Leaving school without qualifications and mental health problems to age 30

  • David M. FergussonEmail author
  • Geraldine F. H. McLeod
  • L. John Horwood
Original Paper



To examine the associations between leaving school without qualifications and subsequent mental health to age 30, using data gathered over the course of a 30-year longitudinal study.


Data were gathered over the course of a 30-year study (Christchurch Health and Development Study) of a birth cohort of 1265 children, born in Christchurch in 1977. This cohort has been studied on 22 occasions from birth to age 30. As part of this study, information was gathered on: (a) school leaving qualifications, (b) mental health problems from 18 to 30; and (c) prospectively assessed childhood and adolescent factors including: child and family background; family violence and child abuse; and adolescent mental health problems.


Leaving school without qualifications was associated with increased risks of subsequent: major depression (OR = 1.37 at 95 % CI 1.05–1.78, p = 0.019); anxiety disorder (OR = 1.99 at 95 % CI 1.55–2.57, p < 0.001); suicidal ideation/attempt (OR = 1.60 at 95 % CI 1.15–2.36, p = 0.005); alcohol abuse/dependence (OR = 1.54 at 95 % CI 1.20–1.98, p < 0.001); and illicit substance abuse/dependence (OR = 2.97 at 95 % CI 2.16–4.07, p < 0.001). Adjustment for the covariate factors above (family social background; family violence; child abuse and adolescent mental health problems) reduced these associations substantially and to the point of statistical non-significance.


The findings of this study suggest that there was no direct causal association between leaving school without qualifications and subsequent mental health problems. Associations were explained by the linkages between leaving school without qualifications and: child and family social background; and mental health around the point of school leaving.


Longitudinal Mental health High school dropout Educational qualifications 



This research was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation (Cure Kids), the Canterbury Medical Research Foundation and the New Zealand Lottery Grants Board.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

127_2014_971_MOESM1_ESM.pdf (383 kb)
Supplementary material 1 (PDF 383 kb)


