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Academic performance, subsequent socioeconomic status and suicide attempt in adulthood: path analyses on Swedish cohort data
  1. Alma Sörberg Wallin1,
  2. Kimmo Sorjonen2,
  3. Anton Lager1,3,
  4. Daniel Falkstedt1
  1. 1 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Clinical Neurosciences, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
  3. 3 Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
  1. Correspondence to Alma Sörberg Wallin, Department of Global Public Health, Karolinska Institutet, Stockholm SE-171 77, Sweden; alma.sorberg.wallin{at}


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
  • education
  • social and life-course epidemiology
  • parasuicide
  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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