Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.
Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany.
Eur Child Adolesc Psychiatry. 2019 Oct;28(10):1341-1352. doi: 10.1007/s00787-019-01296-7. Epub 2019 Feb 26.
We aimed to estimate unbiased effects of mental health problems (MHPs) on school performance in first graders, with an emphasis on rigorous adjustment for potential confounders. A population-based prospective cohort study was performed in the area of Mainz-Bingen (Germany). In 2015, all preschoolers were approached, and the presence and type of MHP (externalising/internalising) and other physical chronic health conditions were identified by the preschool health examination and study-specific questionnaires. At the end of the first grade, school performance (reading, writing, numeracy, and science) was assessed by the class teacher and rated on a four-item scale ranging from - 8 to + 8. Of 3683 children approached, 2003 (54%) were enrolled. School performance was available for 1462 children (51% boys, mean age 7.3 years). Of these, 41% had signs of at least one MHP. Compared to children without indications of mental and physical chronic health conditions, children with MHPs had lower school performance scores [adjusted mean difference - 0.98, 95% CI (- 1.35; - 0.61); P < 0.001]. Regarding the type of MHP, externalising MHPs were associated with poor school performance [adjusted mean difference - 1.44, 95% CI (- 1.83; - 1.05); P < 0.001], while internalising MHPs were not. Children with hyperactivity inattention problems were most affected [adjusted mean difference - 1.96, 95% CI (- 2.36; - 1.56); P < 0.001]. Externalising MHPs and in particular hyperactivity inattention problems may already affect school performance in early primary school. Identification of children with externalising MHPs prior to school entry may help to prevent impaired academic achievement in affected children.
我们旨在估计心理健康问题（MHP）对一年级学生学业成绩的无偏影响，重点是严格调整潜在的混杂因素。在美因茨-宾根地区（德国）进行了一项基于人群的前瞻性队列研究。2015 年，所有学前儿童都被接触到，通过学前健康检查和特定于研究的问卷确定 MHP（外化/内化）和其他身体慢性健康状况的存在和类型。在一年级结束时，由班主任评估学业成绩（阅读、写作、算术和科学），并在-8 到+8 的四分量表上进行评分。在接触到的 3683 名儿童中，有 2003 名（54%）入组。有 1462 名儿童（51%为男孩，平均年龄为 7.3 岁）的学业成绩可用。其中，41%有至少一种 MHP 的迹象。与没有精神和身体慢性健康状况迹象的儿童相比，有 MHP 的儿童的学业成绩较低[调整后的平均差异-0.98，95%置信区间（-1.35；-0.61）；P<0.001]。关于 MHP 的类型，外化 MHP 与较差的学业成绩相关[调整后的平均差异-1.44，95%置信区间（-1.83；-1.05）；P<0.001]，而内化 MHP 则没有。多动注意力问题的儿童受影响最大[调整后的平均差异-1.96，95%置信区间（-2.36；-1.56）；P<0.001]。外化 MHP，特别是多动注意力问题，可能已经影响到小学早期的学业成绩。在入学前识别出患有外化 MHP 的儿童，可能有助于防止受影响儿童的学业成绩受损。
