A Danish study published in JAMA Psychiatry found that almost all mental disorders occurring in childhood or adolescence impaired an individual’s ability to perform in school and negatively affected educational achievement. The findings point to the importance of robust educational support for young people with psychiatric conditions.

Low educational achievement during childhood predicts a number of adverse outcomes in adulthood, including greater risk of low socioeconomic status, poor health, suicidal behavior, and premature death. Children who have psychiatric disorders are more likely to miss days of school and more likely to drop out of high school.

Soren Dalsgaard, MD, PhD, of the National Centre for Register-Based Research, Aarhus University, Denmark, and colleagues conducted a population-based cohort study using data obtained from the Danish Civil Registration System and other nationwide registers. They assessed 2 cohorts: all children born in Denmark between 1988 and 1999 who were alive at age 17 years and all children who took the final examination at the end of ninth grade in both Danish and mathematics. The exposure was clinical diagnosis by a psychiatrist of any mental disorder before the age of 16 years.

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In the study population (N=629,622), 83% of the sample (n=523,312) took the final examination and 6% (n=38,001) were diagnosed with a mental disorder. Those who had a diagnosis of a mental disorder were less likely to take the final examination (0.52) compared with individuals without mental disorders (0.88). The proportion of individuals taking the examination varied across mental disorders and was lowest among those with intellectual disabilities (girls: 0.11; boys: 0.7) and highest for those with anorexia nervosa (girls: 0.83; boys: 0.80).

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Girls were more likely than boys to take the examination in both the cohort with (0.63 vs 0.45) and without (0.91 vs 0.86) mental disorders. When compared with the grades of same-sex individuals without mental disorders, grades were significantly lower among boys with disorders than among girls (standardized mean grade difference, -0.30 vs -0.24). However, both boys and girls with anorexia nervosa scored higher than their peers without mental disorders (standardized mean grade difference, 0.31 and 0.38, respectively). Among individuals with anxiety, attachment disorders, attention-deficit/hyperactivity disorder, and other developmental disorders, girls achieved relatively lower standardized mean grades compared with boys.

The study included a number of limitations, including the fact that hospitals report diagnoses to the Danish registries, thus excluding those with a diagnosis from a private practice psychiatrist from the database. This flaw may have led to a slight underestimation of the negative impact of mental illness on educational achievement.

“For children and adolescents, school is not merely for learning skills such as mathematics and writing but also for achieving developmental milestones and interacting with peers,” the researchers noted. Given the negative consequences of childhood mental disorders on achievement in adulthood, they also called for “additional support in school for children and adolescents with mental disorders.”


Dalsgaard S, McGrath J, Ostergaard SD, et al. Association of mental disorder in childhood and adolescence with subsequent educational achievement. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2020.0217