2. Why focusing on school absenteeism?
A serious public mental health issue
Associated with school dropout
Key factor for:
violence
injury
substance use
psychiatric disorder
economic deprivation
BACKGROUND Aim Methods Results Conclusion

4. Risk factors for school absenteeism
Child factors
Parent factors
Family factors
Peer factors
School factors
Community factors
School absence
BACKGROUND Aim Methods Results Conclusion

5. Risk factors for school absenteeism
Child factors
Gender
Age
Anxiety
Depression
Oppositional behavior
Chronic illness
Pain
Sleep problems/fatigue
Extreme obesity
Parent and family factors
Family structure
Education level
Income
Chronic illness/disability
Parents
Siblings
Emotional disorders
Parental involvement in the school
Peer factors
Bullying
Early peer rejection
School factors
Teacher-student relationship
Teacher-parent relationship
Students feeling of being:
Safe
Accepted
Respected
Child factors
Parent factors
Family factors
Peer factors
School factors
Community factors
School absence
BACKGROUND Aim Methods Results Conclusion

6. Risk factors for school absenteeism
Child factors
Child factors:
Anxiety
Depression
Oppositional behavior
Chronic illness
Parent factors
Parent factors:
Unemployment
Parental involvement in school activities
Family factors
Peer factors
Family factors:
Language spoken at home
School factors
Community factors
School absence
BACKGROUND Aim Methods Results Conclusion

7. How to categorize school absenteeism?
Danish primary and lower secondary school:
Legal
Due to medical illness or other accepted causes
Absence with permission from the head master
Illegal
E.g. truancy
BACKGROUND Aim Methods Results Conclusion

8. Background AIM Methods Results Conclusion
Overall Aim
In a sample of children from 0 th - to 9 th grade in 5 schools in the municipality of Aarhus, with children, parents, and teachers as informants the primary aim is to investigate the individual and relative importance of several domains of risk factors (individual, parental, family, peer, and school) for school absenteeism
Background AIM Methods Results Conclusion

9. Aim of this presentation
To investigate:
Associations between school absence and individual and contextual factors
The psychological characteristics of children with problematic school absence
Background AIM Methods Results Conclusion

11. Background Aim METHODS Results Conclusion
design
Cross-sectional study
Survey with students, parents, and teachers as informants
Absence data from the municipality
Register data (not obtained yet)
Data collected in winter/spring 2014
Background Aim METHODS Results Conclusion

12. Background Aim METHODS Results Conclusion
school absence data
Registered on a daily basis by the teachers for each student and are monthly reported to the municipality of Aarhus.
The school absence data are linked to the child’s civil registration number
In this presentation: overall absence from August 2013 to April 2014 (164 school days)
Background Aim METHODS Results Conclusion

13. Background Aim METHODS Results Conclusion
Procedure- Teachers
The class teacher completes the questionnaires during their working hours
A questionnaire for each student in the class
Strength and difficulties questionnaire (SDQ)
Questions about parental involvement
A questionnaire about the class
Wellbeing in the class
How the teacher managed absence
Background Aim METHODS Results Conclusion

14. Background Aim METHODS Results Conclusion
Procedure- parents
One parent invited to complete questionnaire
at home. Distributed: intranet
Questionnaire:
Strength and difficulties questionnaire (SDQ)
Parental involvement
Upbringing
Child health
Anxiety
Reason for absence (school refusal assessment scale)
Background Aim METHODS Results Conclusion

15. Background Aim METHODS Results Conclusion
Procedure- students
Completed survey in class using IPads/ schools laptop
Research assistants administered the data collection
Children from 0th to 1st grade did not receive a questionnaire.
Background Aim METHODS Results Conclusion

16. Data collection-students
WHO-5 (wellbeing)
Anxiety
Wellbeing in school (teachers, friends, bullying)
Upbringing
Spare time
Health and pain
Strength and difficulties questionnaire (SDQ)
Reason for absence
Background Aim METHODS Results Conclusion

