Diagnosis of depression in adolescents can negatively impact educational performance, study shows

A study funded by NIHR Maudsley BRC has shown that the onset of depression in adolescents is likely to have a negative impact on subsequent educational performance. Previous research has shown this relationship, but it has been difficult to understand the magnitude of this impact and describe it in a way that could be meaningful to young people, families and staff within health and education settings.

Pupils diagnosed with depression before age 15 were 40 per cent less likely to achieve expected GCSE attainment thresholds (achieve five or more A* to C GCSEs including English and Maths), as compared to those who did not receive a depression diagnosis.

Innovative data set

Researchers utilised a large and innovative data set which links Child and Adolescent Mental Health Service (CAMHS) records from 2007-2013 to educational records collected by the Department for Education. Health records were drawn from South London and Maudsley NHS Foundation Trust, through the Clinical Record Interactive Search (CRIS), which provides authorised researchers with regulated, secure access to anonymised electronic health information.

In a sample of 63,623 pupils from south London, researchers investigated the effect of having a depression diagnosis on subsequent GCSEs. GSCE results are important because they influence later educational and occupational opportunities.

Impact of depression diagnosis

The study found that pupils with depression before age 15 were 40 per cent less likely to achieve expected GCSE attainment thresholds (achieve five or more A* to C GCSEs including English and Maths), as compared to those who did not receive a depression diagnosis. This effect was sustained even after taking into account pupils’ prior educational SATs performance and demographic characteristics. It found that 42 per cent of pupils with a diagnosis of depression before age 15 reached the expected GCSE attainment threshold, compared to 56 per cent of those without depression.

The results showed that pupils with depression were less likely to achieve five or more A* to C GCSEs and equivalent grades including English and Maths (roughly the equivalent of five 4 and above grades under the new grading structure). The strength of this association was similar irrespective of pupil gender, ethnicity, and eligibility for Free School Meals.

Lead author on the study, Alice Wickersham, NIHR Maudsley BRC PhD Student said:  

"We knew that symptoms of depression have a negative impact on school performance. But this study demonstrates the magnitude of this impact for a group of pupils in Child and Adolescent Mental Health Services who had been diagnosed with depression before taking their GCSEs.

“The finding persists even after taking performance in primary school into account; typically, these pupils have not always struggled with their school performance. In addition, the negative impact was persistent across genders, socioeconomic groups, and ethnic groups, suggesting pupils from many different backgrounds would benefit from additional educational support after receiving a depression diagnosis."

Monitoring and support

According to the researchers the study highlights the importance of supporting all adolescents with depression, or who are at risk of developing depression, to improve their educational attainment and their mental health. New digital approaches to monitoring depression in young people are essential to offering timely support.  

Senior author Johnny Downs, NIHR Clinician Scientist at the Department of Child & Adolescent Psychiatry and Centre for Translational Informatics said:

“This work provides a robust estimate of the attainment gap for young people who develop depression in early adolescence. We also know from Alice’s prior work, that young people with depression had higher levels of educational attainment than their peers – so depression onset represents significant loss in academic potential.

“As a clinician, the important messages I take away is that: first, depression is a highly treatable condition and therefore could represent a modifiable risk factor for improving educational achievement in significant number of young people; second, we need to enhance our methods of monitoring symptoms of young people who may be at risk of depression so we can try and act earlier and mitigate problems before they become pervasive -  I hope that systems like the myHealthE platform we’ve developed at the Maudsley BRC will help; finally, that we need to know more about how to factor in learning and educational engagement into our current treatment plans for adolescent depression. We tend to focus on symptomatic change and immediate risk, which is often crucial to help immediate recovery, however very little is known about how to re-establish healthy learning routines towards the end of treatment, which may help restore young people, recovering from depression, back onto their prior educational attainment trajectory.”

The research highlights the need for tailored educational interventions to support children and adolescents with depression, particularly in the lead up to key educational milestones, such as GCSEs.

Estimating the impact of child and early adolescent depression on subsequent educational attainment: secondary analysis of an existing data linkage was published in Epidemiology and Psychiatric Sciences.