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EXPERT REACTION: Suicide attempts more common into adulthood for kids struggling at school

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Suicide attempts were significantly more common among people who had done badly at school at age 16, according to a Swedish study of over 26,000 people. The researchers followed people right up until age 46, finding that hospitalisation due to suicide attempts and self-harm was almost five times more common for people who were in the bottom 25 per cent of their year, compared to those in the top 25 per cent. The study authors say that it is not clear whether people attempt suicide due to school failure, or whether poor performance may indicate people who are vulnerable.

Journal/conference: Acta Psychiatrica Scandinavica

Link to research (DOI): 10.1111/acps.12817

Organisation/s: Karolinska Institutet, Sweden

Funder: Forte

Media Release

From: Wiley-Blackwell

Academic Performance Predicts Risk of Suicide Attempt

In a recent Acta Psychiatrica Scandinavica study, poor academic performance, measured as grade point average (GPA) at age 16, was a robust and strong predictor of suicide attempt up to middle age.

For the study, researchers followed 26,315 Swedish girls and boys up to maximum 46 years of age. After controlling for potential confounding factors including childhood IQ, those in the lowest GPA quartile had a near five-fold higher risk of suicide attempt than those in the highest quartile.

“This is a highly elevated risk, and it is remarkable that it reaches far into adulthood. We would however need to know more to identify helpful interventions—for example, is school failure in itself a risk factor, or is poor performance rather an indicator of vulnerability?” said lead author Dr. Alma Sorberg Wallin, of the Karolinska Institutet, in Stockholm, Sweden.

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Alexandra Martiniuk is a Professor of Epidemiology at the University of Sydney

This was a large study of over 26,000 youth followed until middle-age to see if there are any relationships between school grades (Grade Point Average/GPA) and later suicide/self-harm attempts. The study found that graduating high school students who had the lowest grades had a 5-fold increased risk of suicide. This was similar for men and women.
 
The study shows that grades are a better predictor of suicide attempts than IQ – though of course IQ predicts, to some extent, having good grades.
 
This is a strong study due to the number of people enrolled and the use of a nationally representative sample, with strong data collected on IQ when the children were 13 years old and GPA at 16 years old. With such strong data the authors were able to tease out relationships between IQ, GPA and other factors which relate to suicide, such as socioeconomic status, gender, psychiatric disorders, parental well-being, etc. 
 
The study is from a reputable university and Sweden is well known for its robust, nationally representative datasets.  The findings showed a linear relationship (the worse your grades the higher risk for attempting suicide), and are in keeping with less extensive research done in other countries including the USA, China and New Zealand.
 
The authors hypothesised a few ideas for why grades in high school would predict later suicide attempts. Perhaps better grades predict the ability to gain admission to further education (as happens in Australia) and this may lead to a better socio-economic position in life and/or more control over one’s life? Alternatively, it could be that characteristics in childhood - like impulsivity or behaviour challenges - are associated with suicidality, and these characteristics are likely to lead to poor school grades.  Doing poorly in school typically pummels one’s self-esteem and this could also increase risk of suicidality.
 
This study was not able to answer why the relationship between school grades and suicide attempts exists, and there is little existing research that can provide an answer. But there are some important questions that this study can answer. For instance, it wasn’t the tumultuous time just after high school that increased the risk of suicide. It also didn’t make a difference whether children were older for their year (ie delaying school entry by 6-12 months).
 
So what to do about the results? Programs to improve social and emotional abilities in children can increase academic performance and lower emotional distress. Suicide prevention programming supporting youth as well as adults who have or had low GPA are also likely to be useful.

Last updated: 08 Nov 2017 10:38am
Andrew Fuller is a clinical psychologist and Fellow of the Department of Psychiatry and the Department of Learning and Educational Development at the University of Melbourne

Australia has an uneven education system. We have many great schools and we also have schools and areas where opportunities are limited. Not having the opportunity to reach your potential is a risk factor. We also know from Resilient Youth's research on 193,000 Australian young people that the level of resilience promotes academic success and also protects students against suicide.

Last updated: 08 Nov 2017 10:36am

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