Academic Predictors of Mental Health Problems Among Adolescents in Grades 7 through 12.

The prevalence of mental health disorders has increased steadily in the United States over the past few decades. (1) Amid this general decline of mental health, studies show that many young children and adolescents are suffering from mental illnesses, specifically depression and anxiety. (2) Students with mental illnesses, including depression and anxiety, have been found to experience lower academic outcomes than students without mental health issues. (3) As such, it is not surprising that the prevalence of mental health disorders has increased while academic achievement in the nation has simultaneously declined. (4) In the United States, 20 percent of school-aged children experience severely debilitating mental health problems at some point in their lives, (5) and some states have reported that their graduation rate is as low as 68 percent. (6) In response, school-based mental health treatments have begun to rectify not only the behavioral symptoms, but also the academic symptoms of mental health issues. (7) In addition to mental health symptoms, these behavioral treatments have sought to address students' academic struggles, such as lower grades, academic performance, and other measures of educational outcomes. (8)

This research study aims to examine the circumstances in which a student with a mental health issue displays academic struggles by exploring the likelihood that the poor academic performance could be an indicator of mental health conditions. Specifically, the study investigates whether academic struggles can be used to predict the display of symptoms of mental health issues, while controlling for the effect of children's demographic characteristics, including gender, grade level, and race. To provide background, this study begins with a literature review.

Common Mental Health Symptoms: Depression and Anxiety

The documented high prevalence of severe mental health problems in children and adolescents (9) corresponds to high rates of depression and anxiety. (10) Depression and anxiety are among the psychological characteristics that research has shown can impact the academic outcomes of school-aged children. (11) Research has indicated that both depression and anxiety are highly prevalent among children, and are both commonly displayed with comorbidity among children. (12) A study by Kristine Amlund Hagen et al. (13) found that among students between the ages of thirteen and eighteen, approximately 40 percent suffered from a mental health disorder, also noting comorbidity in mental health conditions to be commonly experienced among that age group. There is a wide range of symptoms of mental health issues related not only to behaviors, but also to academic performance, including lowered IQs and declining grade point averages. (14) This illustrates the importance of considering that a student's academic struggles could be related to a mental health disorder, and reinforces the need to consider that poor academic functioning could be an indicator of mental health issues.

Mental Health and Academic Outcomes

Academic achievement is critical during childhood and adolescence, (15) and mental health is a key developmental factor related to the educational success of adolescents. (16) As mental health problems have increased in the nation over the past few decades, there has been an increase of research on effective methods of improving mental health. (17) As such, many of these studies have focused primarily on the improvement of children's academic functioning related to their enhanced mental health, (18) reflective of the literature that has linked childhood academic achievement to child mental health. (19)

Studies have shown that both depression and anxiety have a negative impact on students' academic success. (20) Conversely, a study by Susana Marques et al. (21) found that a positive and hopeful outlook--as opposed to depressive thoughts or rumination--was also positively related to academic success. (22) These findings heavily imply that students who experience depression, low levels of life satisfaction, or negative thoughts, are more likely to have negative academic outcomes than students who do not experience these adverse issues related to behavioral health. (23) Furthermore, the prevalence of mental health disorders has increased steadily over the past few decades, (24) and more children who are suffering from mental health issues are possibly at risk for negative impacts to their academic functioning. As depression and anxiety are psychological issues that studies have shown can impact the academic outcomes of school-aged children, (25) existing literature suggests that students with mental health issues are represented among the students who are reported to suffer from academic issues at a higher rate than those without mental health problems.

Academic Performance

Good mental health among students is, itself, a beneficial outcome for students. (26) A higher level of mental health is also advantageous to students because of its long-term benefits on many other outcomes related to their futures, including improved long-term academic achievement, vocational outcomes, and other socioeconomic factors, in addition to increased educational attainment. (27) Research has investigated the relationship between mental health and academic performance in school-aged children, finding that their mental health problems are likely to be related to poor educational performance, including lowered grades, reading difficulties, repeating a grade, and learning delays. (28) Additional studies have otherwise found positive correlations between mental health and educational performance in children, (29) such as an association between good mental health and high grades in writing, spelling, and reading. (30) These studies that display the relationship between mental health and academic achievement have demonstrated the need for further exploration of methods to identify students in need of mental health treatment through the observation of their academic performance.

Academic Engagement

It has been found that many mental health conditions can be dependable predictors for many outcomes, including those related to academics, (31) as studies have shown that many schoolaged children exhibiting externalized behavioral problems, like behavioral outbursts, also demonstrate internalized problems that manifest in classrooms, such as failure to pay attention, and a lack of motivation to participate in lessons. (32) Additionally, higher levels of school engagement, such as focusing and participating in classes, have been found to be a strong predictor of academic achievement, and have also been found to be predictors of lower symptoms of depression. (33) The implication of these findings is that good academic performance is related to good mental health through the modification of academic engagement. However, few studies have examined whether poor academic outcomes can be predicted by mental health issues, without the added variable of school engagement.

Declines in academic performance, such as the inability to pay attention in class, or lack of preparation, can lead to the subsequent decline of grades and are commonly understood to be related to mental health disorders. However, these usually must be severe and must be displayed over a long period of time before considered to be so. (34) Moreover, these symptoms may lead to academic decline, but the academic decline itself is not commonly noticed as an indicator of mental health issues. Therefore, it is important to explore other variables that could be related to mental health issues, such as academic performance, to better identify students in need of mental health services.

Traditionally, the mental health field has focused on behavioral and medical pathologies related to mental illness, such as schizophrenia, depression or anxiety, rather than conducting research on the symptoms of mental health problems that are neither behavioral or medical, (35) such as indicators of academic success. (36) In more recent years, more studies have begun to explore the connection between mental health issues and academic symptoms, including academic performance. These studies show evidence that schools that integrate mental health support services with education improve academic performance. (37) For example, empirical studies have found that...