Mental health and educational achievement in UK adolescents

Lead Research Organisation: University of Bristol
Department Name: Social Medicine


Educational achievement at the end of compulsory education has strong links with important aspects of adult life such as employment, health, and social functioning worldwide. In the UK, a recent review from the Department of Education concluded that without achieving a 'pass' (A*-C grade, or 9-5 grade nowadays) in maths and English exams, adolescents will not be considered for higher education and face poor employment prospects. This has important implications, as in 2013 over one-quarter of UK adolescents left school without these grades. Therefore, it is important to conduct research intended to understand and to minimise educational failure in secondary school.

The mechanisms that affect educational achievement remain unclear to a large extent nowadays, although the role of mental health is increasingly acknowledged. This project will implement novel analysis approaches using one of the excellent data resources available in the UK, in order to elucidate the relationship between depressed mood and school grades at secondary school, which has thus far not been examined in this manner within educational research. Moreover, we will look at the impact of depressed mood and educational failure during secondary school on full-time education and employment status in late adolescence and early adulthood.

In this project, we will address a wide range of relevant research questions about the relationship between depression and school grades in adolescence and educational/employment statuses in early adulthood. Results from previous studies suggest a nonlinear relationship between depression and grades in adolescence, which means that academic performance might not decrease proportionally as depressive symptoms increase. Moreover, we aim to identify which characteristics of the child, family, school and area can be used to identify children at high risk of suffering educational/employment impacts from depressed mood. In other words, we are looking for risk and protective factors that should be considered when mental health screenings are conducted in secondary schools in the UK. Furthermore, we will explore the hypothesis that both depressed mood and educational failure have an impact on each other.

Another goal of this project is to determine the critical periods, both in terms of short- and long-term effects, in our relationships of interest, and the individuals at high risk. For instance, we will use data from the same children at different periods to find out the stage or age at which occurrence of depression is most likely to be associated with negative consequences such as educational failure at the end of secondary school. This will shed some light on when screenings should be scheduled in schools and who are the most vulnerable children who should be prioritised for intervention.

To fulfil the goals of this project, we will need to use large, high-quality databases. Fortunately, the UK has world-leading data resources that will allow us to address our research questions appropriately. We plan to use data from the Avon Longitudinal Study of Parents And Children (ALSPAC). The ALSPAC study has chartered the health of 14,500 families in the Bristol area since the early 90s. This is a unique case amongst large sample UK longitudinal studies, as it provides child data year on year. The richness of this data resource will make it possible to examine the relationship between depression and educational achievement at different stages, and to look at previous records for individuals who experience negative outcomes in early adulthood, such as educational failure and unemployment. Most of the team members have previous experience analysing ALSPAC data, which will facilitate the process of data access and data manipulation.

Planned Impact

This project will help schools to better appreciate the importance of addressing mental health needs of adolescents. We aim to identify protective factors, relevant variables at the individual, family and school level and strength and directionality of the association between mental health and educational achievement at each age or key stage. Furthermore, we intend to disentangle the role of mental health in the transition from compulsory education to higher education and employment in early adulthood. This will shed some light on WHICH variables should be screened, WHEN should screenings take place, and WHO are the adolescents that should be prioritised for school-based prevention or early intervention programs.

We intend to improve mechanisms to identify subjects at high risk in schools, inform intervention development, and shed light on how depressed mood is associated with school grades and employment throughout adolescence and early adulthood, respectively. This will allow us to offer a major contribution to the field of mental health and well-being, a current priorities for ESRC. This is a very important objective, as designing timely and effective interventions for mental health and educational achievement, at a key developmental time period, will have a long-term positive impact on our potential users.

We list below several audiences that will benefit from the outputs of this research project.

1) Adolescents affected by (or at high risk of) depression and/or school failure: our research is primarily aimed at helping this group; in fact, our main goal is to reach a better understanding of the association between depression and educational achievement in adolescence, and further education, training or employment in adulthood, respectively. A large survey just released by the Department of Education found that over one third of the girls screened (age 14-15) suffered from depression or anxiety (Sanghani, 2016, August 22), which stresses the importance of our topic at present. From a long-term perspective, understanding the role of mental health in the transition from compulsory education to higher education, training or employment has the potential to increase the proportion of adolescents who develop successful careers as adults.

2) Policy makers involved in developing and commissioning interventions aimed to promote mental health and/or maximise educational achievement among adolescents: if the role of mental health in educational achievement can be disentangled, it can be addressed through a range of different psychological (and potentially pharmacological) interventions and hence this might provide an indirect way to tailor and optimise interventions aiming to improve educational achievement. We will extend our analysis to early adulthood, so that our findings also have the potential to provide some insights for policy makers interested in maximising the proportion of adolescents who become employable adults.

