title: Impact of exposure to conflict, tsunami and mental disorders on school absenteeism: findings from a national sample of Sri Lankan children aged 12-17 years.
abstract: BACKGROUND
  Armed conflicts and natural disasters are common. Millions of people, including children are killed, injured, disabled and displaced as a result. The effects of conflict and natural disaster on mental health, especially of children are well established but effects on education have received less attention. This study investigated associations between conflict and/or tsunami exposure in Sri Lanka and their associations with absenteeism in a national sample of school children.
  
  
  METHODS
  A cross-sectional survey was conducted in 2006-7 among 1,505 randomly selected school children aged 12-17 years attending government schools in 17 districts. The hypotheses were that absenteeism would be more common in children previously affected by conflict or the 2004 tsunami and that at least part of this effect would be accounted for by mental disorders. Survey information included socio-demographic, conflict and tsunami exposure, mental health status (Strengths and Difficulties Questionnaire) and information on absenteeism (defined as 20% or greater non-attendance over one year).
  
  
  RESULTS
  The total sample of consisted of 1,505 students aged 12-17 years with a mean age of 13.7 years. 120 children reported at least one conflict exposure and 65 reported at least one tsunami exposure while only 15 reported exposure to both conflict and tsunami. Prevalence of emotional disorder caseness was 2.7%, conduct disorder caseness 5.8%, hyperactivity disorder caseness 0.6%, and 8.5% were identified as having any psychiatric disorder. Absenteeism was present in 26.8%. Overall, previous exposure to tsunami (OR 2.29 95% CI 1.36-3.84) was significantly associated with absenteeism whereas exposure to conflict was not (OR 1.32 95% CI 0.88-1.97), although some specific conflict-related exposures were significant risk factors. Mental disorder was strongly associated with absenteeism but did not account for its association with tsunami or conflict exposure.
  
  
  CONCLUSIONS
  Exposure to traumatic events may have a detrimental effect on subsequent school attendance. This may give rise to perpetuating socioeconomic inequality and needs further research to inform policy and intervention.
authors.affiliation: Health Service & Population Research Department, Institute of Psychiatry, King's College London, UK. chesmal@gmail.com.
authors.forename: Chesmal
authors.initials: C
authors.lastname: Siriwardhana
authors.forename: Gayani
authors.initials: G
authors.lastname: Pannala
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
authors.forename: Athula
authors.initials: A
authors.lastname: Sumathipala
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D002648:Child; D002669:Child Welfare; D003430:Cross-Sectional Studies; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012572:School Health Services; D012574:Schools; D013188:Sri Lanka / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011795:Surveys and Questionnaires