Lower levels of education in children and adolescents were associated with symptoms of depression. These results from a systematic review and meta-analysis were published in the Journal of the American Academy of Child & Adolescent Psychiatry.
Researchers from King’s College London searched publication databases for prospective longitudinal studies (N = 31) on depression and educational attainment in participants aged 4 to 18 years until November 13, 2018.
The included studies had sample sizes between 129 and 7276 participants aged 6 to 17 years with follow-up times of <1 to 14 years. All studies were gender balanced, with the exception of 1, which included 88% girls and 22% boys. The variants of the child depression inventory were the most commonly implemented diagnostic tool.
The measured co-founders were not very consistent in all studies. Some analyzes reported a greater effect of depression in boys and others in girls. Many studies found that a component of ethnicity, social connectivity, or school quality contributed to this. One study found a link between exam performance at 18 years of age and depression at 12 years of age, suggesting lasting effects of childhood depression.
A subset of 22 studies was selected for the meta-analysis. The omitted studies did not report bivariate associations between depression and educational level.
It has been observed that depression and educational qualifications are negatively associated (summarized by Fischer’s z [z]-0.19; 95% Cl, -0.22 to -0.16; at 13.32; P <0.001) with a correlation coefficient of -0.19, which accounted for 3.6% of the variance in educational level.
The follow-up time (P = 0.934) or age at baseline (P = 0.989) were not significant contributors to the observed association. In the meta-analysis studies, moderate heterogeneity was observed (I2, 62.9%; Q.56.66; P <0.001) without publication bias (Egger test P = 0.630).
The mean Newcastle-Ottawa scale (NOS) was 7/11 and 6 studies met less than half of the quality criteria. Although the NOS score indicated that these studies were of high quality overall, the researchers found that none of the studies included a performance analysis to justify their presented sample sizes, and many studies did not include effect estimates, P-values, standard errors, or confidence intervals.
This study was limited by the underlying study designs. Few studies performed multivariate analyzes that took into account potential co-founders such as socio-economic status or basic level of education. This limited the researchers’ ability to pool effect sizes for potential covariates. It remains unclear to what extent other factors contributed to the variance observed for educational level.
These results indicated that there was a small but significant negative association between symptoms of depression in educated adolescents. More studies quantifying the effect contributing to the interaction between educational attainment and depression are needed to more fully examine these relationships.
Wickersham A., Sugg HVR, Epstein S. et al. Systematic review and meta-analysis: the relationship between depression in children and adolescents and later educational level. J Am Acad Child Adolesc Psychiatry. 2020; S0890-8567 (20) 32049-9. doi: 10.1016 / j.jaac.2020.10.008.
This article originally appeared on Psychiatry Advisor