17. Results
Preliminary data

18. n= 2021 STUDENTS n= 1731 (86%) Assessed for eligibility 2nd-9th grade
Non-participants
Changed school
Disagreed to participate
No contact to parents
Final student sample
n= 1731 (86%)
Age: ±2.37
♂= 877 (50.7%) ♀=854 (49.3%)
Background Aim Methods RESULTS Conclusion

19. Assessed for eligibility 0th-9th grade n=2473
PARENTS
n= 1104 (45%)
TEACHERS
n= 2108(85%)
Background Aim Methods RESULTS Conclusion

20. Background Aim Methods RESULTS Conclusion
PREVALENCE
(1% of school days)
(1% of school days)
Background Aim Methods RESULTS Conclusion

21. SDq-levels and mean days of absence
SDQ Total
Normal
Range
M (SD)
Above 80% percentile
Difference
TEACHER REPORTED
n=1643
n=462
Cohens d
Total absence
7.7 (7.4)
11.7 (11.8)
0.41***
Legal absence (illness)
4.3 (5.2)
6.2 (7.2)
0.30***
Legal absence (other)
2.1(3.6)
2.3 (4.2)
0.05
Illegal absence
1.2 (3.8)
3.2 (7.9)
0.32***
PARENT REPORTED
n=825
n=267
6.8 (6.4)
9.3 (10.5)
0.29***
3.8 (4.5)
5.3 (6.5)
0.27**
2.3 (3.8)
2.2 (4.3)
d=0.03
0.7 (1.8)
1.7 (6.5)
d=0.21*
De viser jo samme mønster. Måske resultaterne fra forældrenes SDQ kan undværes?
Note: *<.05, **<.01, ***<.001c

22. SDq-levels and mean days of absence
SDQ Total
Normal
Range
M (SD)
Above 80% percentile
Difference
STUDENT REPORTED
n=879
n=239
Cohens d
Total absence
8.2 (8.4)
10.2 (9.9)
0.22**
Legal absence (illness)
4.6 (5.6)
5.2 (6.4)
0.10
Legal absence (other)
2.1 (3.6)
2.0 (3.2)
0.03
Illegal absence
1.5 (4.2)
2.9 (6.8)
0.25**
Note: *<.05, **<.01, ***<.001
Background Aim Methods RESULTS Conclusion

23. Associations with absence
Total absence
Children
(n=1118#/
1731)
Parents
(n=1104)
Teachers
(n=2108)
Internalizing (SDQ)
.06*
.20***
.24***
Externalizing (SDQ)
.08*
.09*
.16***
Prosocial behavior (SDQ)
-.04
.02
-.15***
Wellbeing (WHO-5)
-.12*** -
Home/school cooperation
-.17***
Note:
# Only children from 4th-9th grade completed the SDQ
*<.05, **<.01, ***<.001
Background Aim Methods RESULTS Conclusion

24. Associations with absence
Legal (illness)
Legal (other)
Illegal C P T
Internalizing (SDQ)
.06*
.21***
.20***
-.02
.01
.06
.12***
.18***
Externalizing (SDQ)
.05
.07*
.08***
-.03
-.002
-.10**
.10**
.17***
Prosocial behavior (SDQ)
.09*
.02
-.05
-.16***
Wellbeing (WHO-5)
-.08**
.002
-.12***
Home/school cooperation
-.09**
-.10***
.04
.05*
.-12***
.003
-.22***
Note: *<.05, **<.01, ***<.001c
Indsætter ikke n her, da der ikke er plads, men det er samme tal, som forrige slide
Background Aim Methods RESULTS Conclusion

25. Problematic absence
Our definition: More than 10% absence from school in the period August April 2014 (164 school days). Only absence classified as either due to illness or illegal absence are included.

