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Cited by 127Suicide and Self-Harm StudiesYouth Substance Use and School AttendanceHomicide, Infanticide, and Child Abuse

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

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Epstein, Sophie, Roberts, Emmert, Sedgwick, Rosemary, Polling, Catherine, Finning, Katie, Ford, Tamsin, Dutta, Rina, Downs, Johnny·2020·European Child & Adolescent Psychiatry
DOI 10.1007/s00787-019-01327-3PMC PMC7116080
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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.

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  • School absenteeism is associated with youth suicidal ideation with a significant pooled OR of 1.20, equivalent to 20% increased risk.

    “Epstein et al. (2020) explored the association between school absenteeism and youth suicidal ideation from 34 studies found a significant pooled OR of 1.20, equivalented to 20% increased risk of suicidal ideation (Table 2).”

    From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Epstein et al. (2020)

    The Results report a pooled adjusted odds ratio of 1.20 for suicidal ideation (95% CI 1.02–1.42; P = 0.03), and the Discussion describes this as a 20% increase in odds. However, the Results > Identified studies says 32 studies were included, not 34. The estimate describes increased odds, not necessarily a 20% increase in risk. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Review studies show that school attendance problems are closely linked to mental health difficulties and can be both a cause and a consequence of emotional and behavioral challenges.

    “Review-studies show that SAPs are closely linked to mental health difficulties and can be both a cause and a consequence of emotional and behavioral challenges”

    From “So That You Can Feel Well”: Perspectives of Students with Social, Emotional and Behavioral Difficulties on Factors that Support School Attendance (2025) · cites this paper as Epstein et al., 2020

    The Introduction links poor school attendance with mental health problems and says it can arise from internalising or externalising disorders. The Discussion reports some longitudinal evidence that absenteeism may be a risk factor for self-harm and suicidal ideation, but says the predominantly cross-sectional evidence cannot establish causal direction. The source therefore supports an association and a possible two-way relationship, not the broader claim that attendance problems can cause emotional and behavioral challenges generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • School absenteeism is a risk factor for self-harm with a significant pooled OR of 1.37.

    “Epstein et al. (2020) also investigated school absenteeism as a risk factor for self-harm and found a significant pooled OR of 1.37.”

    From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Epstein et al. (2020)

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Cited by

Sorted by citations

Authors
Epstein, S., Roberts, E., Sedgwick, R., Polling, C., Finning, K., Ford, T., Dutta, R., & Downs, J.
Affiliations
  • King's College London (GB)
  • University of Exeter (GB)
Corresponding author
Epstein, Sophie
ORCID
Venue
European Child & Adolescent Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2019-04-15
Volume
29
Issue
9
Pages
1175-1194
ISSN
  • 1018-8827 (ISSN-L)
  • 1435-165X
DOI
10.1007/s00787-019-01327-3
PMC
PMC7116080
OpenAlex
W2939243323
Cited by
127
References
12
Citations by year
2026: 25 · 2025: 19 · 2024: 23 · 2023: 12 · 2022: 19 · 2021: 20 · 2020: 8 · 2019: 1
FWCI
1.90
Type
journal article
Language
en
Open access
Licence
Locations
  • European Child & Adolescent Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Bristol Research (University of Bristol) (submittedVersion)
Funders
  • Wellcome Trust (105757/Z/14/Z, 107496/Z/15/Z)
  • MQ: Transforming Mental Health (MQDS16/52)
  • National Institute for Health and Care Research (ACF-2015-17-018, CS-2018-18-ST2-014, ACF-2017-17-019)
  • Department of Health and Social Care
  • Academy of Medical Sciences (AMS-CSF4-Dutta)
  • University of Exeter
  • King's College London
  • Medical Research Council (MR/N00616X/1, MR/L017105/1, 107496/Z/15/Z)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Education › Youth Substance Use and School Attendance
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
school absenteeism, self-harm, suicidal ideation, suicide risk, children and adolescents, social exclusion, suicide prevention
MeSH terms
Absenteeism, Adolescent, Adult, Child, Cross-Sectional Studies, Female, Humans, Male, Risk Factors, Self-Injurious Behavior, Young Adult, Suicidal Ideation

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