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Original Investigation
March 2016

Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania
  • 2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  • 3Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
  • 4School of Social and Community Medicine, University of Bristol, Bristol, England
  • 5Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, England
  • 6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
JAMA Psychiatry. 2016;73(3):239-246. doi:10.1001/jamapsychiatry.2015.2917

Importance  Depression is a common cause of morbidity and disability worldwide. Parental depression is associated with early-life child neurodevelopmental, behavioral, emotional, mental, and social problems. More studies are needed to explore the link between parental depression and long-term child outcomes.

Objective  To examine the associations of parental depression with child school performance at the end of compulsory education (approximately age 16 years).

Design, Setting, and Participants  Parental depression diagnoses (based on the International Classification of Diseases, Eighth Revision [ICD-8], International Classification of Diseases, Ninth Revision [ICD-9], and the International Statistical Classification of Diseases, 10th Revision [ICD-10]) in inpatient records from 1969 onward, outpatient records beginning in 2001, and school grades at the end of compulsory education were collected for all children born from 1984 to 1994 in Sweden. The final analytic sample size was 1 124 162 biological children. We examined the associations of parental depression during different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years, as well as any time before the child’s final year of compulsory schooling) with the final school grades. Linear regression models adjusted for various child and parent characteristics. The dates of the analysis were January to November 2015.

Main Outcome and Measure  Decile of school grades at the end of compulsory education (range, 1-10, with 1 being the lowest and 10 being the highest).

Results  The study cohort comprised 1 124 162 children, of whom 48.9% were female. Maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance. After covariate adjustment, these associations decreased to −0.45 (95% CI, −0.48 to −0.42) and −0.40 (−0.43 to −0.37) lower deciles, respectively. These effect sizes are similarly as large as the observed difference in school performance between the lowest and highest quintiles of family income but approximately one-third of the observed difference between maternal education of 9 or less vs more than 12 years. Both maternal depression and paternal depression at different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years) generally were associated with worse school performance. Child sex modified the associations of maternal depression with school performance such that maternal depression had a larger negative influence on child school performance for girls compared with boys.

Conclusions and Relevance  Diagnoses of parental depression throughout a child’s life were associated with worse school performance at age 16 years. Our results suggest that diagnoses of parental depression may have a far-reaching effect on an important aspect of child development, with implications for future life course outcomes.