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Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK

Ann John Orcid Logo, Yasmin Friedmann, Marcos del Pozo Banos Orcid Logo, Aura Frizzati, Tamsin Ford, Anita Thapar

The Lancet Psychiatry, Volume: 9, Issue: 1, Pages: 23 - 34

Swansea University Authors: Ann John Orcid Logo, Yasmin Friedmann, Marcos del Pozo Banos Orcid Logo

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DOI (Published version): 10.1016/s2215-0366(21)00367-9

Abstract

BackgroundPoor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the...

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Published in: The Lancet Psychiatry
ISSN: 2215-0366
Published: Elsevier BV 2022
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-12-02T14:10:59.0835611</datestamp><bib-version>v2</bib-version><id>57778</id><entry>2021-09-06</entry><title>Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK</title><swanseaauthors><author><sid>ed8a9c37bd7b7235b762d941ef18ee55</sid><ORCID>0000-0002-5657-6995</ORCID><firstname>Ann</firstname><surname>John</surname><name>Ann John</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>94dd4462b95e78880040791727786dfc</sid><firstname>Yasmin</firstname><surname>Friedmann</surname><name>Yasmin Friedmann</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f141785b1c0ab9efe45665d35c081b84</sid><ORCID>0000-0003-1502-389X</ORCID><firstname>Marcos</firstname><surname>del Pozo Banos</surname><name>Marcos del Pozo Banos</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-09-06</date><deptcode>HDAT</deptcode><abstract>BackgroundPoor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion.MethodsIn this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7&#x2013;16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13&#x2013;2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation.FindingsSchool attendance, school exclusion, and health-care data were available for 414&#x2009;637 pupils (201&#x2009;789 [48&#xB7;7%] girls and 212&#x2009;848 [51&#xB7;3%] boys; mean age 10&#xB7;5 years [SD 3&#xB7;8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2&#xB7;1 (95% CI 2&#xB7;0&#x2013;2&#xB7;2) for those with neurodevelopmental disorders to 6&#xB7;6 (4&#xB7;9&#x2013;8&#xB7;3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2&#xB7;0 (1&#xB7;9&#x2013;2&#xB7;1) for those with neurodevelopmental disorders to 5&#xB7;5 (4&#xB7;2&#x2013;7&#xB7;2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1&#xB7;7 (1&#xB7;3&#x2013;2&#xB7;2) for those with eating disorders to 22&#xB7;7 (20&#xB7;8&#x2013;24&#xB7;7) for those with a record of drugs misuse. aORs for exclusion ranged from 1&#xB7;8 (1&#xB7;5&#x2013;2&#xB7;0) for those with learning difficulties to 11&#xB7;0 (10&#xB7;0&#x2013;12&#xB7;1) for those with a record of drugs misuse.InterpretationChildren and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required.FundingThe Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council.TranslationFor the Welsh translation of the abstract see Supplementary Materials section.</abstract><type>Journal Article</type><journal>The Lancet Psychiatry</journal><volume>9</volume><journalNumber>1</journalNumber><paginationStart>23</paginationStart><paginationEnd>34</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2215-0366</issnPrint><issnElectronic/><keywords/><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-01-01</publishedDate><doi>10.1016/s2215-0366(21)00367-9</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU College/Department paid the OA fee</apcterm><funders>The Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council</funders><projectreference/><lastEdited>2022-12-02T14:10:59.0835611</lastEdited><Created>2021-09-06T13:34:13.6388121</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>1</order></author><author><firstname>Yasmin</firstname><surname>Friedmann</surname><order>2</order></author><author><firstname>Marcos</firstname><surname>del Pozo Banos</surname><orcid>0000-0003-1502-389X</orcid><order>3</order></author><author><firstname>Aura</firstname><surname>Frizzati</surname><order>4</order></author><author><firstname>Tamsin</firstname><surname>Ford</surname><order>5</order></author><author><firstname>Anita</firstname><surname>Thapar</surname><order>6</order></author></authors><documents><document><filename>57778__21898__2cac565dbfe940ef963dcd46cbc8479f.pdf</filename><originalFilename>57778.pdf</originalFilename><uploaded>2021-12-16T14:19:53.4866148</uploaded><type>Output</type><contentLength>655846</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 The Author(s). 