Mental Health and Chronic Absenteeism Among Children and Adolescents: A Scoping Review

Background and Purpose: Chronic absenteeism, influenced by a complex interplay of risk and protective factors, poses significant challenges for K–12 students in the U.S. and can lead to long-term adverse consequences. Its prevalence has increased sharply, with a 91% rise from 2018–2019 to 2021–2022. Mental health challenges are known contributors to absenteeism, yet the relationship between mental health and chronic absenteeism remains underexplored. This scoping review aimed to examine the relationship between chronic absenteeism and mental health challenges, as well as the effects of mental health interventions on chronic absenteeism among children and adolescents in the U.S.

Methods: A literature search was conducted in July 2024 using four databases across five interfaces: Medline via Ovid and PubMed, PsycINFO via Ovid, Embase via Ovid, and Web of Science Core Collection. Reference lists of articles that passed full-text screening were also examined. Studies were included if they were published in English, peer-reviewed empirical research conducted in the U.S., focused on K–12 students experiencing chronic absenteeism, and measured at least one mental health challenge or intervention. The review followed PRISMA-ScR guidelines.

Results: Of the 289 records screened, eight quantitative studies met the inclusion criteria. All studies identified associations between mental health challenges and chronic absenteeism. Five studies examined internalizing behaviors (e.g., anxiety, loneliness, low self-esteem, and depression). Four found statistically significant associations with chronic absenteeism, while the fifth observed slightly higher mental distress scores among chronically absent students (7.8 vs. 7.6), though the difference was not statistically significant. Overall, students with internalizing behaviors consistently showed higher odds of chronic absence. Two studies examining emotional impairment and emotional disturbance found particularly high rates of chronic absenteeism (38.1% and 47.1%, respectively), with one study showing students with emotional disturbances were 19 percentage points more likely to be chronically absent than students without disabilities. Findings on externalizing behaviors were mixed: two studies found students with externalizing behaviors less likely to be chronically absent, one found no association, and another found higher absenteeism rates among students with ADHD (3.8%) compared to those without ADHD (2.0%), as well as among students with behavioral problems (6.1%) compared to those without behavioral problems (1.6%). No studies examined mental health interventions or the potential bidirectional relationship between chronic absenteeism and mental health.

Conclusions and Implications: This scoping review highlights the multifaceted relationships between mental health and chronic absenteeism, particularly the role of internalizing behavior, emotional impairments, and emotional disturbances. However, existing studies have primarily focused on mental health challenges as risk factors and have not examined the effects of chronic absenteeism on students’ mental health or the impact of mental health interventions on attendance. These findings reveal a critical research gap. Future research should explore the effects of chronic absenteeism on students’ mental health and assess the effectiveness of mental health interventions in reducing chronic absenteeism. These insights are essential for informing school-based strategies and policies that support student well-being and attendance.