Abstract
Background: More than 10% of young people in the UK self-harm, while 1 in 6 young people have poor mental health. In order to prevent mental health problems or to intervene early, it is essential to have ways to identify groups at higher risk. School absence is known to be associated with a number of adverse psycho-social outcomes. An association may also exist between absence and later mental health difficulties. Data on school absence is universally collected by schools, but its role as a predictor of mental health problems and self-harm is not well understood.Aim: To investigate the longitudinal association between school absence and mental health problems/self-harm in different groups of adolescents and identify clinical, educational and socio-demographic factors which may explain or affect the magnitude of this relationship.
Methods: I conducted a scoping review of the literature examining the longitudinal association between school absence and mental health outcomes, and updated a systematic review and meta-analysis on the association between school absence and self-harm and suicidal ideation. I developed a Natural Language Processing tool for identifying and extracting data on self-harm from electronic health records. I then conducted four empirical studies, the first two using routinely collected, linked mental health and education data from South London and Maudsley NHS Trust and the National Pupil Database (NPD). In these studies, I explored the association between school absence two important mental health outcomes: i) subsequent accepted referrals to Child and Adolescent Mental Health Services, and ii) presentations to Emergency Departments with self-harm. In a further two studies, I used a similar approach, except with self-reported outcomes, in a nationally representative cohort using a linkage between the Millennium Cohort Study and the NPD.
Results: My scoping review and systematic review identified an association between school absence and mental health problems and self-harm. However, the existing evidence base has a number of critical limitations, including a dearth of longitudinal studies. The studies I conducted using both secondary care mental health data in South London and national survey data found positive associations between school absence and the following outcomes: accepted referrals to mental health services, self-reported mental health problems, self-harm presentations to Emergency Departments, and self-reported self-harm. Associations between school absence and self-harm were stronger in females. Associations between absence and both mental health problems and self-harm were stronger in the South London sample using clinical outcomes compared to the national sample using self-reported outcomes.
Conclusions: This thesis provides evidence for an association between school absence and later mental health problems and self-harm in adolescents. This suggests that school absence could be used as a risk indicator for mental health problems or self-harm. In addition, school absence may itself contribute to a greater risk of later mental health problems and self-harm. These findings can inform policy and practice in health and education to support prevention of and early intervention for mental health problems in schools.
| Date of Award | 1 Mar 2024 |
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| Original language | English |
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| Supervisor | Rina Dutta (Supervisor), Craig Morgan (Supervisor), Johnny Downs (Supervisor) & Tamsin Ford (Supervisor) |