26. Characteristics of problematic absence group
Remaining sample
n=2260
Cohens d / phi
Age
12.8 (2.4)
11.6 (2.4)
.50***
Gender
57% males
51 % males
.03
Divorced parents
53%
31%
.12***
Chronic illness
45%
22%
.11**
Pain
64%
47%
.08**
Obesity
16% 4%
.12**
Wellbeing (WHO-5)
16.0 (4.9)
18.4 (4.1)
.53***
OBS: jeg har ikke kunne finde en måde at omregne phi til cohens d. Men phi rates som en correlation: 0.1 lille, 0.3 medium. O.5 stor effekt
Problematisk absence er defineret som havende mere end 10% fravær (eller 16 dage) pga sygdom eller pjæk. Alt lovlig fravær (feriefravær) er ekskluderet fra den totale fravær.
Kronisk sygdom er beregner på baggrund af hvor mange forældre, som har sagt ja til at barnet har en kronisk sygdom.
Smerte er beregnet pa baggrund af, om barnet har sagt ja til at det har oplevet smerter de sidste tre måneder.
Overvægt er rapporteret af forældrene.
Note: *<.05, **<.01, ***<.001.
Cohen’s d: =small, 0.5= medium, 0.8= large
phi: = small, 0.3=medium, 0.5= large
Background Aim Methods RESULTS Conclusion

27. Background Aim Methods RESULTS Conclusion
Characteristics of problematic absence group
Problematic absence
n=213
Remaining
n=2260
Cohens d
Home/school cooperation:
Parent-rated
Teacher-rated
3.1 (0.6)
3.0 (0.8)
3.3 (0.5)
3.3 (0.6)
.36*
.50***
Internalizing(SDQ):
Child-rated
5.4 (3.4)
5.8 (3.3)
4.8 (3.8)
4.4 (3.2)
2.8 (3.0)
2.0 (3.0)
.30***
.95***
.82***
Externalizing (SDQ):
5.9 (3.8)
4.6 (3.4)
5.7 (5.2)
3.2 (4.1)
.36***
.56***
.53***
Note: *<.05, **<.01, ***<.001.
Cohen’s d: =small, 0.5= medium, 0.8= large
Background Aim Methods RESULTS Conclusion

28. Characteristics of problematic absence group
Remaining n=2260
phi
Close friend
78%
84%
.04
Bullying
19%
20%
.002
Low academic performance
51%
23%
.18***
Special education need
33%
14%
.15***
Current contact to school psychologist (PPR)
36%
11%
.21***
Close friend= ja til: har du en god ven, du kan snakke med
Bullying: har sagt ja til at de har oplevet obning
Academic performance er rated af læreren
Specie education need er rapporteret af læreren
Kontakt til PPR i skoleåret 2013/2014
Note: *<.05, **<.01, ***<.001.
phi: 0.1= small, 0.3=medium, 0.5= large
Background Aim Methods RESULTS Conclusion

29. Background Aim Methods Results CONCLUSION
Summary of the results
Children with problematic absence have more emotional and behavioral problems (in the subclinical range)
Associations between absence and wellbeing and emotional and behavioral problems.
Children with legal absence due to medical illness have highest level of emotional problems
Background Aim Methods Results CONCLUSION

30. Background Aim Methods Results CONCLUSION
Summary of the results
Children with legal absence due to medical illness have highest level emotional problems
Background Aim Methods Results CONCLUSION

31. Background Aim Methods Results CONCLUSION
Implications
Develop and target interventions to children with problematic absence
Background Aim Methods Results CONCLUSION

32. This project is a part of Trygfonden’s Centre for Child Research
Research group
Lead researcher: Mikael Thastum, professor, Department of Psychology, Aarhus University
Johanne Jeppesen Lomholt, postdoc, Trygfonden’s Centre for Child Research, Aarhus University
Jacob Arendt Nielsen, professor, KORA
Jill Mehlby, senior researcher, KORA
Municipality of Aarhus
This project is a part of Trygfonden’s Centre for Child Research