Examining school attendance as a predictor of self-harm in adolescents: A series of longitudinal studies using linked mental health and education data

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Self-harm is when a person hurts themselves on purpose in any way. More than 1 in 10 young people harm themselves before they turn 18. Self-harm with or without suicidal intent, is a major concern, as it is a sign of distress and a strong predictor of later suicide. Many young people have had problems for some time before they start to self-harm but do not feel able to seek help. To prevent self-harm, we need to find ways to identify those at risk as early as possible so that the right help can be provided.A good place to identify problems early is in school. However, schools have limited resources so cannot regularly ask their students how well they are coping. Schools do however keep records of all students' attendance and so information about poor attendance, which is one way that young people begin to show signs of problems, can be gathered.I have reviewed existing studies which suggest that poor school attendance increases the risk of self-harm but these studies lack quality and are inconclusive. However, previous research does suggest that a link between attendance and later self-harm could be possible for a number of reasons. Poor school attendance could increase social isolation and loneliness which are known to increase the risk of self-harm. Also poor attendance could result from hidden problems that a young person is encountering such as bullying or having an unwell parent, which can also increase the risk of self-harm. My research will explore whether poor school attendance can provide an "early warning sign" that young people are at risk of self-harm. I will also explore why those with poor attendance might be at higher risk, to help understand what type of support is needed. Whatever the reason, if this research shows that poor attendance is a sign of higher risk then it will inform schools and policy-makers that this group requires extra support in order to prevent self-harm.I also will explore whether school attendance patterns in young people who have known mental health problems could give mental health professionals extra information about whether a young person is at increased risk for severe self-harm. Things which increase the risk of self-harm in the general population may be different to those which increase the risk in young people who are already vulnerable due to having mental health problems or suicidal thoughts. An understanding of this would provide information to improve clinical practice.My research will consist of two studies. In one study, I will examine anonymised mental health records linked to education records for three groups of 11-17 year-olds to explore whether school attendance can predict who is more likely to present to Accident and Emergency (A&E) with self-harm and what may explain this. The three groups are: a) Young people in 4 boroughs of South London, b) Those who have attended Child and Adolescent Mental Health Services (CAMHS), c) Those who have reported suicidal thoughts to CAMHS. In another study, I will use data from the Resilience, Ethnicity and Adolescent Mental Health (REACH) study, which includes 11-14 year-olds in 12 schools in South London who may never have sought help for their problems. Here, I will explore whether school attendance can predict who is more likely to self-harm, this time according to young people's own reports rather than only those who present to A&E. The methods used in these studies provide an important example of using information which is routinely collected by schools and health services to understand which young people may be at risk of problems in future. Similar methods could be used to identify other signs of risk and to help predict other problems. The findings of my studies will provide information to help clinicians, education professionals and policy-makers understand which young people may be at higher risk of self-harm, and could contribute to the development of self-harm prevention strategies.