Authorised and unauthorised absence from school as predictors of youth mental health: findings from two large data linkages

There is a growing evidence base for a relationship between school absence and later mental health problems, but little is known about whether authorised and unauthorised absence are useful differential predictors of mental health outcomes. Here, we analysed the relationship between school absence and later mental health using data linkages between routinely collected data in England’s National Pupil Database (NPD) and two other datasets: a nationally representative longitudinal cohort study (analysis sample N = 6142) and electronic healthcare records at an NHS Trust in South London (analysis sample N = 47,926). We conducted multivariable logistic regression analyses for the associations between authorised, unauthorised, and overall absence and later mental health problems. Authorised, unauthorised, and overall absence were all associated with an increased risk of later mental health problems; the magnitude of increased odds of later mental health problems among those in the top quintile of authorised and unauthorised absence were similar to each other and to overall absence. In the South London clinical sample, after adjustment for covariates, odds ratios for overall absence were 2.77 (95% CI 2.33–3.30) in girls and 1.58 (1.29–1.95) in boys, for authorised absence 2.34 (1.98–2.78) in girls and 1.63 (1.34–1.99) in boys, and for unauthorised absence 1.83 (1.54–2.18) in girls and 1.31 (1.07–1.61) in boys. In the national sample, odds ratios for overall absence were 1.92 (1.42–2.60) in girls and 1.62 (1.10–2.40) in boys, for authorised absence 1.68 (1.32–2.14) in girls and 1.13 (0.01–1.57) in boys, and for unauthorised absence 1.27 (0.99–1.64) in girls and 1.39 (1.00–1.95) in boys. These findings indicate that using authorised or unauthorised absence as predictors of later mental health offers no advantage over overall absence.