title: Youth, suicide attempts and low level of education: A Danish historical register-based cohort study of the outcome of suicide attempt.
abstract: BACKGROUND
  In Denmark, it is a political goal that 95% of all young people should complete an upper secondary education. For some young people, this goal can be difficult to achieve. An association has been established between suicidal behaviour and school performance.
  
  
  OBJECTIVE
  We hypothesise that young people who have attempted suicide have a lower chance of finishing secondary education.
  
  
  METHODS
  We used Danish historical population registers to perform a longitudinal cohort design and extended Cox regression modelling to estimate crude and adjusted estimates of the effect of suicide attempt on secondary education. We used the birth cohorts 1983-1989, and all subjects were followed from birth until the end of 2011 (n = 355,725).
  
  
  RESULTS
  For suicide attempters, the likelihood of completing secondary education was one-third of non-attempters (crude hazard ratio = 0.38). A part of the impact can be explained by confounding factors. Individuals with a suicide attempt at age 16-20 years or with multiple suicide attempts were most likely not to complete secondary education. Compared to mentally ill non-attempters, suicide attempters with mental illness were more likely not to finish secondary education.
  
  
  CONCLUSIONS
  A suicide attempt is not necessarily causal for not finishing secondary education, but it is a marker, and it predicts an increased likelihood of not finishing secondary education. We need to identify individuals at risk for suicide attempts and subsequently provide the necessary support. Completing secondary education is important, as it provides better chances of employment, higher wages and more opportunities for individuals in the future.
authors.affiliation: Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark Research Unit, Department of Child and Adolescent Mental Health Odense, University Hospital, Odense, Denmark ech@ibc.dk.
authors.forename: Erik
authors.initials: E
authors.lastname: Christiansen
authors.affiliation: Centre for Integrated Register-based Research, National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Agerbo
authors.affiliation: Centre for Suicide Prevention, Department of Child and Adolescent Mental Health Odense, University of Southern Denmark, Odense, Denmark.
authors.forename: Kim Juul
authors.initials: KJ
authors.lastname: Larsen
authors.affiliation: Research Unit, Department of Child and Adolescent Mental Health Odense, University Hospital, Odense, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Bilenberg
authors.affiliation: Department of Psychiatry, Odense and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Stenager
mesh_terms: D000124:Achievement; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003718:Denmark; D004522:Educational Status; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D016016:Proportional Hazards Models; D012042:Registries; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Suicide attempt; cohort study; register based; upper secondary education; youth