Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK.
Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK.
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DOI：
10.1016/s2215-0366(21)00367-9
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Thapar A
中科院分区：
文献类型：
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作者：
John A;Friedmann Y;DelPozo-Banos M;Frizzati A;Ford T;Thapar A
学校出勤率低，无论是由于旷课还是被排斥，都会导致多种社会、教育和终身社会经济方面的不利因素。我们的目标是衡量一系列被诊断为神经发育和精神障碍，并在24岁前记录的自我伤害与上学和排斥之间的联系。在这项全国性的回溯性电子队列研究中，我们从威尔士人口服务局的数据集中提取了一个队列，其中包括2012/13-2015/16学年(2012年9月1日至2016年8月31日期间)在威尔士公立学校就读的7-16岁(在英国，16岁是离开学校的年龄)个人。使用青少年心理健康数据平台，我们将出勤和排除数据与国家人口以及初级和二级卫生保健数据集联系起来。我们确定了所有在24岁之前有神经发育障碍(ADHD和自闭症谱系障碍[ASD])、学习困难、品行障碍、抑郁、焦虑、饮食障碍、酒精或药物滥用、双相情感障碍、精神分裂症、其他精神障碍或有自我伤害记录(我们的解释变量)的学生。结果是缺课和被排除在外。使用具有Logit连接函数的二项分布的可交换相关结构的广义估计方程来计算旷工和排挤的优势比(OR)，并对性别、年龄和剥夺进行了调整。有414名 637名学生的就学、入学和医疗保健数据(2012年9月1日，201名 789[48.7%]女孩和212名 848[51.3%]男孩；平均年龄10.5岁[SD3.8]；种族数据不可用)。有神经发育障碍、精神障碍或自我伤害记录的人比没有记录的人更有可能在任何学年缺席或被排除在外。神经发育障碍患者缺席的未调整OR值为2.1(95%CI 2.0-2.2)，双相情感障碍患者为6.6(4.9-8.3)。神经发育障碍患者的缺勤调整OR值为2.0(1.9~2.1)，双相情感障碍患者的调整OR值为5.5(4.2~7.2)。排除的未调整OR从进食障碍者的1.7(1.3-2.2)到有滥用药物记录的22.7(20.8-24.7)不等。排除学习困难者的AORS为1·8(1·5~2·0)，有药物滥用史者为11·0(10·0~12·1)。24岁以下有神经发育或精神障碍或自残记录的儿童和年轻人比没有记录的儿童和年轻人更有可能旷课。被排斥或持续缺席是当前或未来精神健康状况不佳的潜在指标，通常会收集这些指标，并可用于有针对性的评估和早期干预。需要综合的学校和保健战略，以支持年轻人参与学校生活。医学研究理事会、MQ心理健康研究和经济社会研究理事会。摘要的威尔士语翻译见补充资料部分。
Poor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion. In this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7–16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13–2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation. School attendance, school exclusion, and health-care data were available for 414 637 pupils (201 789 [48·7%] girls and 212 848 [51·3%] boys; mean age 10·5 years [SD 3·8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2·1 (95% CI 2·0–2·2) for those with neurodevelopmental disorders to 6·6 (4·9–8·3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2·0 (1·9–2·1) for those with neurodevelopmental disorders to 5·5 (4·2–7·2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1·7 (1·3–2·2) for those with eating disorders to 22·7 (20·8–24·7) for those with a record of drugs misuse. aORs for exclusion ranged from 1·8 (1·5–2·0) for those with learning difficulties to 11·0 (10·0–12·1) for those with a record of drugs misuse. Children and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required. The Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council. For the Welsh translation of the abstract see Supplementary Materials section.