Nationwide data indicated that absence and exclusion from school were associated with a record of neurodevelopmental disorder, mental disorder, and self-harm. These findings were published in The Lancet Psychiatry.

Data were sourced from the Welsh Demographic Service Dataset which comprised individuals (N=5,341,392) aged 7-16 years enrolled in state-funded schools between 2012-2016. Individuals with linked data (n=414,637) about primary and secondary health care were assessed for risk factors of missing >10% of school sessions in 1 year and school exclusion.

The study population was 51.3% boys; aged mean 10.5 (standard deviation [SD], 3.8) years on September 1, 2012, and 14.0% had a record of neurodevelopmental disorder, mental disorder, or self-harm by age 24 years.

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Absenteeism during ≥1 school year occurred among 28.5%. Among those with absenteeism, 5.0% had a neurodevelopmental disorder, 15.0% a mental disorder, and 4.4% a record of self-harm. The proportion of students with absenteeism without a record of these disorders remained stable at 12.5% between ages 7-11 years, increasing to 18% between ages 11-16 years.

Risk for absenteeism (all P <.0001) associated with bipolar disorder (adjusted odds ratio [aOR], 5.5), schizophrenia (aOR, 4.2), drug misuse (aOR, 4.1), self-harm (aOR, 3.4), alcohol misuse (aOR, 3.2), other psychotic disorders (aOR, 3.2), depression (aOR, 2.8), conduct disorder (aOR, 2.6), anxiety (aOR, 2.5), any mental disorder (aOR, 2.5), eating-disorders (aOR, 2.1), neurodevelopmental disorders (aOR, 2.0), attention-deficit/hyperactivity disorder (aOR, 2.0), autism spectrum disorder (aOR, 2.0), and learning difficulties (aOR, 2.0).

Exclusion from school occurred among 3.7% and permanent exclusion among 0.1%. Excluded individuals had a neurodevelopmental disorder (13.0%), mental disorder (20.8%), and a record of self-harm (10.0%). Children aged 7-11 years with none of these conditions were unlikely to be excluded from school (0.5%), increasing to 2.9% by age 15 years.

Risk for exclusion (all P <.0001) associated with: drug misuse (aOR, 11.0), bipolar disorder (aOR, 7.3), self-harm (aOR, 6.7), schizophrenia (aOR, 6.5), alcohol misuse (aOR, 6.3), attention-deficit/hyperactivity disorder (aOR, 6.1), conduct disorder (aOR, 6.0), neurodevelopmental disorders (aOR, 4.4), other psychotic disorders (aOR, 4.2), depression (aOR, 3.3), any mental disorder (aOR, 2.8), autism spectrum disorder (aOR, 2.6), anxiety (aOR, 2.4), eating disorders (aOR, 1.9), and learning difficulties (aOR, 1.8).

In general, boys were more likely to be absent or excluded than girls as were individuals with more morbidities. Pupils who were excluded were more likely to have a record of absenteeism.

This study may have underestimated the effect of mental health disorders as younger children had less time for evidence to be recorded.

These findings suggested that a record of neurodevelopmental disorder, mental disorder, or self-harm by 24 years of age is associated with increased risk for absenteeism and exclusion from school. Additional study is needed to assess whether improving school attendance could have an effect on the incidence of mental health disorders.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


John A, Friedmann Y, DelPozo-Banos M, Frizzati A, Ford T, Thapar A. Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK. Lancet Psychiatry. Published online November 23, 2021. doi:10.1016/S2215-0366(21)00367-9