Mental health difficulties, attainment and attendance: a cross-sectional study


Evidence for the association between mental health difficulties and academic outcomes is sparse and shows mixed results. The aim of this study was to investigate the association between educational attainment, absenteeism and mental health difficulties while controlling for various child characteristics such as special educational needs and socioeconomic background. 15,301 Year 7 pupils (mean age 11.91; SD = 0.28) from England completed the Strengths and Difficulties Questionnaire. Attainment, persistent absenteeism and child characteristics were derived from the National Pupil Database. Multilevel regression analysis showed that mental health difficulties were negatively associated with attainment and positively associated with persistent absenteeism. When all mental health difficulties were modelled simultaneously, behavioural difficulties, hyperactivity/attention difficulties and difficulties with peers were negatively associated with attainment. Emotional difficulties and hyperactivity/attention difficulties were positively associated with persistent absenteeism. The results of the current study highlight the importance of integration between mental health support and policy creation in relation to mental health difficulties and wellbeing in schools.

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We are extremely grateful to all the students who took part in this study, and the local authorities and schools for their help in recruiting them. The authors would like to thank the members of CPRU: Terence Stephenson, Catherine Law, Amanda Edwards, Ruth Gilbert, Steve Morris, Helen Roberts, Cathy Street and Russell Viner.


The data used in this study was collected as part of the HeadStart learning programme and supported by funding from the Big Lottery Fund. The content is solely the responsibility of the authors and does not necessarily reflect the views of the Big Lottery Fund. The Policy Research Unit in the Health of Children, Young People and Families is funded by the NIHR Policy Research Programme. This paper is based on independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm’s length bodies, and other Government Departments. Jessica Deighton was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust.

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Correspondence to Suzet Tanya Lereya.

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Lereya, S.T., Patel, M., dos Santos, J.P.G.A. et al. Mental health difficulties, attainment and attendance: a cross-sectional study. Eur Child Adolesc Psychiatry 28, 1147–1152 (2019).

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  • Mental health difficulties
  • Attainment
  • Absenteeism