Background Poor academic performance in childhood is associated with suicide attempt in adulthood, but the mechanisms are not known. We investigated educational attainment as a possible pathway.
Methods We followed two sets of cohorts, born around 1950/1970, respectively, in the Swedish population-representative ‘Evaluation Through Follow-up’ study for a first suicide attempt in national records up to 2013. Data on grade point average (GPA) at age 13/16 and educational attainment (years of schooling) in adulthood were used. The path models included linear and Cox proportional hazards regressions. A model with matched age range during follow-up was used to compare the cohorts.
Results In the 1970 cohort, the association between GPA and suicide attempt between age 26 and 46 was partly mediated by attained education (total association, β=−0.82; via education: −0.29, per SD increase in GPA), but GPA also had a direct path to suicide attempt (β=−0.53). There was no evidence of such a pathway in the 1950 cohort between age 41 and 65. In the age-matched analysis, at age 26–46, the association between GPA and suicide attempt was stronger in the 1970 cohort compared to the 1950 cohort (β=−0.72 and −0.24, respectively).
Conclusions Differences in attained education seem to partly explain the associations of academic performance with suicide attempt up to middle age. Furthermore, there is some indication that academic performance may have become more important for young people’s mental health than it was in previous generations.
- Cohort studies
- social and life-course epidemiology
- social inequalities
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Contributors ASW and DF conceived the study and drafted the first versions of the manuscript, ASW performed the data management and KS performed the statistical analyses. All authors contributed to the design of the study and the interpretation of data, contributed with important intellectual content to the manuscript and have approved the final version to be published.
Funding This study was funded by Forte (grant numbers 2015-00057 and 2017-00173).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Regional Ethics Board in Stockholm, Sweden, approved this project. The data were linked and anonymised by Statistics Sweden before granting access for research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.
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