Adolescent girls who had a serious school failure by the 12th grade - being expelled, suspended or dropping out - were significantly more likely to have suffered a serious bout of depression at the age of 21 than girls who did not have these problems (Journal of Adolescent Health, August, 2008).

Recent research showed that girls who had early conduct problems in elementary school also were at increased risk for depression in early adulthood. However, the study did not show any link for boys between academic, behavior or social problems and depression at age 21.

"For girls there are broader implications of school failure," said Carolyn McCarty, PhD, a research associate professor of pediatrics at the University of Washington in Seattle and lead author of the study. "We already know that it leads to more poverty, higher rates of being on public assistance and lower rates of job stability. And now this study shows it is having mental health implications for girls."

The study showed that girls who were expelled from school were more than twice as likely to suffer depression - 44 percent compared to 20 percent of girls who were not expelled. Thirty-three percent of the girls who dropped out of school later became depressed compared to 19 percent who were not dropouts. Twenty-eight percent of the girls who were suspended later suffered depression versus 19 percent of girls who weren't suspended.

Overall, 45 percent of the girls and 68 percent of the boys in the study experienced a major school failure, but Dr. McCarty said these rates were not surprising since the participants in the study came from high-crime neighborhoods. However, the depression rate was higher among girls, 22 percent versus 17 percent for the boys.

"This gender paradox shows that while school failure is more atypical for girls it appears to have more severe consequences when it does occur," she said. "One reason may be that school failure stigmatizes girls more strongly or is harder for them to overcome. We do know that girls with conduct problems, such as school failure, tend to have long-term problems with cascading effects."

She said the  overall gender rates of depression in the study are comparable to previous studies, although the 17 percent rate for boys was somewhat high.

Data for the study was drawn from the UW's ongoing Seattle Social Development Research Project that was launched in 1985 and has been tracking 808 people since they were in the fifth grade. Students were drawn from 18 Seattle schools in high-crime neighborhoods to study the development of positive and antisocial behaviors. Participants were almost equally divided by gender and identified themselves as white (46 percent), black (24 percent), Asian-American (21 percent), Native American (6 percent) and other groups (3 percent).

Dr. McCarty said the study points to the need for communities to create integrated prevention programs to help children deal with academic, social and behavioral problems.

"When adolescents have these kinds of problems and experiences, the response tends to be focused purely on the academic, in part because the school and mental health systems are distinct. We need to look more broadly at functioning and see what is going on with other aspects of their lives including the psychological. We can't just put a Band-Aid on one thing that seems to be a problem because often there is an underlying bigger issue that has to be addressed," she said.

"When school failure emerges we should have remedies and be ready to intervene at that point to prevent later depression" said Dr. McCarty, who is directing a middle school study that is evaluating early prevention efforts to thwart depression. "Social and emotional skills are vital to adolescents and they may or may not be taught by schools and their parents. We need to have school-based prevention programs available before problems get much bigger and harder to resolve."

Co-authors of the study are W. Alex Mason, Richard Kosterman and J. David Hawkins of the UW's Social Development Research Group; Liliana Lengua, associate professor of psychology; and Elizabeth McCauley, professor of psychiatry and behavioral sciences.

Funding for the research came from the National Association of Schizophrenia and Affective Disorder, National Institute of Mental Health, National Institute on Drug Abuse and the Robert Wood Johnson Foundation.