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

Abstract

Background Anxiety may be associated with poor attendance at school, which can lead to a range of adverse outcomes. We systematically reviewed the evidence for an association between anxiety and poor school attendance. Methods Seven electronic databases were searched for quantitative studies that reported an estimate of association between anxiety and school attendance. Anxiety had to be assessed via standardised diagnostic measure or validated scale. Articles were screened independently by two reviewers. Meta‐analyses were performed where possible, otherwise results were synthesised narratively. Results A total of 4930 articles were screened. Eleven studies from six countries across North America, Europe and Asia, were included. School attendance was categorised into: (a) absenteeism (i.e. total absences), (b) excused/medical absences, (c) unexcused absences/truancy and (d) school refusal. Findings from eight studies suggested associations between truancy and any anxiety disorder, as well as social and generalised anxiety. Results also suggested cross‐sectional associations between school refusal and separation, generalised and social anxiety disorders, as well as simple phobia. Few studies investigated associations with absenteeism or excused/medical absences. Conclusions Findings suggest associations between anxiety and unexcused absences/truancy, and school refusal. Clinicians should consider the possibility of anxiety in children and adolescents with poor attendance. However, there is a lack of high quality evidence, little longitudinal research and limited evidence relating to overall absenteeism or excused/medical absences, despite the latter being the most common type of absence. These gaps should be a key priority for future research.

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.…”

Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

“…Antidepressant medication is recommended for many adolescents with school attendance problems, and cognitivebehavioral therapies for this population often focus on depression symptoms (Maynard et al, 2015;Londono Tobon et al, 2018;Melvin and Gordon, 2019). Finning et al (2019), in their meta-analysis of depression and school attendance problems, concluded that symptoms of depression are indeed common to many different types of school attendance problems. The authors also postulated several possible mechanisms for this association, such as social withdrawal, sleep disturbance, and low energy.…”

“…Second, the depression item noted above may also indicate a relative amount of boredom, frustration, burnout, or lack of self-efficacy with respect to the school environment or academic performance (Fiorilli et al, 2017). Finning et al (2019) noted that another mechanism explaining depression and school attendance problems might be loss of motivation. Surveys of youth with school attendance problems or who have dropped out of school regularly reveal boredom with classes and the school environment as a key reason for leaving (Strand, 2014;Attwood and Croll, 2015;Kearney, 2016).…”

“…First, the sample was an eclectic one that ranged from having no formal school absences to having many school absences. Second, sample size constraints did not permit more nuanced analyses of absenteeism type, setting, or demographic or developmental differences, though studies generally indicate emotional distress across many absence types in this population (Finning et al, 2019). Third, the primary dependent measure was based on selfreport, though these kinds of measures are commonly used for youth with internalizing symptoms (Chorpita et al, 2000).…”

“…Externalizing problems common to this population include non-compliance, defiance, verbal and physical aggression, temper tantrums, refusal to move, running away from school or home, and antisocial and disruptive behavior at school and elsewhere (Ingul et al, 2012;Kearney, 2019). In addition, internalizing and externalizing problems are highly comorbid within and across each set in this population (Hankin et al, 2016;Finning et al, 2019).…”