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Review: The association between anxiety and poor attendance at school – a systematic review
Open accessAbstract
BACKGROUND: Anxiety may be associated with poor attendance at school, which can lead to a range of adverse outcomes. We systematically reviewed the evidence for an association between anxiety and poor school attendance. METHODS: Seven electronic databases were searched for quantitative studies that reported an estimate of association between anxiety and school attendance. Anxiety had to be assessed via standardised diagnostic measure or validated scale. Articles were screened independently by two reviewers. Meta-analyses were performed where possible, otherwise results were synthesised narratively. RESULTS: A total of 4930 articles were screened. Eleven studies from six countries across North America, Europe and Asia, were included. School attendance was categorised into: (a) absenteeism (i.e. total absences), (b) excused/medical absences, (c) unexcused absences/truancy and (d) school refusal. Findings from eight studies suggested associations between truancy and any anxiety disorder, as well as social and generalised anxiety. Results also suggested cross-sectional associations between school refusal and separation, generalised and social anxiety disorders, as well as simple phobia. Few studies investigated associations with absenteeism or excused/medical absences. CONCLUSIONS: Findings suggest associations between anxiety and unexcused absences/truancy, and school refusal. Clinicians should consider the possibility of anxiety in children and adolescents with poor attendance. However, there is a lack of high quality evidence, little longitudinal research and limited evidence relating to overall absenteeism or excused/medical absences, despite the latter being the most common type of absence. These gaps should be a key priority for future research.
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“Indeed, anxiety-related school refusal may be viewed more sympathetically by school staff than truancy”
From Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1) (2019) · cites this paper as Finning et al., 2019
In the citing paper
“their discourse reveals underlying pedagogical knowledge of the association between mental health and school attendance, as widely established in literature (e.g., Finning et al., 2019;Lereya et al., 2019).”
From Their voices matter: student and professional perspectives on overcoming school attendance problems in the context of social, emotional, and behavioral difficulties (2025) · cites this paper as Finning et al., 2019
In the citing paper
“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 Finning et al., 2019
In the citing paper
“The relationships between social anxiety and school absenteeism (SAB) remain fragmented [16,17].”
In the citing paper
“This gap persists amid inconsistencies in findings [16] and a lack of robust theoretical perspectives [18,19].”
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“Extant literature on school burnout and related school attendance problems indicates heightened negative reactivity, avoidance of academic-related situations, and elevated anxiety symptoms in affected adolescents [4, 8, 9].”
Fernández‐Sogorb, A., Pérez‐Marco, M., Gonzálvez, C., & Kearney, C. A. (2026) · Child & Youth Care Forum · doi:10.1007/s10566-026-09972-x
Strauss, J., Coley, R. L., & Teixeira, S. N. (2026) · Children & Schools · doi:10.1093/cs/cdag015
Sharpe, J., & Heary, C. (2026) · Emotional and Behavioural Difficulties · doi:10.1080/13632752.2026.2730010
McGahan, J., Pearson, R. M., Fraser, H., Campbell, A., Hearn, J. H., Braithwaite, E. C., Bowes, L., Hill, J., Sharp, H., & Wright, N. (2026) · Archives of Women s Mental Health · doi:10.1007/s00737-026-01751-w
“…there is a need for a more nuanced understanding of established risk factors including pupil anxiety and depression (Egger et al. 2003; Finning et al. 2019a), special educational needs and disabilities, disadvantaged backgrounds (Roberts and Long 2025) and poor family functioning…”
Yu, S., Reardon, T. C., Ukoumunne, O. C., Njuguna, R. G., Dodd, H. F., Halliday, G., Hill, C., Jasper, B., Jones, B., Lawrence, P. J., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/87123
“Second, child anxiety problems are strongly related to school absence [36].”
Gürbüz, A. A., & Akdağ, B. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1955613
Chatzoglou, E., Fishstrom, S., McFadden, K., & Vaughn, S. R. (2026) · Learning Disabilities Research and Practice · doi:10.1177/09388982261496951
Goulding, K., & Freeman, E. E. (2026) · Children · doi:10.3390/children13101440
“…anxiety has been found to be associated with non-completion of high-school [33] and school can’t or attendance problems in neurotypical students [9,104], it should be investigated whether such relationships exist in neurodivergent students and contribute to the observed gaps in academic…”
A qualitative meta-synthesis of adolescents’ perceptions of school attendance problems
Kalvatn, A. S., Inglingstad, M., & Rasalingam, A. (2026) · Frontiers in Education · doi:10.3389/feduc.2026.1892533
Metadata
- Authors
- Finning, K., Ukoumunne, O. C., Ford, T., Danielson‐Waters, E., Shaw, L., Romero De Jager, I., Stentiford, L., & Moore, D. A.
- Affiliations
- University of Exeter (GB)
- University of Bristol Medical School Bristol UK
- University of Exeter Medical School Exeter UK
- Corresponding author
- Finning, Katie
- Venue
- Child and Adolescent Mental Health
- Publisher
- Wiley
- Published
- 2019-02-27
- Volume
- 24
- Issue
- 3
- Pages
- 205-216
- ISSN
- 1475-357X (ISSN-L)
- 1475-3588
- OpenAlex
- W2920440182
- Cited by
- 189
- References
- 50
- Citations by year
- 2026: 40 · 2025: 38 · 2024: 33 · 2023: 17 · 2022: 22 · 2021: 21 · 2020: 11 · 2019: 7
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Child and Adolescent Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Wellcome Trust (104908/Z/14/Z)
- Topics
- Social Sciences › Education › Youth Substance Use and School Attendance
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Keywords
- anxiety disorders, school attendance, school absenteeism, truancy, school refusal, social anxiety, generalized anxiety disorder, separation anxiety, phobia, children and adolescents
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