Study finds prevention of mental health problems among schoolchildren could avoid dropout

Brasilia [Brazil], January 24 : The impact of mental health on a child's education and schooling was never taken seriously in this day and age of ruthless and cut-throat competition. At least ten out of every 100 girls older than the appropriate age for their school grade could have accompanied their age group if mental health problems were prevented or treated.
New findings from an innovative survey led by a group of Brazilian and British scientists and reported in an article published in the journal 'Epidemiology and Psychiatric Sciences' reveals many things. The authors set out to estimate the weight and impact of various kinds of psychiatric disorders on educational outcomes.
Among children in the Brazilian public education system, data on the incidence of mental health problems are also reflected by grade repetition: five out of every 100 girls would not have been failed. For boys, the age-grade distortion would have been avoided in 5.3 per cent of cases, and grade repetition in 4.8 per cent.
Using data for 2014, they concluded that externalizing disorders had broader and more robust negative effects on educational attainment than disorders associated with anxiety and fear. A breakdown by gender showed that they were particularly harmful to girls, resulting in lower levels of literacy and more frequent bullying.
At least 11 out of every 100 reports of physical or psychological bullying by girls in Brazilian schools could have been avoided if externalizing disorders had been prevented or treated. For boys, phobias and depression entailed higher school dropout rates.
"In epidemiological terms, boys generally have more externalizing disorders, with case numbers reaching double those of girls. In terms of educational outcomes, however, we found that the risk is greater for girls.
One of the hypotheses that could explain this finding is a social stigma, since aggressive or oppositional behavior is not expected from girls, and they may suffer more and perform less well at school. The same is true of depression in the case of boys. Society assumes they don't cry or express feelings," Mauricio Scopel Hoffmann, first author of the article, told Agencia FAPESP. Hoffmann is a professor in the Department of Neuropsychiatry at the Federal University of Santa Maria (UFSM) in Rio Grande do Sul (Brazil).
The data was obtained from the Brazilian High-Risk Cohort Study for Childhood Psychiatric Disorders (BHRC[KM1]), a large school-based survey that has followed over 1,000 children since 2010.
In their discussion of the 2014 data, the researchers contextualized their findings from a populational perspective and, while warning that their estimates were probably conservative, concluded that at that time at least 591,000 schoolchildren could have been in the right grade for their age if psychiatric disorders had been prevented or treated. Repetition could have been avoided for some 196,000 on the same basis.
According to Hoffmann, the situation continued to be similar seven years later, evidencing the importance of prevention and treatment of mental problems if educational results are to be improved. In 2014, 49.8 million children were enrolled in the first nine grades at 188,700 public and private schools. In 2020, these numbers had fallen to 47.3 million and 179,500 respectively.
Considered one of the most ambitious childhood mental health surveys ever conducted in Brazil, the BHRC, also known as Project Connection - Minds of the Future, is part of the National Institute of Developmental Psychiatry (INPD).
INPD has been supported by FAPESP and the National Council for Scientific and Technological Development (CNPq). Its principal investigator was Euripedes Constantino Miguel Filho, a professor in the Department of Psychiatry at the University of Sao Paulo's Medical School (FM-USP).
For this latest study, the researchers analyzed baseline (2010-11) data and three-year follow-up (2013-14) BHRC data, considering a screening stage and an assessment stage. Propensity score weights (PSWs) were used to balance participants with and without psychiatric conditions for baseline characteristics.
In the screening stage, all parents at 22 state-funded schools in Porto Alegre and 35 in Sao Paulo were invited to participate on compulsory school registration days in 2010. A total of 2,511 families were selected for the full household assessment, including children aged 6-14.
Psychiatric disorders were grouped into three broad categories: fear-related conditions, including panic, separation and social anxiety disorder, specific phobia and agoraphobia; distress-related conditions, including anxiety disorder, depressive disorders, bipolar disorder, obsessive-compulsive disorder, and post-traumatic stress disorder; and externalizing conditions, including attention deficit, hyperactivity, and oppositional-defiant conditions.
The researchers used the Development and Wellbeing Assessment (DAWBA), a package of interviews, questionnaires, and rating techniques, and calculated population-attributable risk percentages to estimate the proportion of adverse educational outcomes that could be attributed to psychiatric conditions. The analyses were conducted separately for males and females.
"One of the aims was to find out whether undesired school events could be avoided if mental health problems were treated, and to what extent," Hoffmann said. "We obtained a very clear practical result, since outcomes such as age-grade distortion, repetition, dropout, and bullying are linked to this question," Hoffmann said.
Besides the adverse impacts on education, particularly for girls, mental health problems can limit future socio-economic opportunities, leading to an increase in gender inequity in the labour market, for example.
Estimates suggested that one in four people may develop mental health problems during their lifetime. Psychiatric disorders were among the leading causes of incapacitation in the 14-50 age group. According to projections by the World Health Organization (WHO), the cost of these cases to the world economy could reach USD 6 trillion in 2030.
"Correct diagnosis is the first step," Hoffmann said. "This would help reduce some of the problems faced by schools. Policies that encourage detection of psychiatric disorders in childhood and adolescence, permitting early intervention, could have profound consequences for educational attainment throughout the population."
The school census carried out in 2020 by Brazil's Ministry of Education pointed to age-grade distortion in 22.7 per cent of the children enrolled in the final grades of primary education, and 26.2 per cent of those in secondary education. The proportion increased from the third year of primary schooling onward, peaking in the seventh year of primary school and the first year of secondary school.
The distortion resulted from the number of children who had failed and/or dropped out in a given school year, among other factors. The process would be hard to reverse. Children who fell behind in the early years of their basic education tended to remain too old for their grade until adolescence, and often dropped out before they graduated from high school as a result.
Indeed, Brazil had the fourth-highest percentage of schoolchildren who repeated a grade at least once during their formal education among 79 countries analyzed in a report published by the Organization for Economic Cooperation and Development (OECD). In the 15-year-old age group, 34 per cent repeated a grade at least once. Ahead of Brazil were Morocco with 49.3 per cent, Colombia with 40.8 per cent, and Lebanon with 34.5 per cent. The report was published in 2020 and ws based on indicators from the OECD's Program for International Student Assessment (PISA).
According to Hoffmann, who is a medical doctor, education and health should partner to strengthen prevention as one of the ways to reduce the adverse effects of psychiatric disorders on schooling. "Attention deficit and hyperactivity disorder [ADHD] is an example. We know only 20 per cent of these cases are detected in Brazil. If we could lift that to 30 per cent, some 8,000 grade repetitions could be avoided each year," he said.
Teachers could usefully help. The Brazilian research group has created a handbook to help teachers deal with student mental health problems, stressing the importance of their role as mediators to avoid stigma.
Mental health has come to the fore during the COVID-19 pandemic, and new research has focused on the effects on children and adolescents of social distancing, confinement, and remote schooling. According to Hoffmann, a group led by Patricia Pinheiro Bado, a researcher in the field of neuroscience and human behavior, was investigating the links between engagement in online learning and child mental health.
Recently published British research presented evidence that children, adults, and seniors with prior mental health problems had suffered more during the pandemic owing to job loss, illness, and emotional hardship.
In Brazil, where schools remained closed for a long period because of COVID-19, the United Nations Children's Fund (UNICEF) estimated that 1.5 million children aged 6-17 were out of school and not taking online classes in November 2020, while another 3.7 million attended school but no school activities were available and they were unable to continue learning at home.