  1. 1.
    Braveman P, Egerter S, Williams DR (2011) The social determinants of health: coming of age. Annu Rev Public Health 32:381–398PubMedCrossRefGoogle Scholar
  2. 2.
    Cutler DM, Lleras-Muney A (2006) Education and health: evaluating theories and evidence. National Bureau of Economic Research, CambridgeCrossRefGoogle Scholar
  3. 3.
    Oreopoulos P, Salvanes KG (2011) Priceless: the nonpecuniary benefits of schooling. J Econ Perspect 25(1):159–184CrossRefGoogle Scholar
  4. 4.
    Townsend L, Flisher AJ, King G (2007) A systematic review of the relationship between high school dropout and substance use. Clin Child Fam Psychol 10(4):295–317CrossRefGoogle Scholar
  5. 5.
    Eide ER, Showalter MH (2011) Estimating the relation between health and education: what do we know and what do we need to know? Econ Educ Rev 30:778–791CrossRefGoogle Scholar
  6. 6.
    Kawachi I, Adler NE, Dow WH (2010) Money, schooling, and health: mechanisms and causal evidence. Ann N Y Acad Sci 1186:56–58PubMedCrossRefGoogle Scholar
  7. 7.
    Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112PubMedCrossRefGoogle Scholar
  8. 8.
    Freudenberg N, Ruglis J (2007) Reframing school dropout as a public health issue. Public Health Res Pract Policy 4(4):1–11Google Scholar
  9. 9.
    Lee J (2011) Pathways from education to depression. J Cross Cult Gerontol 26:121–135PubMedCrossRefGoogle Scholar
  10. 10.
    Fergusson DM, Swain-Campbell NR, Horwood LJ (2002) Outcomes of leaving school without formal educational qualifications. N Z J Educ Studies 37(1):39–55Google Scholar
  11. 11.
    Ou S-R (2008) Do GED recipients differ from graduates and school dropouts? Findings from an inner-city cohort. Urban Educ 43(1):83–117CrossRefGoogle Scholar
  12. 12.
    Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 1977(July):513–531CrossRefGoogle Scholar
  13. 13.
    Bronfenbrenner U (1986) Ecology of the family as a context for human development: research perspectives. Dev Psychol 22(6):723–742CrossRefGoogle Scholar
  14. 14.
    Agnew R (1985) A revised strain theory of delinquency. Soc Forces 64(1):151–167CrossRefGoogle Scholar
  15. 15.
    Agnew R (1992) Foundation for a general strain theory of crime and delinquency. Criminology 30(1):47–87CrossRefGoogle Scholar
  16. 16.
    Bandura A (1971) Social learning theory. General Learning Corporation, New YorkGoogle Scholar
  17. 17.
    Kosidou K, Dalman C, Fredlund P, Lee BK, Galanti R, Isacsson G, Magnusson C (2013) School performance and the risk of suicide attempts in young adults: a longitudinal population-based study. Psychol Med. doi: 10.1017/S0033291713001852 PubMedGoogle Scholar
  18. 18.
    Kaplan DS, Damphousse KR, Kaplan HB (1994) Mental health implications of not graduating from high school. J Exp Educ 62(2):105–123. doi: 10.2307/20152404 CrossRefGoogle Scholar
  19. 19.
    Liem JH, Lustig K, Dillon C (2010) Depressive symptoms and life satisfaction among emerging adults: a comparison of high school dropouts and graduates. J Adult Dev 17:33–43CrossRefGoogle Scholar
  20. 20.
    Topitzes J, Godes O, Mersky JP, Ceglarek S, Reynolds AJ (2009) Educational success and adult health: findings from the Chicago Longitudinal Study. Prev Sci 10:175–195PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Araya R, Rojas G, Fritsch R, Acuna J, Lewis G (2001) Common mental disorders in Santiago, Chile: prevalence and socio-demographic correlates. Br J Psychiatry 178:228–233PubMedCrossRefGoogle Scholar
  22. 22.
    Borrell C, Rodriguez M, Ferrando J, Brugal MT, Pasarin MI, Martinez V, Plasencia A (2002) Role of individual and contextual effects in injury mortality: new evidence from small area analysis. Injury Prev 8(4):297–302CrossRefGoogle Scholar
  23. 23.
    Kogan SM, Luo Z, Brody GH, McBride Murry V (2005) The influence of high school dropout on substance use among African American youth. J Ethn Subst Abuse 4(1):35–51PubMedCrossRefGoogle Scholar
  24. 24.
    Herzog AR, Franks MM, Markus HR, Holmberg D (1998) Activities and well-being in older age: effects of self-concept and educational attainment. Psychol Aging 13(2):179–185PubMedCrossRefGoogle Scholar
  25. 25.
    Lorant V, Kunst AE, Huisman M, Costa G, Mackenbach J (2005) Socio-economic inequalities in suicide: a European comparative study. Br J Psychiatry 187:49–54. doi: 10.1192/bjp.187.1.49 PubMedCrossRefGoogle Scholar
  26. 26.
    Maki NE, Martikainen PT (2008) The effects of education, social class and income on non-alcohol- and alcohol-associated suicide mortality: a register-based study of Finnish men aged 25–64. Eur J Popul 24:385–404CrossRefGoogle Scholar
