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

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.