SYDNEY, Nov 9 - Researchers in Sweden followed more than 26,000 high schoolstudents from age 16 to 46.
They found hospitalisations due to suicide attempts and self-harm was almost five times more common for people who were in the bottom 25 per cent of their year compared to the top performing students.
"Poor academic performance in compulsory school, at age 16, was a robust predictor of suicide attempt past young adulthood and seemed to account for the association between lower childhood IQ and suicide attempt," the researchers concluded.
The findings, published in journal Acta Psychiatrica Scandinavica, has led to calls for greater emotional and social support at school for this vulnerable group.
"Programs to improve social and emotional abilities in children can increase academic performance and lower emotional distress," said Associate Professor Alexandra Martiniuk, from the George Institute for Global Health.
"Suicide prevention programming supporting youth as well as adults who have or had low (grades) are also likely to be useful," she said.
One of the reasons for the increased risk of self-harm could be that school grades predict the ability to gain admission to further education, said Martiniuk.
"This may lead to a better socio-economic position in life and/or more control over one's life."
It could also be that a child's impulsivity or behaviour - characteristics both linked to poor grades - that explains the greater tendency to attempt suicide, she noted.
Either way, Martiniuk says doing poorly in school typically "pummels" a student's self-esteem.
Andrew Fuller is a clinical psychologist and research fellow at the University of Melbourne and says its very important that children a taught how to become more resilient to protect them against suicide.
"Australia has an uneven education system. We have many great schools and we also have schools and areas where opportunities are limited. Not having the opportunity to reach your potential is a risk factor," he said.
Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.
Suicide Call Back Service 1300 659 467.
MensLine Australia 1300 78 99 78.
Multicultural Mental Health Australia www.mmha.org.au.
Local Aboriginal Medical Service details available from www.bettertoknow.org.au/AMS