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spelling 2022-12-02T14:10:59.0835611 v2 57778 2021-09-06 Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 94dd4462b95e78880040791727786dfc Yasmin Friedmann Yasmin Friedmann true false f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 2021-09-06 HDAT BackgroundPoor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion.MethodsIn this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7–16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13–2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation.FindingsSchool attendance, school exclusion, and health-care data were available for 414 637 pupils (201 789 [48·7%] girls and 212 848 [51·3%] boys; mean age 10·5 years [SD 3·8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2·1 (95% CI 2·0–2·2) for those with neurodevelopmental disorders to 6·6 (4·9–8·3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2·0 (1·9–2·1) for those with neurodevelopmental disorders to 5·5 (4·2–7·2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1·7 (1·3–2·2) for those with eating disorders to 22·7 (20·8–24·7) for those with a record of drugs misuse. aORs for exclusion ranged from 1·8 (1·5–2·0) for those with learning difficulties to 11·0 (10·0–12·1) for those with a record of drugs misuse.InterpretationChildren and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required.FundingThe Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council.TranslationFor the Welsh translation of the abstract see Supplementary Materials section. Journal Article The Lancet Psychiatry 9 1 23 34 Elsevier BV 2215-0366 1 1 2022 2022-01-01 10.1016/s2215-0366(21)00367-9 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU College/Department paid the OA fee The Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council 2022-12-02T14:10:59.0835611 2021-09-06T13:34:13.6388121 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ann John 0000-0002-5657-6995 1 Yasmin Friedmann 2 Marcos del Pozo Banos 0000-0003-1502-389X 3 Aura Frizzati 4 Tamsin Ford 5 Anita Thapar 6 57778__21898__2cac565dbfe940ef963dcd46cbc8479f.pdf 57778.pdf 2021-12-16T14:19:53.4866148 Output 655846 application/pdf Version of Record true © 2021 The Author(s). This is an Open Access article under the CC BY 4.0 license true eng https://creativecommons.org/licenses/by/4.0/
title Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
spellingShingle Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
Ann John
Yasmin Friedmann
Marcos del Pozo Banos
title_short Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
title_full Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
title_fullStr Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
title_full_unstemmed Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
title_sort Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
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author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
94dd4462b95e78880040791727786dfc_***_Yasmin Friedmann
f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
author Ann John
Yasmin Friedmann
Marcos del Pozo Banos
author2 Ann John
Yasmin Friedmann
Marcos del Pozo Banos
Aura Frizzati
Tamsin Ford
Anita Thapar
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container_title The Lancet Psychiatry
container_volume 9
container_issue 1
container_start_page 23
publishDate 2022
institution Swansea University
issn 2215-0366
doi_str_mv 10.1016/s2215-0366(21)00367-9
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description BackgroundPoor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion.MethodsIn this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7–16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13–2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation.FindingsSchool attendance, school exclusion, and health-care data were available for 414 637 pupils (201 789 [48·7%] girls and 212 848 [51·3%] boys; mean age 10·5 years [SD 3·8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2·1 (95% CI 2·0–2·2) for those with neurodevelopmental disorders to 6·6 (4·9–8·3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2·0 (1·9–2·1) for those with neurodevelopmental disorders to 5·5 (4·2–7·2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1·7 (1·3–2·2) for those with eating disorders to 22·7 (20·8–24·7) for those with a record of drugs misuse. aORs for exclusion ranged from 1·8 (1·5–2·0) for those with learning difficulties to 11·0 (10·0–12·1) for those with a record of drugs misuse.InterpretationChildren and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required.FundingThe Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council.TranslationFor the Welsh translation of the abstract see Supplementary Materials section.
published_date 2022-01-01T04:13:46Z
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