Mental health, early school achievement and subsequent school failure among adolescents in Sweden

<i>Aims:</i> Increasing self-reported mental health problems among adolescents in many countries, accompanied by worsening results in international studies of school achievement, raises questions about how school, learning and mental health interact. The purpose of the present study is to analyse the associations between mental health, early school achievement and subsequent school failure in the final year of compulsory schooling in Sweden. <i>Methods:</i> This study is based on a Swedish representative sample of 9020 children born in 2004, which was drawn in 2014 by Statistics Sweden. Three logistic regression models were analysed: regressing school failure in school year 9 on psychiatric diagnoses, grades in school year 6 and sociodemographic variables. <i>Results:</i> Psychiatric diagnoses and grades in school year 6 are strongly associated with school failure in school year 9. These two variables interact, and their combined effects on school failure is striking. Almost every second student with a psychiatric diagnosis and not achieving passing grades in all subjects in school year 6 fails in school year 9. The corresponding figure is 2% for students with no psychiatric diagnosis and passing grades in all subjects in school year 6. <b><i>Conclusions:</i></b> <b>Early identification of signs of risk factors for school failure provides opportunities to prevent mental health problems and to support school achievement. To properly estimate the magnitude of risk factors for failure in school year 9, the interactive effects of psychiatric diagnoses and grades in school year 6 on school failure need to be accounted for.</b>