3) Teachers and other educational professionals at the secondary level: by clarifying the relationship between mood and attainment, we will be able to work with education services and schools to ensure that mental health needs are an important consideration of the school environment and part of an essential component of usual service delivery in schools.

4) The scientific community (see Academic Beneficiaries).

5) Government agencies and tax payers: NHS expenditure on child and adolescent mental health was estimated to be £700m in 2012/13, including part of an investment of £60m to improve access to psychological therapies over 2011-15/16 (Department of Health, 2015). Optimising the use of the available resources to promote mental health has the potential to substantially improve well-being in the population and gradually reduce NHS expenses, if part of the mental disorders that require long-term treatment in late adolescence and adulthood can be identified and tackled at an early stage.
We examined depressive symptoms in 9,399 people, with nine repeated measures between ages 10-24. This yielded five different trajectories:
- Stable Low (70.5% of the sample), mild or no symptoms throughout the observation period.
- Late Risers (11.6%), rise in symptoms from late adolescence.
- Rise & Fall (9.4%), rise and then decrease in symptoms during adolescence.
- Decreasers (5.1%), moderate symptoms in late childhood that decrease over time.
- Early Risers (3.5%), high symptoms starting from early adolescence.

The Early Risers and Late Risers groups are at higher risk when 24 years old of poor mental health (high depression scores in adulthood exceeding the proposed threshold of 11 points) and NEET status (not in employment, education or training) at 24 than the other groups. Late Risers are of most concern, as they represent 11.6% of the total and might be harder to identify as high-risk at an early stage.

We examined the associations between depressive symptoms and educational achievement at key stages 2 to 5 in 13,600 participants. The work confirms a negative association between depression and academic achievement; more depressive symptoms correlate with poorer education results. The association works both ways; poor attainment at 16 leads to higher depressive symptoms at 18, and early depressive symptoms affects later attainment. The end of compulsory education (GCSEs, age 16) seems to be especially important, as (1) it is negatively affected by depressive symptoms at an early stage, and (2) it affects depressive symptoms at a later stage.

NOTE: we now have one paper published in JAMA Network Open, a second paper in the British Journal of Psychiatry Open and another paper has been submitted to Journal of Child Psychology and Psychiatry and is under review. We have also published a Policy Briefing document.
Exploitation Route Transitions from childhood to adolescence (around ages 12-13 years) and from adolescence to adulthood (18-19 years) might be sensitive periods for peaks of depressed mood, and they should be targeted by strategies aimed at preventing depression among young people and providing accessible services. Such periods are also closely related to educational transition points in the UK.

Further research is needed to understand the risk factors that might lead to a rise of depressive symptoms in late adolescence, particularly to identify those young people who do not appear as high-risk at an earlier age.

Further investment in a range of mental health provision in schools is needed to provide support to a wider group of children and young people. This may help prevent depression escalating and impacting on long-term social, occupational and economic outcomes.

If schools target depressed mood in those at risk, this might boost school grades.

Any policy initiatives need to take account of the fact that depression may cause lower academic attainment and vice versa.

These findings highlight the need for a new approach to mental health services that takes account of these developmental trajectories and provides support across adolescence to early adulthood. Novel strategies need to be put in place to minimise the negative impact of the current service model, with often abrupt transition from child to adult services at age 18 that may lead to young people falling through the gap between services or becoming unsettled by a change in support.

Students who are struggling academically and those at risk of dropping out also need support. Educational and mental health services would benefit from future research to explore mechanisms underlying educational failure.
Sectors Education,Healthcare

Title Database to examine the associations of interest 
Description We obtained a rich database with all relevant indicators of depressive symptoms from childhood to adulthood, educational attainment at each key stage, and employment status in early adulthood for all participants of the Avon Longitudinal Study of Parents and Children who had available data. We also retrieved a wide range of potential confounders and other variables relevant to our analyses. We had support from Louise Jones, a data buddy from the ALSPAC team 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This database enabled us to perform a variety of advanced analyses that will be reported in several journal articles (currently under review or in preparation). 
Description Dissemination event on 1 February 2019 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact We invited key professionals from a wide range of sectors with a common interest in mental health in young people. We got responses from 23 people interested in attend a half-day event in central Bristol, which took place on the 1st of February, 2019. The event consisted of four presentations about ongoing research projects based in Bristol with overlapping interests, starting with ours. There were lively discussions at the end of each presentation.
Year(s) Of Engagement Activity 2019
Description Meeting with young people from the ALPHA group (Cardiff) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact We presented a brief (non-technical) summary of the Project and invited the young people attending the event to join the debate on the relevance of the findings we have obtained so far, as well as to list some priorities areas this or future projects should address.
Year(s) Of Engagement Activity 2018