Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up
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The study sought to examine the association of mental disorders with educational attainment in a community sample.
Data were from 5001 respondents aged 15–54 in the 1990–1992 National Comorbidity Survey (NCS), re-interviewed in the 2001–2003 NCS follow-up (NCS-2). Discrete-time survival analysis was used to examine the association of disorders present at baseline (NCS) or having first onset after the baseline (assessed in NCS-2) with educational outcomes among 3954 eligible respondents. Mental disorders were categorized into internalizing fear disorders (simple phobia, social phobia, panic disorder with/without agoraphobia and agoraphobia without panic disorder), internalizing anxiety-misery disorders (major depressive disorder, generalized anxiety disorder and post-traumatic stress disorder), externalizing disorders (alcohol and drug use disorders, conduct disorder) and bipolar disorder. Analyses were conducted separately in students and non-students at baseline.
Among students, baseline bipolar and externalizing disorders, as well as fear, anxiety-misery and externalizing disorders with onset after baseline were associated with lower odds of high school graduation; baseline anxiety-misery disorders with lower odds of going to college; and baseline externalizing disorders and bipolar disorder with onset after baseline with lower odds of college graduation. Among non-students, baseline fear disorders were associated with lower odds of high school graduation and bipolar disorder with lower odds of going to college. Assuming that the regression coefficients represent causal effects, mental disorders accounted for 5.8–11.0 % of high school and 3.2–11.4 % of college non-completion.
Expanding access to mental health services for youth might have a net positive societal value by helping to prevent some of these adverse educational outcomes.
KeywordsMental illness Education Social consequences Epidemiology Burden of mental illness
The secondary analysis of the NCS/NCS-2 data reported here was supported by National Institute of Mental Health (NIMH) (RM PI; Grant number R01MH096826). The NCS data collection was also supported by NIMH (RCK PI; Grant number R01MH46376), while NCS-2 data collection was supported by the National Institute on Drug Abuse (RCK PI; Grant number R01DA012058). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government. A complete list of NCS and NCS-2 publications can be found at http://www.hcp.med.harvard.edu/ncs. The NCS-2 is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. These activities were supported by the NIMH (R.C.K., Grant number R01MH070884), the John D. and Catherine T. Macarthur Foundation, the Pfizer Foundation, the US Public Health Service (R.C.K., Grant numbers R13MH066849, R01MH069864, and R01DA016558), the Fogarty International Center (R.C.K., R03TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
Conflict of interest
Dr. Mojtabai has received research funding from Bristol Myers-Squibb and Lundbeck pharmaceuticals. In the past 12 months, Dr. Kessler has served as a consultant for Hoffmann-La Roche, Inc. and the Johnson & Johnson Wellness and Prevention. Dr. Kessler has served on advisory boards for Mensante Corporation, Johnson & Johnson Services Inc. Lake Nona Life Project, and U.S. Preventive Medicine. Dr. Kessler owns 25 % share in DataStat, Inc. Other authors declare no potential conflict of interest.
Original collection of NCS and NCS-2 data has been approved by the Institutional Review Board of Harvard University and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The analyses reported here have been approved by the Institutional Review Board of Johns Hopkins University, Bloomberg School of Public Health. All persons interviewed for NCS and NCS-2 surveys gave their informed consent prior to their inclusion in the study.
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