Open Access Research article

Continuous admission to primary school and mental health problems

Sijmen A Reijneveld12*, Carin H Wiefferink2, Emily Brugman2, Frank C Verhulst3, S Pauline Verloove-Vanhorick24 and Theo GW Paulussen2

Author Affiliations

1 University Medical Center Groningen, University of Groningen, Department of Health Sciences, P.O. Box 196, 9700 AD Groningen, The Netherlands

2 TNO (Netherlands Organization of Applied Scientific Research) Quality of Life, Division of Child Health, Leiden, The Netherlands

3 Erasmus University Rotterdam, Academic Hospital Rotterdam-Sophia, Rotterdam, The Netherlands

4 Leiden University Medical Center, Department of Pediatrics, Leiden, The Netherlands

For all author emails, please log on.

BMC Public Health 2006, 6:145  doi:10.1186/1471-2458-6-145

Published: 6 June 2006



Younger children in a school class have higher rates of mental health problems if admission to primary school occurs once a year. This study examines whether this relative age effect also occurs if children are admitted to school continuously throughout the year.


We assessed mental health problems based on parent-reports (using the Child Behavior Checklist, CBCL) and on professional assessments, among two Dutch national samples of in total 12,221 children aged 5–15 years (response rate: 86.9%).


At ages 5–6, we found a higher occurrence of mental health problems in relatively young children, both for mean CBCL scores (p = 0.017) and for problems assessed by child health professionals (p < 0.0001). At ages 7–15, differences by relative age did not reach statistical significance.


Continuous admission to primary school does not prevent mental health problems among young children, but may do so at older ages. Its potential for the prevention of mental problems deserves further study.