Prevention of mental health problems among schoolchildren could avoid grade repetition and dropout

At least ten out of every 100 girls older than the appropriate age for their school grade could have accompanied their age group if mental health problems were prevented or treated, especially externalizing disorders (problematic behavior relating to poor impulse control, such as attention deficit and hyperactivity, aggression, impulsivity, and rule-breaking). Among children in the Brazilian public education system, data on the incidence of mental health problems are also reflected by grade repetition: five out of every 100 girls would not have been failed. For boys, the age-grade distortion would have been avoided in 5.3% of cases, and grade repetition in 4.8%.

These findings come from an innovative survey led by a group of Brazilian and British scientists and reported in an article published in the journal Epidemiology and Psychiatric Sciences. The authors set out to estimate the weight and impact of various kinds of psychiatric disorders on educational outcomes. 

Using data for 2014, they concluded that externalizing disorders had broader and more robust negative effects on educational attainment than disorders associated with anxiety and fear. A breakdown by gender showed that they were particularly harmful to girls, resulting in lower levels of literacy and more frequent bullying.

At least 11 out of every 100 reports of physical or psychological bullying by girls in Brazilian schools could have been avoided if externalizing disorders had been prevented or treated. For boys, phobias and depression entailed higher school dropout rates."In epidemiological terms, boys generally have more externalizing disorders, with case numbers reaching double those of girls. In terms of educational outcomes, however, we found that the risk is greater for girls.

One of the hypotheses that could explain this finding is a social stigma, since aggressive or oppositional behavior is not expected from girls, and they may suffer more and perform less well at school. The same is true of depression in the case of boys. Society assumes they don't cry or express feelings," Mauricio Scopel Hoffmann, first author of the article, told Agência FAPESP. Hoffmann is a professor in the Department of Neuropsychiatry at the Federal University of Santa Maria (UFSM) in Rio Grande do Sul (Brazil).

The study was part of Hoffmann's postdoctoral research and was supported by FAPESP (grants 14/50917-0 and 08/57896-8). Hoffmann was supported by a Newton International Fellowship awarded by the Academy of Medical Sciences through the UK Government's Newton Fund Program. The Newton Fund also supported Sara Evans-Lacko, last author of the article. Both were then research fellows at the LSE's Care Policy and Evaluation Center in London (2019-20).

The data was obtained from the Brazilian High-Risk Cohort Study for Childhood Psychiatric Disorders (BHRC[KM1]), a large school-based survey that has followed over 1,000 children since 2010.

In their discussion of the 2014 data, the researchers contextualized their findings from a populational perspective and, while warning that their estimates were probably conservative, concluded that at that time at least 591,000 schoolchildren could have been in the right grade for their age if psychiatric disorders had been prevented or treated. Repetition could have been avoided for some 196,000 on the same basis.

According to Hoffmann, the situation is similar seven years later, evidencing the importance of prevention and treatment of mental problems if educational results are to be improved. In 2014, 49.8 million children were enrolled in the first nine grades at 188,700 public and private schools. In 2020, these numbers had fallen to 47.3 million and 179,500 respectively.