Objective: To determine the prevalence of frequent absence (>20% of the school year) for reasons recorded as “medical” in secondary schools; to test the hypothesis that it is associated with physical symptoms and psychiatric disorder and not with serious organic disease; to assess unmet need for psychiatric management.
Design: Survey using routinely collected data and case–control study
Setting: Local authority secondary schools in Edinburgh, UK.
Participants: School students in the first 4 years of secondary school: cases were those with frequent medical absence and controls those 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 absences. Only seven of 92 (8%) cases had a serious organic disease and 10 of 92 (11%) had symptom-defined syndromes; the remainder had physical symptoms and minor medical illness. Frequent medical absence was strongly associated with psychiatric disorder (45% in cases vs 17% in controls, p<0.001, 95% CI for odds ratio 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.
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Funding The study was funded by a grant from the Health Foundation. The funders had no role in the conduct of the study or analysis of study data.
Competing interests None.
Ethics approval The study was approved by the Local Research Ethics Committee and also by the Ethics Committee of the Education Department of City of Edinburgh Council.
Patient consent Obtained.
Contributors: All authors contributed to the interpretation of data and the drafting of the article or revising it critically for important intellectual content. All have given final approval to the submitted manuscript. The study was conceived and designed by MS and PH. The analysis was undertaken by RE.
Provenance and peer review Not commissioned; externally peer reviewed.