© 2009 The Royal College of Psychiatrists
Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study
Department of Psychiatry
Hong Kong Mood Disorders Center, Chinese University of Hong Kong, Hong Kong
Center for Reducing Health Disparities, Department of Internal Medicine, University of California, Sacramento, California, USA
Department of Psychiatry, Leipzig University, Germany
Instituto Nacional de Psiquiatria and Universidad Autónoma Metropolitana-Xochimilco Calzada Mexico Unidad Xochimilco, Mexico
State University of New York, Stony Brook, New York, USA
Department of Neurosciences and Psychiatry, University Hospitals Gasthuisberg Leuven, Belgium
IRCCS Centro S. Giovanni di Dio – Fatebebenefratelli Brescia, Italy
Institute for Development, Research, Advocacy and Applied Care, St George Hospital University Medical Centre, Lebanon
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Sant Joan de Deu-SSM, Barcelona, Ciber en Salud Mental, Instituto de Salud Carlos III, Spain
Department of Mental Health, Graduate School of Medicine, Tokyo University, Japan
Ministry of Health, Mental Health Services, Israel
Department of Rural and Indigenous Health, School of Rural Health Faculty of Medicine, Nursing and Health Sciences, Monash University, Moe, Australia
Department of Social Psychiatry and Psychiatric Epidemiology, University Medical Centre, Groningen, The Netherlands
Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, Massachusetts
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Correspondence: Professor Sing Lee, Director, Hong Kong Mood Disorders Centre, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, NT, Hong Kong. Email: singlee{at}cuhk.edu.hk
R.C.K. has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer Inc, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceutical Inc, Pfizer Inc and Sanofi-Aventis.
These activities were supported by the US National Institute of Mental Health (R01-MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01-DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organization, Eli Lilly & Co, Ortho-McNeil Pharmaceutical, Inc, GlaxoSmithKline and Bristol-Myers Squibb. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The European Study of the Epidemiology of Mental Disorders (ESEMeD) is funded by the European Commission (contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP) and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Act 4 Lebanon, anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche and Novartis. The Mexican National Comorbidity Survey (MNCS) is supported by the National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the Pan American Health Organization. Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS–R) is supported by the National Institute of MentalHealth (U01-MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (grant 044708) and the John W. Alden Trust.
Background
Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries.
Aims
To examine the association between early-onset mental disorder and subsequent termination of education.
Method
Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM–IV mental disorders and subsequent non-attainment of educational milestones.
Results
In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4–15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education.
Conclusions
Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.