Mental health in adolescence and subsequent receipt of medical benefits in young adulthood: The mediating role of upper secondary school completion

Abstract

Background: Mental health problems in adolescence are associated with impaired function in young adulthood. Our aim was to assess how a hypothetical reduction in mental health problems in adolescence was related to medical benefits in young adulthood and to examine the mediating role of completion of upper secondary school. Methods: We used a population-based sample of more than 10,000 10th-grade adolescents with self-reported data on internalizing and externalizing mental health problems. The sample was linked to the Norwegian national registers of education and medical benefits. The mediation analysis was based on a causal inference framework. Results: During a three-year period in young adulthood, 6.4% of men and 5.9% of women received medical benefits. A two-point hypothetical reduction in externalizing problems was related to a lower probability of receiving medical benefits of 1.5 (95% confidence interval (CI) 1.0–2.1) percentage points in young men and 1.8 (95% CI 1.3–2.3) percentage points in young women. The proportion mediated by the completion of upper secondary school was 52% (95% CI 36–76) among boys and 42% (95% CI 29–60) among girls. The corresponding reduction in the probability of receiving medical benefits was 1.8 percentage points for internalizing problems in both sexes (95% CI boys 1.2–2.4 and girls 1.4–2.2). The proportion mediated was lower for internalizing problems and was only significant among girls (19%). Conclusions: Intervention and prevention strategies targeting internalizing and externalizing problems in adolescents may have the potential to reduce the receipt of medical benefits in young adulthood. The completion of upper secondary school seems to be a mechanism for this association, especially for externalizing problems.

Keywords

Mental health medical benefits longitudinal studies mediation

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References

OECD. Off to a good start? Jobs for youth. Paris: OECD, 2010.

OECD. Jobs for youth, Norway. Paris: OECD, 2008.

Lee

Tsang

Breslau

. Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study. Br J Psychiatry 2009;194:411–7.

De Ridder

Pape

Johnsen

. School dropout: a major public health challenge: a 10-year prospective study on medical and non-medical social insurance benefits in young adulthood, the Young-HUNT 1 Study (Norway). J Epidemiol Community Health 2012;66:995–1000.

WHO. Health for the world’s adolescents: a second chance in the second decade. Geneva, World Health Organization, 2014.

Erskine

Moffitt

Copeland

. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015;45:1551–63.

Sagatun

Heyerdahl

Wentzel-Larsen

. Mental health problems in the 10^th grade and non-completion of upper secondary school: the mediating role of grades in a population-based longitudinal study. BMC Public Health. 2014;14:16.

Esch

Bocquet

Pull

. The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving. BMC Psychiatry 2014;14:237.

Breslau

Miller

Joanie Chung

. Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. J Psychiatr Res 2011;45:295–301.

10.

Fergusson

Horwood

. Early conduct problems and later life opportunities. J Child Psychol Psychiatry 1998;39:1097–108.

11.

Patel

Flisher

Hetrick

. Mental health of young people: a global public-health challenge. Lancet 2007;369:1302–13.

12.

Costello

Maughan

. Annual research review: optimal outcomes of child and adolescent mental illness. J Child Psychol Psychiatry 2015;56:324–41.

13.

Copeland

Wolke

Shanahan

. Adult functional outcomes of common childhood psychiatric problems: a prospective, longitudinal study. JAMA Psychiatry 2015;72:892–9.

14.

Norwegian Institute of Public Health. Youth studies 2000–2009, www.fhi.no/artikler/?id=105586 (2013, accessed 22 March 2015).

15.

Brage

Thune

. Medisinske årsaker til uføreytelser blant unge 1977–2006. In: velferdsdirektoratet

Arbeids-og

(ed.) Arbeid og velferd. Oslo: Arbeid-og velferdsdirektoratet, 2008, pp.28–36.

16.

Markussen

Frøseth

Sandberg

. Early leaving, non-completion and completion in upper secondary school in Norway. In: Lamb

Markussen

Teese

. (eds) School dropout and completion: international comparative studies in theory and policy. Dordrecht: Springer, 2011, pp.253–71.

17.

Goodman

Lamping

Ploubidis

. When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. J Abnorm Child Psychol 2010;38:1179–91.

18.

Lie

. Immigration and immigrants 2002. Oslo: Statistics Norway, 2002.

19.

Statistics Norway. Norwegian standard classification of education (NOS C 751), www.ssb.no/english/subjects/04/90/nos_c751_en/nos_c751_en.pdf (2008, accessed 1 January 2008).

20.

Statistics Norway. Income and property statistics for households 2002 (NOS D 310), www.ssb.no/emner/05/01/nos_inntektformue/nos_d310/nos_d310.pdf (2008, accessed 2 January 2008).

21.

Tingley

Yamamoto

Keele

. Mediation: R Package for Causal Mediation Analysis. R package version 4.1.2., http://CRAN.R-project.org/package=mediation (2012, accessed 10 December 2015).

22.

Imai

Keele

Tingley

. A general approach to causal mediation analysis. Psychological Methods 2010;15:309–34.

23.

Fayers

Machin

. Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. Chichester: Wiley, 2007.

24.

Goodman

. Strengths and difficulties questionnaire as a dimensional measure of child mental health. J Am Acad Child Adolesc Psychiatry 2009;48:400–3 [erratum J Am Acad Child Adolesc Psychiatry 2009;48:581].

25.

Pape

Bjorngaard

Holmen

. The welfare burden of adolescent anxiety and depression: a prospective study of 7500 young Norwegians and their families: the HUNT study. BMJ Open 2012;2:e001942.

26.

Gravseth

Bjerkedal

Irgens

. Influence of physical, mental and intellectual development on disability in young Norwegian men. Eur J Public Health 2008;18:650–5.

27.

Sagatun

Heyerdahl

Wentzel-Larsen

. Medical benefits in young adulthood: a population-based longitudinal study of health behaviour and mental health in adolescence and later receipt of medical benefits. BMJ Open 2015;5:e007139.

28.

Fergusson

Woodward

. Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry 2002;59:225–31.

29.

Colman

Murray

Abbott

. Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 2009;338:a2981.

30.

Brage

Bragstad

. Unge på arbeids-og helserelaterte ordninger. Oslo: Arbeids-og velferdsdirektoratet, 2011.

31.

Fergusson

Horwood

Ridder

. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry 2005;46:837–49.

32.

Lambert

Wahler

Andrade

. Looking for the disorder in conduct disorder. J Abnorm Psychol 2001;110:110–23.

33.

Weisz

. Psychotherapy for children and adolescents: evidence-based treatments and case examples. Cambridge: Cambridge University Press, 2004.

34.

Greenberg

. School-based prevention: current status and future challenges. Effective Education 2010;2:27–52.

35.

Smedler

A-C

Hjern

Wiklund

. Programs for prevention of externalizing problems in children: limited evidence for effect beyond 6 months post intervention. Child & Youth Care Forum 2015;44:251–76.