Association between depression diagnosis and educational attainment trajectories: an historical cohort study using linked data.

Background: Depression symptoms are thought to be associated with lower educational attainment, but patterns of change in attainment among those who receive a clinical diagnosis of depression at any point during childhood and adolescence remain unclear. Methods: We conducted a secondary analysis of an existing data linkage between a national educational dataset (National Pupil Database) and pseudonymised electronic health records (Clinical Record Interactive Search) from a large mental healthcare provider in London, United Kingdom (2007 to 2013). A cohort of 222,027 pupils were included. We used Growth Mixture Modelling (GMM) and stakeholder input to estimate trajectories of standardised educational attainment over School Years 2, 6 and 11. Multinomial logistic regression analyses were then used to investigate the association between resulting educational attainment trajectory membership (outcome) and depression diagnosis any time before age 18 (exposure). Results: A five‐trajectory GMM solution for attainment was derived: (1) average/high‐stable, (2) average‐modest declining, (3) average‐steep declining, (4) low‐improving and (5) low‐stable. After adjusting for clinical and sociodemographic covariates, having a depression diagnosis before age 18 was associated with occupying the average‐modest declining trajectory (RRR = 2.80, 95% CI 2.36–3.32, p <.001) or the average‐steep declining trajectory (RRR = 3.54, 95% CI 3.10–4.04, p <.001), as compared to the average/high‐stable trajectory. Conclusions: Receiving a diagnosis of depression before age 18 was associated with a relative decline in attainment throughout school. While these findings cannot support a causal direction, they nonetheless suggest a need for timely mental health and educational support among pupils struggling with depression. [ABSTRACT FROM AUTHOR]