The effect of early onset common mental disorders on educational attainment in Australia
Introduction
Psychiatric disorders have considerable personal and financial costs for individuals and their families. There is also a cost to the broader community, which must be identified and taken into account when estimating the overall burden of mental disorders. One mechanism by which early onset mental disorders may limit subsequent personal opportunities in life for employment and financial security, and contribute to overall societal burden through negative impacts on workforce participation and increased welfare receipt, is the early termination of education (Freudenberg and Ruglis, 2007).
The age of onset of mental disorders has been shown to be an important factor in predicting the course of illness and psychosocial factors such as educational attainment (Zisook et al., 2004, Levine and Rabinowitz, 2009). Several studies have found a link between early onset mental disorders and premature termination of schooling. One of the first studies to examine the effect of pre-existing psychiatric disorders on educational attainment was conducted in the United States, and found that adolescent mood, anxiety and substance use disorders were all associated with the early termination of schooling at the stages of high school graduation, college entry and college completion (Kessler et al., 1995). Subsequent to this investigation, other US studies conducted by Breslau et al. (2008) and Vander Stoep et al. (2003) reported similar findings and estimated that 10–50% of high school dropout may be attributable to the negative effects of prior mental disorders. Data from South Africa showed that post-traumatic stress disorder, major depressive disorder and substance use disorder during childhood and adolescence were associated with an approximate two fold increase in the odds of failing to complete secondary education (Myer et al., 2009). The Christchurch Health and Development study reported two-fold increased likelihood of leaving school early for those with early onset major depression; although this finding was no longer significant after adjusting for childhood adversity (Fergusson and Woodward, 2002). Cross-national research conducted by Lee et al. (2009) supports previous findings. Results from the World Health Organisation World Mental Health Survey demonstrated that in high income countries anxiety disorders, mood disorders and substance use disorders were associated with incomplete secondary education, whereas in low income countries substance use was associated with incomplete secondary education (Lee et al., 2009).
The current study adds to this growing body of international evidence by investigating the impact of early onset mental disorders on educational attainment in Australia. It uses nationally representative data from the 2007 National Survey of Mental Health and Wellbeing and is the first Australian study to investigate this research question. A recent Australian study conducted by Waghorn et al. (2011) demonstrated strong cross-sectional links between psychiatric disorders and disrupted education and employment experiences. The present study builds on this work to investigate the impacts of early onset disorders on subsequent disruption to secondary school education. Education is accessible to all young people in Australia, however, the most recent Australian Census reports that of those aged between 20 and 35 around four per cent did not complete year 10 and 23% did not complete year 12 (Australian Bureau of Statistics (ABS), 2006). Completing year 10 (the age of 15 or 16 depending on the State or Territory) was compulsory in Australia at the time the data for this study was collected (2007). In addition, measures have recently been taken in most states and Territories (in 2009/2010) to encourage attendance until Year 12 (the age of 17 or 18). For example, in the Australian Capital Territory it is now compulsory for young people to participate in full-time education, training or employment until completing year 12 or the equivalent, or until they reach the age of 17 (Australian Capital Territory Government, 2012). These policy changes demonstrate the push for high school education completion in Australia. Given the personal and societal benefits of maximising educational attainment, accurate information about how early onset disorders are affecting levels of educational attainment in Australia is needed. The aim of the current investigation is to identify the impact of early onset (pre-existing) affective, anxiety and substance use disorders on the early termination of secondary school education in Australia.
Section snippets
Sampling and procedure
The analyses used data from the confidentialised unit record file of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). The survey methodology identified a stratified, multistage area probability sample of private dwellings from across Australia, and selected one household member aged between 16 and 85 years from each household for interview. This resulted in a sample of 8841 respondents from 14,805 households; a response rate of 60%. Interviews were conducted by
Results
Table 1 shows the percentage of men and women experiencing an early onset disorder, as well as the percentage experiencing no disorder. In this table, the early onset disorder category is separated into two groups, the first represents the percentage of people with a disorder before the completion of year 10 (<16 years age) and the second represents the percentage of people with a disorder before the completion of year 12 (<18 years), but after the completion of year 12 (16–17 years age). While
Discussion
The current study finds that early onset mental disorders are significantly associated with the subsequent early termination of education in Australia. Males were more likely to have not completed year 10 (the minimal secondary education qualification) if they had previously experienced any mental disorder, particularly any early onset (<16 years age) affective disorder (primarily bipolar), and any substance use disorder (alcohol, cannabis and stimulant use disorders). For women, incomplete
Acknowledgements
PB was supported by the National Health and Medical Research Council Career Development Award Fellowship, 525410.
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