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Psychotropic medication use and academic performance in adolescence: A cross-lagged path analysis
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0001-6008-2296
Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.ORCID iD: 0000-0002-6867-6205
2021 (English)In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 91, p. 25-34Article in journal (Refereed) Published
Abstract [en]

Introduction: The study investigated the directionality of associations between mental health problems and school grades across two timepoints (T1 and T2) during mid to late adolescence; inschool year 9 (ages 15–16) and school year 12 (ages 17–18). The study also investigated variation in the associations as a function of gender and across socioeconomic groups.

Methods: Longitudinal data from several Swedish administrative registers were utilised. Information on prescribed psychotropic drugs was used as a proxy for mental health problems, and teacher-assigned school grades were used to measure academic performance. The study sample comprised 85 186 individuals (50.7% girls) born in 1991 who were alive and resident in Sweden in 2010. Directions of associations were analysed by estimating a series of cross-lagged path models.

Results: The model with the best fit to data showed that higher school grades at T1 were associated with relatively lower rates of mental health problems by T2, for both boys and girls, mainlyi n socioeconomic groups with the highest educated parents. This association was equal in size across all of the socioeconomic groups that were explored.

Conclusions: Performing well in school is equally important for boys’ and girls’ subsequent mental health, but only among adolescents in socioeconomic groups with the highest educated parents. The results underscore the importance of promoting opportunities for youth to do as well as theycan in school.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 91, p. 25-34
Keywords [en]
Mental health, Academic performance, Cross-lagged panel analysis, Bidirectional associations, Gender differences, Socioeconomic background
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-186299DOI: 10.1016/j.adolescence.2021.07.003ISI: 000685543000003PubMedID: 34298339Scopus ID: 2-s2.0-85110755387OAI: oai:DiVA.org:umu-186299DiVA, id: diva2:1581377
Part of project
How are school achievements influenced by poor childhood health? The importance of poor health, family living conditions, schools and neighborhoods for grades and the risk of dropouts., Swedish Research Council
Funder
Swedish Research Council, 2014-1992Marianne and Marcus Wallenberg Foundation, 2014.0154Available from: 2021-07-21 Created: 2021-07-21 Last updated: 2023-09-05Bibliographically approved
In thesis
1. Growing up with poor health and managing school: Studies on ill health and young people's educational achievements
Open this publication in new window or tab >>Growing up with poor health and managing school: Studies on ill health and young people's educational achievements
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim and objectives: The overall aim of this thesis was to empirically investigate consequences of poor health for children’s educational outcomes in Sweden. A central tenet is that health problems impact not only the afflicted individual but also people in their social and emotional proximity, in particular immediate family members. More specific objectives were to study: 1. The relationship between multiple clinically diagnosed mental disorders and children’s educational achievements in Sweden. 2. The bidirectional relationship between mental health problems and academic performance among Swedish adolescents, as well as heterogeneous patterns associated with gender and socioeconomic groups. 3. The effects of parental somatic and psychiatric health problems on the probability of youths leaving upper secondary education before completion in Sweden and potential gender differences in these effects. 4. The relationship between having a sibling with health problems and a healthy sibling’s school grades in the final year of compulsory education in Sweden and how socioeconomic background modifies this relationship.

Theoretical framework: Key concepts applied in the thesis are health and illness. The ability to perform things in life, the ability to act, determines whether a person is healthy or ill. Illness (or poor health, treated as a synonymous term) entails a reduced ability to act in relation to one’s life situation and its demands. Family is viewed from a systems theory perspective. Poor health of a parent reduces his or her ability to maintain regular roles, which may require reorganisation of the family system. Siblings’ health problems can affect other children in the family by inducing concerns and occupying and diverting parents’ time and attention. All of this could be psychosocially stressful in many ways, not least for children in the family and their ability in relation to schooling.

Data and methods: The research objectives were addressed by utilising social and medical microdata from Swedish administrative registers covering the entire population in Sweden. Data pertaining to different populations, collectively covering the period from 1987 to 2017, were used in four studies designated Studies I–IV. Educational achievement was measured in terms of teacher-assigned school grades awarded by the end of compulsory school and in upper secondary school, as well as completion (or non-completion) of an upper secondary education. Poor health was measured through data on outpatient visits to specialist healthcare facilities, psychotropic drug prescriptions and admissions/discharges from Swedish hospitals. Socioeconomic background was measured by parental level of education. The data were analysed by fitting linear and logistic regression models as well as cross-lagged path models.

Results and conclusions: Empirical results of Study I showed that specific diagnosed mental disorders have varying, largely disadvantageous, associations with educational achievements of students that differ between boys and girls. Documentation of this in Sweden adds to evidence that mental disorders have a negative overall association with educational achievement, despite substantial variation in support and educational systems across countries. The results of Study II provided no support for a bidirectional relationship between mental health and academic performance of students aged 15-16 to 18-19 years. However, they support a unidirectional relationship, as a negative relationship was found between school grades at graduation from compulsory school and rates of subsequent psychotropic medication use in upper secondary school. The relationship was equal in size for both boys and girls but mainly among adolescents with the highest educated parents.

Study III showed that having a mother or a father with psychiatric, but not somatic, illness that necessitated hospitalisation after completing compulsory schooling was associated with an increased probability of leaving upper secondary school before completion. No significant gender-based differences in this were found. Results presented in Study IV showed that having one or more siblings with health problems that necessitated recurrent hospitalisations was associated with lower grades. Children with ill siblings were also less likely to be eligible for an upper secondary education compared to children whose siblings did not have poor health. Socioeconomic background did not affect this educational disadvantage.

Results presented in this thesis clearly corroborate the importance of health for children’s education. Children’s educational achievements at the end of compulsory school are inversely related to mental health problems in their adolescence. Thus, academic competence may have positive effects on certain aspects of young people’s mental health, which underscores the importance of promoting opportunities for youth to do as well as they can in school. The reciprocal aspect of the relationship between mental health and academic performance among school-aged children remains an important issue that requires further investigation. However, health is not just an individual issue; parents’ and siblings’ health problems can affect children and have negative ‘spillover’ effects on their schooling and educational achievements. This underlines the importance of a psychosocial perspective when identifying children’s difficulties in school. Taken together, health, and thus the school’s student health task, is highly associated with academic achievement and schools’ pedagogical responsibilities.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2022. p. 66
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 99
Keywords
Educational acchievements, Health, Bidirectionality, Family, Parents, Siblings, Register data
National Category
Social Work
Research subject
Sociology; Psychiatry; Public health
Identifiers
urn:nbn:se:umu:diva-192131 (URN)978-91-7855-732-5 (ISBN)
Public defence
2022-03-04, UB.A.210, Lindellhallen 1, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2022-02-11 Created: 2022-02-02 Last updated: 2024-07-02Bibliographically approved

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Bortes, CristianStrandh, Mattias

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