The impact of child psychiatric conditions on future educational outcomes among a community cohort in Brazil.
The impact of child psychiatric conditions on future educational outcomes among a community cohort in Brazil.
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DOI：
10.1017/s2045796021000561
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发表时间：
2021-10-28
影响因子：
8.1
通讯作者：
Evans-Lacko S
中科院分区：
文献类型：
--
作者：
Hoffmann MS;McDaid D;Salum GA;Silva-Ribeiro W;Ziebold C;King D;Gadelha A;Miguel EC;Mari JJ;Rohde LA;Pan PM;Bressan RA;Mojtabai R;Evans-Lacko S
生命早期的心理健康问题会对教育程度产生负面影响，反过来又对健康、社会和经济机会产生长期的负面影响。我们的目标是：（i）估计不同类型的精神状况对教育成果的影响;（ii）估计可归因于精神状况的不良教育成果的比例。参与者（N = 2511）来自一个以学校为基础的社区队列的巴西儿童和青少年年龄在6-14岁丰富的高家庭风险的精神疾病。我们研究了恐惧的影响-（惊恐、分离及社交焦虑症、特定恐怖症、广场恐怖症及未另列明的焦虑症）、痛苦-（广泛性焦虑症、重度抑郁症和未另作说明的抑郁症、双相情感障碍、强迫症、抽搐、进食和创伤后应激障碍）和与外界有关的疾病（注意力缺陷和多动障碍，行为和对立违抗条件）对留级，辍学，年龄-年级扭曲，识字表现和欺凌犯罪，3年后。精神科医生使用发展和幸福行为评估确定精神状况。倾向评分和逆概率加权用于调整潜在混杂因素，包括合并症和样本损耗。我们计算了人群归因风险百分比，以估计人群中可归因于精神疾病的不良教育结果的比例。分别对雄性和雌性动物进行分析。男性的恐惧和痛苦状况分别与辍学（比值比（OR）= 2.76; 95%置信区间（CI）= 1.06，7.22; p < 0.05）和留级（OR = 2.76; 95% CI = 1.32，5.78; p < 0.01）相关。外部化条件与男性留级有关（OR = 1.66; 95% CI = 1.05，2.64; p < 0.05）和女性（OR = 2.03; 95%CI = 1.15，3.58; p < 0.05），以及男性的年龄分级扭曲（OR = 1.66; 95%CI = 1.05，2.62; p < 0.05）和女性（OR = 2.88; 95%CI = 1.61，5.14; p < 0.001）。在女性中，外部化条件也与较低的识字水平（β =-0.23; 95% CI =-0.34，-0.12; p < 0.001）和欺凌行为（OR = 3.12; 95% CI = 1.50，6.51; p < 0.001）有关。如果所有的外部条件得到预防或治疗，我们估计，5.0和4.8%的年级重复不会发生在女性和男性，分别为10.2（女性）和5.3%（男性）的年龄级失真的情况下，11.4%的女性欺凌犯罪。这项研究提供了证据表明，在一个大型巴西队列中，精神疾病对教育成果产生了负面影响。外部化条件对教育的负面影响最为广泛和强烈，对女性尤其有害，可能会限制未来的社会经济机会。
Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions. Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6–14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising-related conditions (attention deficit and hyperactivity disorder, conduct and oppositional-defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females. Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (β = −0.23; 95% CI = −0.34, −0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration. The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities.