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Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019

Margaret Diogu, Sze Chim Lee Orcid Logo, Marcos del Pozo Banos Orcid Logo, Olivier Rouquette, Ann John Orcid Logo

Journal of Affective Disorders, Volume: 385, Issue: 119394, Start page: 119394

Swansea University Authors: Margaret Diogu, Sze Chim Lee Orcid Logo, Marcos del Pozo Banos Orcid Logo, Olivier Rouquette, Ann John Orcid Logo

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DOI (Published version): 10.1016/j.jad.2025.119394

Abstract

BackgroundEvidence of the negative impact of school absence and exclusion on children and young people's life trajectories has been growing but relevant population-based studies including suicide adjusted for history of mental health conditions are scarce. We aimed to examine the associations b...

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Published in: Journal of Affective Disorders
ISSN: 0165-0327
Published: Elsevier B.V. Elsevier BV 2025
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We aimed to examine the associations between suicide and school absence and exclusion.MethodsWe linked routinely collected electronic education and health data for pupils in Wales, UK during 2012/13&#x2013;2018/19 school years. We identified pupils who were persistently absent or excluded from school and followed them up to identify suicide deaths to 31/12/2021. Firth logistic regression was used to evaluate adjusted odd ratios (aORs) of suicide mortality.ResultsRespectively, 8.6&#x202F;% and 4.3&#x202F;% of pupils (N&#x202F;=&#x202F;584,394) had records of persistent absence and exclusion from school. 123 pupils died by suicide in the cohort (21.0 per 100,000 persons). Adjusted odds ratios for suicide were 2.3 (95&#x202F;% CI: 1.5&#x2013;3.7) following exclusion but non- significant for persistent absence (1.0; 95&#x202F;% CI: 0.6&#x2013;1.7). Other indicators for suicide were male sex, age&#x202F;&#x2265;&#x202F;10&#x202F;years, history of self-harm, high levels mental health comorbidity, autistic spectrum disorders and drug use.LimitationsRelatively low numbers of suicide deaths reduced statistical power. There was no stratification of absence and exclusions into categories based on their nature or causes.ConclusionsLong-term strategies to support those excluded from school, addressing their social, emotional and medical, needs should be implemented given their heightened risk of future suicide. Attendance data, routinely collected by schools, has potential to be developed as an indicator of unmet need.</abstract><type>Journal Article</type><journal>Journal of Affective Disorders</journal><volume>385</volume><journalNumber>119394</journalNumber><paginationStart>119394</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication>Elsevier B.V.</placeOfPublication><isbnPrint/><isbnElectronic/><issnPrint>0165-0327</issnPrint><issnElectronic/><keywords>Absence; Attendance; Data linkage; Exclusion; School pupil; Suicide</keywords><publishedDay>15</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-09-15</publishedDate><doi>10.1016/j.jad.2025.119394</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This work was supported by the Adolescent Mental Health Data Platform (ADP) and the Wolfson Centre for Young People's Mental Health (Grant number 517483). The ADP is funded by MQ Mental Health Research Charity (Grant Reference MQBF/3 ADP). Also funded by the National Centre for Mental Health, NCMH (Grant reference; CA04). The views expressed are entirely those of the authors and should not be assumed to be the same as those of ADP, NCMH or MQ Mental Health Research Charity.</funders><projectreference/><lastEdited>2025-06-13T13:58:45.9326264</lastEdited><Created>2025-05-12T08:45:05.9450091</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Margaret</firstname><surname>Diogu</surname><order>1</order></author><author><firstname>Sze Chim</firstname><surname>Lee</surname><orcid>0000-0001-5822-6633</orcid><order>2</order></author><author><firstname>Marcos</firstname><surname>del Pozo Banos</surname><orcid>0000-0003-1502-389X</orcid><order>3</order></author><author><firstname>Olivier</firstname><surname>Rouquette</surname><order>4</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>5</order></author></authors><documents><document><filename>69492__34408__25400f720e54457e8b751446bff2a17d.pdf</filename><originalFilename>69492.VoR.pdf</originalFilename><uploaded>2025-06-05T16:51:38.7315994</uploaded><type>Output</type><contentLength>980465</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 The Authors. 