  27. 27.
    Fergusson DM, Horwood LJ (2001) The Christchurch Health and Development Study: review of findings on child and adolescent mental health. Aust N Z J Psychiatry 35(3):287–296. doi: 10.1046/j.1440-1614.2001.00902.x PubMedCrossRefGoogle Scholar
  28. 28.
    World Health Organization (1993) Composite International Diagnostic Interview (CIDI). World Health Organization, GenevaGoogle Scholar
  29. 29.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DCGoogle Scholar
  30. 30.
    Elley WB, Irving JC (1976) Revised socio-economic index for New Zealand. N Z J Educ Studies 11(1):25–36Google Scholar
  31. 31.
    Armsden GC, Greenberg MT (1987) The inventory of parent and peer attachment: individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc 16:427–454PubMedCrossRefGoogle Scholar
  32. 32.
    Straus MA (1979) Measuring intrafamily conflict and violence: the conflict tactics (CT) scale. J Marriage Fam 41:75–88CrossRefGoogle Scholar
  33. 33.
    Fergusson DM, Horwood LJ, Lynskey MT (1997) The effects of unemployment on psychiatric illness during young adulthood. Psychol Med 27(2):371–381PubMedCrossRefGoogle Scholar
  34. 34.
    Fergusson DM, Horwood LJ, Lynskey MT (1996) Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry 35(10):1365–1374PubMedCrossRefGoogle Scholar
  35. 35.
    Fergusson DM, Lynskey MT, Horwood LJ (1996) Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse. J Am Acad Child Adolesc Psychiatry 35(10):1355–1364. doi: 10.1097/00004583-199610000-00023 PubMedCrossRefGoogle Scholar
  36. 36.
    Costello A, Edelbrock C, Kalas R, Kessler M, Klaric SA (1982) Diagnostic Interview Schedule for Children (DISC). National Institute of Mental Health, BethesdaGoogle Scholar
  37. 37.
    Robins LN, Helzer JE, Croughan J, Ratcliff KS (1981) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Arch Gen Psychiatry 38(4):381–389PubMedCrossRefGoogle Scholar
  38. 38.
    Moffitt TR, Silva PA (1988) Self-reported delinquency: results from an instrument for New Zealand. Aust N Z J Criminol 21:227–240CrossRefGoogle Scholar
  39. 39.
    White HL, Labouvie EW (1989) Towards the assessment of adolescent problem drinking. J Stud Alcohol 50:30–37PubMedGoogle Scholar
  40. 40.
    Quay HC, Peterson DR (1987) Manual for the Revised Behavior Problem Checklist. University of Miami, MiamiGoogle Scholar
  41. 41.
    Fergusson DM, Horwood LJ, Lynskey MT (1993) The prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. J Am Acad Child Adolesc Psychiatry 32(6):1127–1134PubMedCrossRefGoogle Scholar
  42. 42.
    Zeger SL, Liang K-Y (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42(1):121–130PubMedCrossRefGoogle Scholar
  43. 43.
    Carlin JB, Wolfe R, Coffey C, Patton GC (1999) Tutorial in biostatistics. Analysis of binary outcomes in longitudinal studies using weighted estimating equations and discrete-time survival methods: prevalence and incidence of smoking in an adolescent cohort. Stat Med 18:2655–2679PubMedCrossRefGoogle Scholar
  44. 44.
    Chen H, Cohen P, Chen S (2010) How big is a big Odds Ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput 39(4):860–864CrossRefGoogle Scholar
  45. 45.
    Muntaner C, Eaton WW, Miech R, O’Campo P (2004) Socioeconomic position and major mental disorders. Epidemiol Rev 26:53–62PubMedCrossRefGoogle Scholar
  46. 46.
    Azzi-Lessing L (2013) Serving highly vulnerable families in home-visitation programs. Infant Mental Health J 34(5):376–390CrossRefGoogle Scholar
  47. 47.
    Sweet MA, Appelbaum MI (2004) Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Dev 75(6):1435–1456PubMedCrossRefGoogle Scholar
  48. 48.
    Coatsworth JD, Pantin H, Szapocznik J (2002) Familias Unidas: a family-centered ecodevelopmental intervention to reduce risk for problem behavior among Hispanic adolescents. Clin Child Fam Psychol Rev 5(2):113–132PubMedCrossRefGoogle Scholar
  49. 49.
    Rones M, Hoagwood K (2000) School-based mental health services: a research review. Clin Child Fam Psychol Rev 3(4):223–241PubMedCrossRefGoogle Scholar
  50. 50.
    Marsh JC, Smith BD, Bruni M (2011) Integrated substance abuse and child welfare services for women: a progress review. Child Youth Serv Rev 33:466–472PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • David M. Fergusson
    • 1
    Email author
  • Geraldine F. H. McLeod
    • 1
  • L. John Horwood
    • 1
  1. 1.Christchurch Health and Development Study, Department of Psychological MedicineUniversity of Otago, ChristchurchChristchurchNew Zealand

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