The association between emotional disorder and absence from school in children and young people

Abstract

Anxiety and depressive disorders (“emotional disorders”) are common and impairing mental health conditions in children and young people (CYP), and they may be associated with absence from school. In this thesis I explore the association between emotional disorder and school absence through four original research studies. Firstly, a systematic review (Study One) is presented that evaluates the existing evidence for an association between emotional disorder and poor school attendance. This is followed by two studies that investigate cross-sectional (Study Two) and longitudinal bi-directional (Study Three) relationships between emotional disorder and school absence using data from a large population survey of CYP in the UK. Finally, a qualitative study (Study Four) is presented that explores educational practitioners’ beliefs about risk factors for attendance problems. Findings from the systematic review (Study One) suggested that emotional disorders are associated with higher levels of various “types” of absence. However, the ability to derive clear conclusions was undermined by limitations of the included studies and methodological heterogeneity between them, particularly in terms of how school attendance was measured. The quantitative cross-sectional study (Study Two) revealed strong relationships between several measures of emotional disorder and total, authorised and unauthorised school absence. The strongest relationships were observed for depression, particularly in relation to unauthorised absence. The longitudinal study (Study Three) demonstrated that depression and teacher-reported emotional difficulties predict unauthorised absence three years later, while authorised absence predicts teacher- and parent-reported emotional difficulties three years later. The qualitative study (Study Four) demonstrated that although school staff acknowledge mental health problems as a risk factor for attendance problems, they focus on anxiety rather than other mental health conditions, including depression. Taken together, the findings from this thesis provide evidence for a strong association between emotional disorder and school absence, which may be causal and bi-directional in nature. Implications of the research for clinical and educational practice, as well as for future research in this field, are discussed.