Is Anxiety to Blame for Missed School?

A new systematic review illustrates features of the relationship between anxiety and school attendance patterns.


A team of researchers based in the UK, affiliated with the University of Exeter and the University of Bristol, recently investigated the relationship between mental health and school attendance. Katie Finning and colleagues conducted a systematic review examining overall absenteeism, excused and medical absences, unexcused absences, and school refusal within 11 studies across six countries across North America, Europe, and Asia. Their results point to connections between anxiety, unexcused absences, and school refusal, and also highlight the need for future research examining trends over time to build upon the cross-sectional research currently available.

“To date, there have been no systematic reviews to investigate the relationship between anxiety and school attendance,” they write. “Given the frequent emphasis in the literature on the presumed role of anxiety in poor attendance, the current study aims to systematically review the evidence regarding the association between anxiety and poor school attendance. Although anxiety is commonly comorbid with depression, much of the literature in relation to school attendance has separated these two constructs.”

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A spectrum of individual, family, and community-level factors influence attendance rates. Access to a community, academic material, and professional opportunities may be impacted by school attendance, and, for many students, learning and social opportunities at home represent an insufficient alternative. According to Finning and team, about 10% of students in the UK are absent for 10% or more of the school year. Because this is such a large portion of the student population, it is worth disentangling some of the variables contributing to low attendance.

In recent years, school refusal has widely been attributed to student anxiety, while unexcused absences and truancy are often attributed to externalizing issues and antisocial behavior. However, evidence suggests that these attributions may be reductive, and neglect to paint a thorough picture of the landscape of absenteeism. For example, anxiety may underlie the problem behaviors associated with truancy, and somatic symptoms associated with anxiety may underlie excused and medical absences. Work by Finning and colleagues was designed to assess the extent to which anxiety impacts school attendance in general, and in more specific terms.

Researchers evaluated 11 studies with a combined sample size of 25,725 students from five to 21 years of age. Different techniques were applied in the assessment of anxiety and attendance across studies, but specific characteristics were sufficiently teased out and grouped for synthesis in the systematic review. Analyses were conducted to determine the direction and magnitude of relationships between various forms of anxiety and types of absence.

“The greatest body of evidence was in relation to unexcused absences or truancy, which may be associated with anxiety overall, as well as generalized anxiety disorder and social anxiety specifically. School refusal appears to be associated with SAD, generalized anxiety disorder, social anxiety and simple phobia, although only two studies investigated this relationship,” they add. “There was little evidence with respect to absenteeism in general, or excused/medical absences, and there was also a lack of longitudinal research, preventing any conclusions about the direction of relationships.”

Most studies reviewed were cross-sectional, and researchers noted a need for higher quality evidence and longitudinal research associated with absenteeism and anxiety. Although the current study identified little support for a connection between anxiety and overall absenteeism, a link was established between all types of anxiety and unexcused absences or truancy. Additionally, researchers identified a positive relationship between school refusal and separation anxiety, generalized anxiety disorder, social anxiety, and specific phobias.

The current study highlights the need for further research in this realm to establish the direction trends in absenteeism in tandem with anxiety. Additionally, indications of a link between anxiety and unexcused absences beyond school refusal reflect the importance of further examination of the features of schools that may cause or exacerbate anxiety, and strategies to quell the experience of anxiety when it occurs in the big-picture interest of promoting student growth and learning.



Finning, K., Ukoumunne, O. C., Ford, T., Danielson-Waters, E., Shaw, L., Jager, I. R., . . . Moore, D. A. (2019). Review: The association between anxiety and poor attendance at school – a systematic review. Child and Adolescent Mental Health. (Link)


  1. 2019 and this is a question without answer? really what about in the broken hearts and minds both adult and child – we need no study to know our own suffering all we need do is look at it, touch it, feel it. My school experience was nothing but anxiety – the constant shifting sands and shenanigans the mayhem and fear, the bored indifference forced to endure the sitting the standing the lumps of chalk flying heads bounced off desks dad would like to hurt the Geography teacher for hurting his son – send him for anger management CBT him so he can see not reality but only his perception of reality molded and shaped to locate the problems inside of broken you, sure education hurt but at least i’ve got my job and all the freedom it takes away from me and pays me it back in drips and drabs annual leave and burnout attempts at helping the blind leading the blind the kindness shines inside of us and its trying to make more light blighted by targets and business models mental illnesses and bogus treatments fear and self assessments tick box bollox ‘caseness’ and crassness the deserving and the shirkers narrative swinging monkeys singing in the digital trees I want to be like you oooo a lying politician too oooo so I can learn to be anti human too 0000

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  2. Sigh… This is what happens when you brand “anxiety” as a problem instead of looking for its cause. Their conception of “anxiety” is a disembodied head with a weird expression on its face and the word “anxiety” written across the forehead, as if anxiety were just some “thing” associated with heads and having no relationship to the school, its staff, its students, their parents, or the community in which the anxious person lives.

