title: Associations between delayed completion of high school and educational attainment and symptom levels of anxiety and depression in adulthood.
abstract: BACKGROUND
  There is a higher prevalence of anxiety and depression among adults with lower educational attainment. Delayed completion of high school (HS) is common and represents a potentially complicating factor in the relationship between educational attainment and anxiety and depression. This study aims to investigate whether delayed HS completion is associated with symptom levels of anxiety and depression in adulthood and whether it interacts with later educational attainment in predicting symptom-levels of anxiety and depression in adulthood.
  
  
  METHODS
  The sample consisted of 10 149 participants from the Nord-Trøndelag Health Survey (HUNT 3) between 30 and 46 years of age in 2006. The outcome variables were symptoms of anxiety and depression as measured by the HADS scale. Variables measuring educational attainment were obtained from the National Educational Database in Norway. We used linear regression to estimate associations between educational attainment, delayed HS completion and symptom levels of anxiety and depression in adulthood.
  
  
  RESULTS
  We found delayed HS completion to be associated with higher symptom levels of both anxiety and depression. There was a dose-response association suggesting that each additional year of delay in HS was associated with higher symptom levels for both anxiety and depression. Mean symptom levels of both anxiety and depression were significantly lower among individuals who completed HS within a normative timeframe vs those who were substantially delayed in their HS completion. For anxiety symptoms, we found a statistically significant interaction between delayed HS completion and later educational attainment. This interaction suggested that individuals with a combination of being delayed in HS and having no higher educational attainment had significantly higher levels of anxiety symptoms than all other combinations of later educational attainment and normative/delayed HS completion. For depression, associations between predictors and symptom levels were additive.
  
  
  CONCLUSIONS
  Delayed HS completion is associated with symptom levels of both depression and anxiety and interacts with later educational attainment in predicting symptom levels of anxiety. Individuals with a combination of delayed HS completion and lower educational attainment had particularly high symptom levels of anxiety.
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark. ome@arbejdsmiljoforskning.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: Melkevik
authors.affiliation: Norwegian Institute of Public health, Oslo, Norway.
authors.forename: Lars Johan
authors.initials: LJ
authors.lastname: Hauge
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Bendtsen
authors.affiliation: Norwegian Institute of Public health, Oslo, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Reneflot
authors.affiliation: Norwegian Institute of Public health, Oslo, Norway.|Department of Community Medicine, University of Tromsø, Tromsø, Norway.|Center for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway.|University of New South Wales, School of Psychiatry, Sydney, Australia.
authors.forename: Arnstein
authors.initials: A
authors.lastname: Mykletun
authors.affiliation: Norwegian Institute of Public health, Oslo, Norway.
authors.forename: Leif Edvard
authors.initials: LE
authors.lastname: Aarø
mesh_terms: D000124:Achievement; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D004522:Educational Status; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies