Internalizing Disorders as Risk Factors for Early School Leaving: A Systematic Review

Abstract

Internalizing problems (anxiety and depression) are repeatedly reported to be associated with dropout from secondary school and adverse social and health outcomes later in life, but the evidence appears inconsistent. The aim of this study was to systematically review the evidence for internalizing problems as a risk factor for early school leaving. A systematic search in major databases with thematic search strings for both internalizing disorders and early school leaving yielded 3188 records, of which 14 were included after screening and reading of full texts by two researchers independently after preset inclusion and exclusion criteria. The review process identified four prospective, three trajectory and seven retrospective studies. Variation in measurements, design, adjustments and statistics precluded meta-analyses. The results were mixed. Internalizing problems were reported to increase the risk of early school leaving in prospective studies, but not when adjusted for conduct disorder and ADHD. It is somewhat unclear if the association is robust for adjustment for externalizing problems in studies applying trajectory analyses and non-diagnostic instruments. There were no systematic gender differences in reported associations. In conclusion, internalizing problems were repeatedly reported to increase the risk of early school leaving, but this association was partly or fully accounted for by adjustment for comorbid externalizing problems. However, whether this is adjusting for mediating or confounding factors remains unanswered.