Abstract
BackgroundThere is a higher prevalence of anxiety and depression among adults with lower educational attainment. Delayed completion of high school (HS) is common and represents a potentially complicating factor in the relationship between educational attainment and anxiety and depression. This study aims to investigate whether delayed HS completion is associated with symptom levels of anxiety and depression in adulthood and whether it interacts with later educational attainment in predicting symptom-levels of anxiety and depression in adulthood.MethodsThe sample consisted of 10 149 participants from the Nord-Trøndelag Health Survey (HUNT 3) between 30 and 46 years of age in 2006. The outcome variables were symptoms of anxiety and depression as measured by the HADS scale. Variables measuring educational attainment were obtained from the National Educational Database in Norway. We used linear regression to estimate associations between educational attainment, delayed HS completion and symptom levels of anxiety and depression in adulthood.ResultsWe found delayed HS completion to be associated with higher symptom levels of both anxiety and depression. There was a dose–response association suggesting that each additional year of delay in HS was associated with higher symptom levels for both anxiety and depression. Mean symptom levels of both anxiety and depression were significantly lower among individuals who completed HS within a normative timeframe vs those who were substantially delayed in their HS completion. For anxiety symptoms, we found a statistically significant interaction between delayed HS completion and later educational attainment. This interaction suggested that individuals with a combination of being delayed in HS and having no higher educational attainment had significantly higher levels of anxiety symptoms than all other combinations of later educational attainment and normative/delayed HS completion. For depression, associations between predictors and symptom levels were additive.ConclusionsDelayed HS completion is associated with symptom levels of both depression and anxiety and interacts with later educational attainment in predicting symptom levels of anxiety. Individuals with a combination of delayed HS completion and lower educational attainment had particularly high symptom levels of anxiety.
Highlights
There is a higher prevalence of anxiety and depression among adults with lower educational attainment
Distribution of anxiety and depression symptoms across levels of educational attainment and normative/delayed high school (HS) completion Our findings indicated an educational gradient where lower educational attainment was associated with higher symptom levels of anxiety and depression, and that delayed completion of HS was associated with relatively higher symptom levels of both, as compared to normative HS completion (Table 1)
Symptom levels of both anxiety and depression were significantly higher among individuals with elementary school and high school with delayed completion relative to individuals with bachelor or master/PhD level education
Summary
There is a higher prevalence of anxiety and depression among adults with lower educational attainment. Social causation theory suggests that there is an elevated risk among individuals of low SES due to mechanisms such as increased stress [6], limited coping recourses [7], or lack of occupational direction, control and planning [8]. Social selection theory on the other hand explains the educational gradient in anxiety and depression by impaired social mobility among individuals with mental disorders [9], suggesting that early onset of anxiety and/or depression impairs individuals’ ability to attain higher educational credentials. Results from other studies provide evidence in support of social selection theory as they suggest that individuals with early onset internalizing disorders are less likely to complete high school and to make other educational transitions [14,15,16]. A study by Fergusson and colleagues [17] provides results in line with social selection as they found that the increased risk of mental disorders among individuals without upper secondary credentials attenuated to non-significance when controlling for childhood adversity and adolescent mental health problems at 14 to 16 years of age
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