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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 10/2012

01-10-2012 | Original Paper

School performance and hospital admission due to unipolar depression: a three-generational study of social causation and social selection

Authors: Ulf Jonsson, Anna Goodman, Anne-Liis von Knorring, Lars von Knorring, Ilona Koupil

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 10/2012

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Abstract

Purpose

Both “social causation” and “social selection” offer plausible explanations for an association between education and mental health. We aimed to explore these processes in unipolar depression, with a specific focus on school performance and family tradition of education.

Method

Grandchildren (N = 28,089, 49% female, aged 13–47 years in 2002) of a cohort born in Uppsala, Sweden, in 1915–1929 were studied in national registers. We obtained data on final grade point average (GPA) in compulsory school, hospitalizations for unipolar depression, grandparental/parental education and other parental social characteristics. Hospitalization in adolescence and adulthood were studied separately, as were hospitalization for depression with or without a lifetime externalizing disorder.

Results

Low compulsory school GPA (1–2 SD or >2 SD below average vs. average GPA) was associated with increased rate of adolescent hospitalization for unipolar depression, both with externalizing comorbidity [hazard ratio (HR) point estimates of 66–80] and without (HR point estimates of 4–6). By contrast, low GPA was only associated with first-time hospitalization in adulthood for the subgroup with externalizing comorbidity (HR point estimates of 4–6). These associations were largely independent of family education and social characteristics. Overall, low parental/grandparental education was not related to increased rates of hospitalization.

Conclusion

The association between school performance and hospitalization for depression depended on adolescent hospitalization or externalizing comorbidity, suggesting that disorders with an early onset are decisive. Contrary to the social patterning of many health outcomes, low grandparental/parental education did not appear to increase the rate of hospitalization for unipolar depression in the offspring.
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Metadata
Title
School performance and hospital admission due to unipolar depression: a three-generational study of social causation and social selection
Authors
Ulf Jonsson
Anna Goodman
Anne-Liis von Knorring
Lars von Knorring
Ilona Koupil
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 10/2012
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-012-0476-y

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