Systematic review and meta-analysis: The association between child and adolescent depression and later educational attainment

Abstract

Objective: The association between depression and educational attainment in young people is unclear. This systematic review and meta-analysis examines the longitudinal association between depression and subsequent attainment, and its potential effect modifiers and mediators. Method: We searched Embase, PsycINFO, PubMed, ERIC and British Education Index from inception to 23 October 2019, conducted citation searching, and contacted authors for articles. Eligible studies reported on the longitudinal association between depression in children and adolescents age 4-18 years and later educational attainment. Two reviewers independently conducted screening, data extraction, and risk of bias assessment. Correlation coefficients were pooled in meta-analysis, and effect modifiers were explored using metaregression and stratification. Other evidence on confounders, modifiers and mediators was narratively synthesized. PROSPERO record: CRD42019123068. Results: Thirty-one studies were included, of which 22 were pooled in meta-analysis. There was a small but statistically significant association between depression and lower subsequent attainment (pooled Fisher’s z=-0.19, 95% CI=-0.22 to -0.16, I 2=62.9%). Fifteen studies also reported an enduring effect after adjusting for various confounders. No statistically significant effect modifiers were identified. Social and school problems may mediate between depression and low attainment. Conclusion: Depression was associated with lower educational attainment, but further research is needed to establish mechanisms. Nonetheless, there is a clear need for mental health and educational support among children and adolescents with depression.