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.”
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)