Frequent Medical Absence in Secondary School Students: A Survey and Case Control Study

Abstract

Objective: To: (a) determine the prevalence of frequent absences (> 20% of the school year) for reasons recorded as ‘medical’ in secondary schools; (b) test the hypotheses that it is most commonly associated with physical symptoms and psychiatric disorder and not with serious organic disease; (c) seek evidence of unmet need for psychiatric management.

Design: Survey using routinely collected data and case-control study.

Setting: Local Authority Secondary Schools in Edinburgh, United Kingdom.

Participants: School students in the first four years. Cases were students with frequent medical absence; controls were students with a good attendance record (best 10% of year group) matched for age, gender and school class.

Measures: Period prevalence of frequent absences. Cases and controls (students and their parents) completed questionnaires about the students’ symptoms. Students were given a psychiatric diagnostic interview and a medical examination. The records of specialist medical services used by the students were reviewed.

Results: A substantial minority (2.2%) of students had frequent medical absence. Only 7/93 (8%) of cases had a serious organic disease and 7/93 (8%) had symptom defined syndromes; the remainder had physical symptoms and minor medical illness. Frequent medical absence was however strongly associated with psychiatric disorder (45% in cases vs. 17% in controls, p<0.001, 95% CI for OR 1.37 to 4.02). Only 14 of the 41 cases (34%) with a psychiatric diagnosis had attended NHS psychiatric services.

Conclusions: Frequent absence for medical reasons is common and more comprehensive management, including psychiatric assessment, is required to prevent long term adverse consequences.