Examining the direction of association between attendance-related difficulties and maternal depression symptoms in two UK birth cohorts

Abstract Purpose Poor school attendance is a high priority for schools. Parental mental health is associated with school attendance problems, however, the direction of this relationship is unclear. This study examines the longitudinal direction of association between school attendance-related difficulties and parental mental health in two prospective UK birth cohorts. Methods Data from two prospective birth cohorts were utilised: the Avon Longitudinal Study of Parents and Children (ALSPAC) ( n = 6375) and the Wirral Child Health and Development Study (WCHADS) ( n = 718). Results In ALSPAC, school avoidant behaviours were associated with increased likelihood of subsequent maternal depression symptoms above clinical threshold (RR = 1.48 [95% CI 1.11, 2.00] p = 0.006) but maternal depression was not associated with later school avoidance (RR = 1.02 [95% CI 0.74, 1.40] p = 0.911). Similarly, separation anxiety behaviours were associated with increased maternal depression (RR = 1.20 [95% CI 1.21, 1.30], p < 0.001) but maternal depression did not predict later separation anxiety (RR = 1.06 [0.97,1.15] p = 0.237). In WCHADS, attendance-related difficulties at age 7 were associated with higher maternal depression symptoms at age 9 (b = 0.22, 95% CI 0.03, 0.42, p = 0.028), whereas maternal depression symptoms at age 7 were not associated with attendance-related difficulties at age 9 (OR = 0.98, 95% CI 0.78, 1.23, p = 0.869). Conclusions We provide the first evidence that relationships between maternal mental health and school attendance-related difficulties most likely operate from child behaviours to maternal depression, not the other way around. This indicates that attendance interventions should replace parenting blaming narratives and instead integrate support for parents when issues arise.