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

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

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

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

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

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

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

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

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

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

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

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

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

Results Preliminary data

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: 11.66 ±2.37 ♂= 877 (50.7%) ♀=854 (49.3%) Background Aim Methods RESULTS Conclusion

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

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

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

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

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

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

Problematic absence Our definition: More than 10% absence from school in the period August 2013- April 2014 (164 school days). Only absence classified as either due to illness or illegal absence are included.

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: 0.2=small, 0.5= medium, 0.8= large phi: 0.1= small, 0.3=medium, 0.5= large Background Aim Methods RESULTS Conclusion

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: 0.2=small, 0.5= medium, 0.8= large Background Aim Methods RESULTS Conclusion

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

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

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

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

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