The effect of mental health problems on having a 'neither in employment nor in education or training' period and the mediating role of high school dropout: a register-based study with a 14-year follow-up.

Introduction: This study investigates (1) whether mental health problems among individuals aged 12-15 years impact (a) high school dropout (ages 16-20 years) and (b) having a 'neither in employment nor in education or training' (NEET) period (ages 21-26 years); (2) the process of mediation and interaction by high school dropout in the association between mental health problems and NEET; and (3) whether these associations differ based on (non-)employment and mental health problems of parents.

Methods: Longitudinal register data were used (n=196 227). Log-linear regression analyses were used to assess the association between reimbursed medication for mental health problems and high school dropout or NEET period for at least 12 months. Causal mediation analysis was used to assess the mediation and interaction effects of high school dropout in the association between mental health problems and NEET. Stratified analyses were performed based on parental employment and mental health status.

Results: Mental health problems were strongly associated with high school dropout (RR 1.96, 95% CI 1.88; 2.04) and NEET (RR 2.44, 95% CI 2.35; 2.52). High school dropout had a small mediating effect in the relationship between mental health problems and NEET. Individuals with parents with mental health problems or non-employment more often experienced high school dropout and being NEET, but the mediating effect of dropout on NEET was lower in these individuals.

Conclusion: Preventing mental health problems early in the lifecourse is of paramount importance to promote educational outcomes and employment participation, but high school dropout only plays a marginal role in this relationship.