# School Absence and Mental Health in a Help-Seeking Sample From Child and Adolescent Psychiatry

## TL;DR

This study found that over two-thirds of children with mental health issues in psychiatric care miss school, highlighting the need for mental health professionals and schools to collaborate in supporting these students.

## Contribution

The study provides new insights into the prevalence and factors associated with problematic school absence in an international sample of children with mental health problems.

## Key findings

- 66.9% of children and adolescents with mental health problems missed school, with severe absence (8+ days) affecting 25%.
- Older children, those in inpatient treatment, and those with phobic anxiety or multiple diagnoses were more likely to have severe school absence.
- Children with ADHD missed less school, possibly due to treatment like medication.

## Abstract

Problematic school absence (PSA) can severely impact children’s mental health. Research on the prevalence of PSA in child and adolescent psychiatry is still limited. This study explores the prevalence and severity of PSA in Dutch and German young people with mental health problems.

This study included 354 patients aged 6-20 years (M = 13.0; SD = 3.5) from three psychiatric clinics in the Netherlands and Germany (151 Dutch and 203 German children), recruited between March and June 2019. Parents completed the Strengths and Difficulties Questionnaire and the School-Non-Attendance-ChecKlist. The study analysed PSA and associated factors.

School absence occurred in 66.9% of the sample. Any PSA was significantly associated with inpatient treatment, conduct problems and comorbidity, while attention-deficit/hyperactivity disorder, and other behavioural disorders were negatively associated. Severe PSA (missing 8 or more of 20 school days) was associated with higher age, inpatient treatment, and phobic anxiety disorders.

This study showed a high prevalence of PSA among children with mental health problems in an international sample. Given its impact on children’s development and future prospects, addressing PSA should be a priority for mental health professionals working with young people with mental health problems.

Why was the study done? Missing school can affect children’s mental health, learning, and future. Children with mental health problems are more likely to miss school, but research on how often and why this happens is limited. This study explored how often young people in mental health care are absent from school and what factors might be linked to that. What did the researchers do? The researchers studied 354 children and teenagers aged 6 to 20 who were receiving mental health care in the Netherlands and Germany. Some stayed in a clinic, while others lived at home. Parents filled in forms about how many school days their child missed and the reasons why. The researchers also looked at the mental health diagnoses of each child to see if there were patterns linked to school absence. What did the researchers find? Two out of three children missed school at least once in the past four weeks. One in four missed 8 or more days, and one in ten missed every day. The main reasons were school refusal, meaning, not wanting or being too anxious to go, and being sent home by the school. Older children, those in clinics, and those with multiple mental diagnoses were more likely to miss school. Children with conduct or anxiety disorders were also more at risk. However, children with attention-deficit and hyperactivity problems missed less school, possibly because many of them were receiving treatment like medication. What do the findings mean? School absence is very common among children and teenagers receiving mental health care, especially in older children, those with multiple mental health problems, and those in clinics. Mental health professionals and schools should work together to support these children. Helping them attend school regularly can improve their well-being and future opportunities. These findings can also help guide future research and care to reduce the risk of long-term school problems.