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IJE Advance Access published online on June 25, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp236
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.

School performance and hospital admissions due to self-inflicted injury: a Swedish national cohort study

Beata Jablonska1,*, Lene Lindberg1, Frank Lindblad2,3, Finn Rasmussen4, Viveca Östberg5 and Anders Hjern5,6

1Division of Applied Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
2Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
3Stress Research Institute, Stockholm University, Stockholm, Sweden.
4Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
5Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
6Department of Children's and Women's Health, Uppsala University, Uppsala, Sweden.

*Corresponding author. Division of Applied Public Health, Department of Public Health Sciences, Karolinska Institutet, Box 17070, SE-104 62, Stockholm, Sweden. E-mail: Beata.Jablonska{at}ki.se


  Abstract

Background Self-inflicted injury in youth has increased in many Western countries during recent decades. Education is the most influential societal determinant of living conditions in young people after early childhood. This study tested the hypothesis that school performance predicts self-inflicted injury.

Methods A national cohort of 447 929 children born during 1973–77 was followed prospectively in the National Patient Discharge Register from the end of their ninth and last year of compulsory school until 2001. Multivariate Cox analyses of proportional hazards were used to test hypotheses regarding grades in ninth grade as predictors of hospital admission due to self-inflicted injury.

Results The risk of hospital admission because of self-inflicted injury increased steeply in a step-wise manner with decreasing grade point average. Hazard ratios were 6.2 (95% confidence interval 5.5–7.0) in those with the lowest level of grade point average compared with the highest. The risks were similar for women and men. Adjustment for potential socio-economic confounders in a multivariate proportional hazards regression analysis attenuated this strong gradient only marginally.

Conclusion School performance is a strong factor for predicting future mental ill-health as expressed by self-inflicted injury.

Keywords Self-inflicted injury, school performance, register study, Sweden

Accepted 26 May 2009


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