Children, adolescents, and young adults with registered mental health problems in general practice and their long-term educational and labor market outcomes.
Abstract
Mental health problems in childhood, adolescence, and young adulthood are associated with adverse educational and labor market outcomes, including delayed cognitive and academic development (1–3), lower educational attainment (4,5), and unemployment (6,7). On a societal level, such outcomes may negatively impact economic growth and welfare (8). Most register data studies on the association between youth mental health problems and educational and labor market outcomes later in life have focused on the association between mental health problems and educational completion and unemployment, while less attention has been paid to Not in Employment, Education, or Training (NEET) status (9). However, the few available studies suggest that youth mental health problems are strongly associated with being NEET (9). Moreover, relatively few studies have examined educational and labor market outcomes simultaneously, despite evidence that educational attainment strongly shapes labor market opportunities in the Netherlands (10–12). In our study, we therefore will investigate both educational and labor market outcomes. Research on educational and labor market outcomes rarely uses Electronic Health Records (EHRs) to identify mental health problems (9). While survey studies focus on population-level trends of self-reported mental health problems, EHRs indicate healthcare utilization patterns and the recognition of mental health problems within the mental healthcare system (13,14). Compared to survey data, EHRs routinely record data in large populations and are less prone to selective nonresponse, response bias, and recall bias (15,16). Existing EHR studies typically rely on indicators such as psychiatric medication use (17) or psychiatric hospital admissions (18). In the Netherlands, however, general practitioners (GPs) are often the first professional contact for mental health problems and function as gatekeepers to these specialized care (19,20). GP EHRs therefore early identify a broad range of mental health problems, including symptoms and complaints, which are less extensively identified in specialized mental healthcare. Whether recorded mental health problems in general practice are associated with long-term educational and labor market outcomes remains largely unknown. This study addresses that question using Dutch general practice data and link these data with educational and labor market data from Statistics Netherlands. It also remains unclear whether associations differ according to the developmental stage at which mental health problems occur (9). Many previous studies measured mental health problems and educational or labor market outcomes at a single point in time, limiting insight into age-specific associations (21–27). Yet mental health problems arising during different developmental stages may have distinct implications for later educational and labor market trajectories (1,2). We therefore examine mental health problems registered in childhood, adolescence, and young adulthood and the extent to which they relate to long-term educational and labor market outcomes. In summary, this study examines long-term educational and labor market outcomes among children, adolescents, and young adults with mental health problems recorded in Dutch general practice. Specifically, we investigate a broad range of mental health problems, including internalizing and externalizing problems, in relation to educational attainment and NEET status. References 1. Jackson MI. Understanding links between adolescent health and educational attainment. Demography. 2009 Nov 1;46(4):671–94. doi:10.1353/dem.0.0078 2. McLeod JD, Fettes DL. Trajectories of Failure: The Educational Careers of Children with Mental Health Problems. 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