    Where is the curiosity? Doesn’t anyone wonder WHY the kids are feeling anxious? Is “school refusal” in a particular case due to some disembodied “anxiety,” or is it due to being worried about the bullies waiting for you at school, or the mean teacher you have to put up with all year long, or the incredibly DULL class periods where you always fall asleep and get in trouble, or the reading group where you’re forced to read out loud and are so worried about making an error and having kids laugh at you that you can’t read at all and they laugh at you anyway?

    This kind of idiotic research shows how the DSM “diagnoses” prevent meaningful research from actually occurring, because everyone stops at the “diagnosis” as if this means they understand the situation.

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  3. It is also what happens when you brand “school attendance” a basic human function along the lines of hunting & gathering, self-defense, child care and learning to cook.

    If school attendance = “mental health” that should say something about both.

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    • Sidney Sugarman said to teach the children how to think, not what to think. America did the opposite. Teach to the test, no time to discuss why or how or answer any questions that a curious student may have. Facts and figures are all that’s left. Many students do poorly with rote memorization but in our attempt to fix our schools we broke them with just that. Tests and measurements all the time. No wonder kids are sick anxious and depressed. And I’ll add that teaching to standardized tests was a major issue well before NCLB blew up any hope of fixing what’s wrong with schools. My parent friends were complaining about homework burden and teaching to the test way back in the 90s.

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  4. These called study is comparing apples to oranges. One cannot hope to research schools when Western European and American education are so staggeringly different. Different year schedule, different history, different inequality factors, different environmental factors. Mozart’s grandfather lived in “ public housing” in Germany and as I recall, it was still a solid well built apartment complex. Not do for those living in some HUD housing today in the States.
    I worked in schools and the fear , stress, curriculum issues, home, life, the isms that kids are so aware of were there and that was before school shootings became a regular part of the scenery. Again not do for Western Europe or any other global school system.
    And the research should not be on problems but how kids survive and find ways to survive the lives we have given them. So many are lost through no fault of their own.

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  5. Not gonna read the sciency-sounding drivel article (not worth the eye strain), just gonna answer the query posed by the title:

    No, “anxiety” is not to blame for kids’ missing school! The awful school environment and the horrible, dreaded experiences it dishes out on a daily basis, are what’s to blame.

    How about this: create an educational experience that fosters curiosity and exploration (the essence of a desire to learn), and you wouldn’t need to make school attendance compulsory.

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  6. No. Playing hooky is to be blamed on most missed school.

    Anxiety is not of necessity a negative. Where school is concerned, anxiety can induce attendance or avoidance. When avoidance is the issue, whatever evasions might be employed to achieve that avoidance need to be scrutinized.

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    • What utter nonsense. I played hooky on less than a handful of occasions. I missed school because I was a chronically ill child often in severe pain that was adequately addressed, medically mistreated by a pediatrician who was later put out of business with a class action lawsuit.

      I slept poorly due to congenital defect that caused sleep apnea, snoring heavily and choking in my sleep for as long as I can remember. I struggled to get out the door on my own at 8,9,10 years old, because no one was home. I sometimes missed the bus and I couldn’t remember the way to walk to school, which was in another neighborhood despite having an elementary school five doors away from my house and ridiculous school boundary lines. I was hungry because my mom would sometimes sleep at work and buy herself takeout and the only food to eat was dry natural peanut butter, moldy bread and spoiled milk. My (much) older siblings thought it was funny to tell me the food in the fridge was poisoned so I wouldn’t eat what little there was for them. Sometimes I didn’t go because I didn’t have lunch money and the school had a policy that a child couldn’t skip lunch, so I’d be sent home with a bill for my charges lunches and I’d get spanked for charging lunch that my mom couldn’t pay for and my piece of shit father spent his money on sports cars and satellite dishes instead of child support.

      This is another of your attempts at a simple answer Frank when issues affecting kids and families are complex.

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  7. Having worked in public, mostly poor and immigrant, elementary schools for many years – as a speech pathologist – I can tell you that the pressure to refer children for medication is strong. I fought back in many ways, giving out copies of “Anatomy of an Epidemic”, pointing out the origins and falacies of the Connors Scales, etc. The most effective thing I did as a member of the “special education team” was refuse to sign off on a referral for any sort of screening until we as a faculty had tried at least two in – school interventions. These were tailored to the child’s needs – move his/her seat, a different teacher, special recognition or a job to boost self-esteem, etc. Once the team became more thoughtful in this way, referrals practically dried up.
    This is not to negate in any way the pressures and difficulties present in our schools today. But there is room for thoughtfulness, and many teachers truly care despite the pressures placed upon them.

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    • Wow, well done! There are SO many things that can be done to help a kid succeed, but we have to actually both observe and care about the child instead of trying to shut him/her up! It’s not rocket science, but it starts with understanding that kids do what they do for a reason – and it’s NOT because they have broken brains!

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