Factors associated with school absenteeism in adolescents with mental illness: a multivariate analysis

school absenteeism is a common functional impairment among adolescents with mental disorders, yet its associated factors remain limited. This study aimed to identify key demographic, clinical, and social factors associated with school absenteeism in this population.

A retrospective cohort study was conducted among 217 adolescents (12-18 years) with mental illness, categorized into school-attending (n=163) and school-suspended (n=54) groups. Baseline data on demographics, clinical characteristics, social support, and family factors were collected. Univariate analyses were used to compare group differences, followed by multivariate logistic regression and restricted cubic spline (RCS) analysis to identify independent predictors of school absenteeism.

In univariate analysis, school-suspended adolescents had significantly lower social support scores (36.2 ± 10.9 vs. 45.5 ± 12.2, p<0.001), higher rates of parental divorce (46.3% vs. 22.1%, p<0.001), and a higher proportion of pre-hospitalization school absenteeism (51.9% vs. 31.3%, p=0.006). Multivariate logistic regression revealed that parental divorce (OR = 3.04, 95%CI=1.59-5.83, p=0.001), pre-hospitalization school absenteeism (OR = 2.37, 95%CI=1.26-4.43, p=0.007), and longer disease course (OR = 1.02, 95%CI=1.00-1.04, p=0.022) were independent risk factors for school absenteeism. Conversely, higher social support was a strong protective factor: compared to the low social support group (score 17-34), the medium (35-51) and high (52-85) support groups had markedly lower odds of school absenteeism (OR = 0.24, 95%CI=0.08-0.74, p=0.013; OR = 0.05, 95%CI=0.01-0.24, p<0.001, respectively). RCS analysis confirmed a linear negative association (P for non-linearity=0.189), with higher social support scores correlating with progressively lower suspension risk.

Parental divorce, pre-hospitalization school absenteeism, and longer disease course are independent risk factors for school absenteeism in adolescents with mental illness, while higher social support acts as a robust protective factor. These findings highlight the need for targeted interventions addressing family stability, social support enhancement, and early intervention for pre-existing school impairment to reduce school absenteeism and promote functional recovery in this vulnerable population.

https://clinicaltrials.gov/, identifier ChiCTR2100046396.