Exploring contradicting associations between anxiety disorders, obsessive-compulsive disorder, and academic...

Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-analysis aimed to clarify the direction and strength of these associations and is the first to synthesise evidence on moderators and mediators.

We searched Embase, PsycINFO, and PubMed from inception to 12 March 2025 for observational studies of anxiety disorders or OCD (exposure variables) and academic achievement (outcome) at any age. Study quality was assessed using the Newcastle-Ottawa Scale. Crude effects were pooled using random-effects meta-analyses, and study-level moderators explored using subgroup analyses. Evidence on confounders, within-study moderators and mediators was synthesised narratively.

CRD42023393935.

Of 7610 studies screened, 23 were included. Study quality was generally low for anxiety disorders but higher for OCD. Meta-analysis of 15 studies (n = 864,729) showed a small negative association between anxiety disorders and academic achievement, Hedges' g = -0.31, 95 % CI [-0.46, -0.16], p < .001, I² = 98.1 %. All four studies examining sex/gender reported stronger negative effects among females. Adjusted estimates varied. Meta-analysis of four studies (n = 809,598) showed no evidence of an association between OCD and academic achievement, Hedges' g = -0.21, 95 % CI [-0.56, 0.14], p = .25, I² = 97.9 %.

Anxiety disorders, but not OCD, were negatively associated with academic achievement in meta-analysis. High meta-analytic heterogeneity and inconsistent adjusted findings suggest context-dependent effects, underscoring the need for more moderation studies. Nonetheless, our findings highlight the need for coordinated efforts between educational and mental health services to better identify and support affected students.