The impact of school absence on mental health in children and young people: Analysis of an English national birth cohort

Abstract

Background Given concerns the role of school closures in increasing mental health problems after the Covid-19 pandemic, we used pre-pandemic data to undertake a causal epidemiological analysis of the associations of school absence with later mental health problems. Methods Longitudinal data from the Millennium Cohort Study were collected pre-pandemic at ages 7 (in 2008), 11 (2012) and 14 years (2015), securely linked with English routine educational data on school absence in the 2 years preceding each cohort wave. We constructed marginal structural models for mental health problems (as outcome) and quartiles of absence (exposure), taking account of baseline and time-varying confounding. Results Those in the highest quartile of absence had odds ratios (OR) for experiencing later mental health problems of 2.216 (1.629, 3.014) at age 7 (n = 6383), and in lagged models OR of 1.508 (1.072, 2.122) at age 11 (n = 6102) and 1.903 (1.234, 2.934) at 14 years (n = 5616). Persistent absence (>10% of school year) was associated with OR for later mental health problems of 2.00 (1.56, 2.57) at 7 years, and in lagged models OR of 2.26 (1.62, 3.14) at 11 years and 2.00 (1.27, 3.16) at 14 years. Conclusions School absence above the second quartile doubled the odds of later mental health problems in both primary and secondary school children in pre-pandemic data. Our findings support there being a strong and potentially causal association between absence from school and later mental health problems, and suggest that absence from school is harmful for CYP’s mental health.