The association between child and adolescent depression and poor attendance at school: A systematic review and meta-analysis

Abstract

Background: Depression in young people may lead to reduced school attendance through social withdrawal, loss of motivation, sleep disturbance and low energy. We systematically reviewed the evidence for an association between depression and poor school attendance.Methods: Seven electronic databases were searched for quantitative studies with school-aged children and/or adolescents, reporting a measure of association between depression and school attendance. Articles were independently screened by two reviewers. Synthesis incorporated random-effects meta-analysis and narrative synthesis.Results: Searches identified 4930 articles. Nineteen studies from eight countries across North America, Europe, and Asia, were included. School attendance was grouped into: 1) absenteeism (i.e. total absences), 2) excused/medical absences, 3) unexcused absences/truancy, and 4) school refusal.Meta-analyses demonstrated small-to-moderate positive cross-sectional associations between depression and absenteeism (correlation coefficient r=0.11, 95% confidence interval 0.07 to 0.15, p=0.005, I 2 = 63%); and depression and unexcused absences/truancy (r=0.15, 95% confidence interval 0.13 to 0.17, p<0.001, I 2 =4%; odds ratio=3.74, 95% confidence interval 2.11 to 6.60, p<0.001, I 2 =65%). Few studies reported associations with school refusal or excused/medical absences, and few utilised longitudinal data, although results from two studies suggested an association between depression and subsequent absenteeism.Limitations: Study quality was poor overall, and methodological heterogeneity, despite creating a broad evidence-base, restricted meta-analysis to only small subsamples of studies.Conclusions: Findings suggest associations between depression and poor school attendance, particularly absenteeism and unexcused absences/truancy. Clinicians and school staff should be alert to the possibility of depression in children and adolescents with poor attendance. Future research should utilise longitudinal data to confirm the direction of the association, investigate associations with excused absences, and test potential moderators of the relationship.

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

“…All four measures of emotional disorder/difficulties were associated with an increased risk of all three types of school absence. These findings were in line with our expectations and previous evidence [14][15][16][17][18].…”

“…Although 18 (26.5%) of the 68 children with depression in this sample also had a conduct or oppositional disorder, the majority of them did not, and thus it is unlikely that the association between depression and unauthorised absence is simply a result of comorbid behavioural disorders. These findings are also in line with a recent systematic review that reported particularly strong evidence with regard to depression and unexcused absence or truancy [17].…”

“…Previous studies have suggested that poor school attendance may be a sign of emotional disorder [14][15][16], and a recent systematic review concluded that anxiety and depression are associated with higher rates of school absence [17,18]. However, that systematic review identified substantial weaknesses with the current evidence base, including poor methodological quality, a lack of comprehensive studies in UK populations, and few studies that have reported associations with authorised or excused absences, despite this being the most common type of absence.…”

Review: The association between anxiety and poor attendance at school – a systematic review

“…Therefore, this paper focuses on associations between anxiety and school attendance, and findings for associations with depression and internalising problems (i.e. combined symptoms of anxiety and depression) are reported elsewhere (Finning, In preparation; Finning et al., ). Understanding the role of anxiety in relation to poor school attendance is important in order that children with anxiety can be identified quickly, and appropriate interventions implemented.…”

Secondary school practitioners’ beliefs about risk factors for school attendance problems: a qualitative study

“…School refusal is typically considered to be related to internalising problems such as depression or anxiety, while truancy is considered to be related to externalising problems. However, a study by Egger, Costello, and Angold (2003) demonstrated that school refusal and truancy are not mutually exclusive, and other studies, including two linked systematic reviews, have shown that truancy is strongly associated with internalising problems (Finning et al 2019a(Finning et al , 2019bMandalia et al 2018;Gase et al 2014). It could therefore be argued that grouping attendance problems into subtypes such as school refusal and truancy lacks empirical support, and may result in adults around the young person making inaccurate assumptions about the underlying aetiology of the problem.…”