School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis

Abstract

Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20–1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02–1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.

Feeling Unsafe at School and Associated Mental Health Difficulties among Children and Adolescents: A Systematic Review

“…Understanding and addressing these associations could help to tackle absenteeism, because as many as 10–14% of students avoided school because they felt unsafe [ 96 , 97 ]. Mental health problems [ 98 , 99 ] and being bullied [ 74 , 89 ] have also been associated with absenteeism. The associations between feeling safe at school, mental health difficulties, and victimization and absenteeism emphasize the importance of comprehensive interventions for the whole school community, targeted sub-groups who are at high risk, and students who have already developed symptoms.…”

Types and correlates of school non-attendance in students with autism spectrum disorders

“…Missing school has a negative impact on children’s academic skills ( Hancock et al, 2013 ) and mental health ( Epstein et al, 2019 ). It increases the risk of dropping out of school ( Schoeneberger, 2012 ), which in turn is linked to adverse life outcomes such as substance abuse ( Townsend et al, 2007 ) and mortality ( Lleras-Muney, 2005 ).…”

Does Mental Well-Being Protect against Self-Harm Thoughts and Behaviors during Adolescence? A Six-Month Prospective Investigation

“…Though adolescents who took part in the second wave of data collection had broadly similar profiles across most variables compared with those who did not, it was also true that those lost to attrition were more likely to report a history of self-harm at baseline. This has been reported in previous research [59] and is not surprising given that young people who engage in self-harm are more likely to be absent or truant from school [60]. Therefore, we were less likely to capture these individuals at follow-up.…”