Frequent medical absences in secondary school students: survey and case-control study.
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.


METHODS
Survey using routinely collected data and case-control study


METHODS
Local authority secondary schools in Edinburgh, UK.


METHODS
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.


METHODS
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.
Jones
R
R
Royal Hospital for Sick Children, Edinburgh, UK.
Hoare
P
P
Elton
R
R
Dunhill
Z
Z
Sharpe
M
M
D000041:Absenteeism; D000293:Adolescent; D002908:Chronic Disease / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D020380:Needs Assessment; D012574:Schools / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*