sante.lu
                marc.ansseau@chu.ulg.ac.be
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                27 August 2014
                27 August 2014
                2014
                : 14
                : 1
                : 237
                Affiliations
                [ ]Centre for Health Studies, Centre de Recherche Public de la Santé, Rue Thomas Edison 1 A-B, Strassen, 1445 Luxembourg
                [ ]Department of Clinical Sciences, University of Liège, Avenue de l’Hôpital 13, Liège, 4000 Belgium
                [ ]Competence Centre of Methodology and Statistics, Centre de Recherche Public de la Santé, Rue Thomas Edison 1 A-B, Strassen, 1445 Luxembourg
                [ ]Department of Psychiatry, Centre Hospitalier de Luxembourg, Rue Ernest Barblé 4, Luxembourg, 1210 Luxembourg
                [ ]Department of Psychiatry, Centre Hospitalier du Kirchberg, Rue Edward Steichen 9, Luxembourg, 2540 Luxembourg
                [ ]Centre Hospitalier Neuro-Psychiatrique, Avenue des Alliés 17, Ettelbruck, 9002 Luxembourg
                Article
                237
                10.1186/s12888-014-0237-4
                4244046
                25159271
                329cac75-b9fc-447b-a947-97994b8fcea0
                © Esch et al.; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 January 2014
                : 8 August 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Clinical Psychology & Psychiatry
                Clinical Psychology & Psychiatry

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