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spelling 2025-06-13T13:58:45.9326264 v2 69492 2025-05-12 Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019 662a76930fba968d30ca8c259aaf04d8 Margaret Diogu Margaret Diogu true false 10628af4988d624b49c4de7bd78b4694 0000-0001-5822-6633 Sze Chim Lee Sze Chim Lee true false f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 0e502db88ea48ce6b053ed0eef9a54ce Olivier Rouquette Olivier Rouquette true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-05-12 MEDS BackgroundEvidence of the negative impact of school absence and exclusion on children and young people's life trajectories has been growing but relevant population-based studies including suicide adjusted for history of mental health conditions are scarce. We aimed to examine the associations between suicide and school absence and exclusion.MethodsWe linked routinely collected electronic education and health data for pupils in Wales, UK during 2012/13–2018/19 school years. We identified pupils who were persistently absent or excluded from school and followed them up to identify suicide deaths to 31/12/2021. Firth logistic regression was used to evaluate adjusted odd ratios (aORs) of suicide mortality.ResultsRespectively, 8.6 % and 4.3 % of pupils (N = 584,394) had records of persistent absence and exclusion from school. 123 pupils died by suicide in the cohort (21.0 per 100,000 persons). Adjusted odds ratios for suicide were 2.3 (95 % CI: 1.5–3.7) following exclusion but non- significant for persistent absence (1.0; 95 % CI: 0.6–1.7). Other indicators for suicide were male sex, age ≥ 10 years, history of self-harm, high levels mental health comorbidity, autistic spectrum disorders and drug use.LimitationsRelatively low numbers of suicide deaths reduced statistical power. There was no stratification of absence and exclusions into categories based on their nature or causes.ConclusionsLong-term strategies to support those excluded from school, addressing their social, emotional and medical, needs should be implemented given their heightened risk of future suicide. Attendance data, routinely collected by schools, has potential to be developed as an indicator of unmet need. Journal Article Journal of Affective Disorders 385 119394 119394 Elsevier BV Elsevier B.V. 0165-0327 Absence; Attendance; Data linkage; Exclusion; School pupil; Suicide 15 9 2025 2025-09-15 10.1016/j.jad.2025.119394 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) This work was supported by the Adolescent Mental Health Data Platform (ADP) and the Wolfson Centre for Young People's Mental Health (Grant number 517483). The ADP is funded by MQ Mental Health Research Charity (Grant Reference MQBF/3 ADP). Also funded by the National Centre for Mental Health, NCMH (Grant reference; CA04). The views expressed are entirely those of the authors and should not be assumed to be the same as those of ADP, NCMH or MQ Mental Health Research Charity. 2025-06-13T13:58:45.9326264 2025-05-12T08:45:05.9450091 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Margaret Diogu 1 Sze Chim Lee 0000-0001-5822-6633 2 Marcos del Pozo Banos 0000-0003-1502-389X 3 Olivier Rouquette 4 Ann John 0000-0002-5657-6995 5 69492__34408__25400f720e54457e8b751446bff2a17d.pdf 69492.VoR.pdf 2025-06-05T16:51:38.7315994 Output 980465 application/pdf Version of Record true © 2025 The Authors. This is an open access article under the CC BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
spellingShingle Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
Margaret Diogu
Sze Chim Lee
Marcos del Pozo Banos
Olivier Rouquette
Ann John
title_short Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
title_full Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
title_fullStr Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
title_full_unstemmed Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
title_sort Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
author_id_str_mv 662a76930fba968d30ca8c259aaf04d8
10628af4988d624b49c4de7bd78b4694
f141785b1c0ab9efe45665d35c081b84
0e502db88ea48ce6b053ed0eef9a54ce
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 662a76930fba968d30ca8c259aaf04d8_***_Margaret Diogu
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
0e502db88ea48ce6b053ed0eef9a54ce_***_Olivier Rouquette
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Margaret Diogu
Sze Chim Lee
Marcos del Pozo Banos
Olivier Rouquette
Ann John
author2 Margaret Diogu
Sze Chim Lee
Marcos del Pozo Banos
Olivier Rouquette
Ann John
format Journal article
container_title Journal of Affective Disorders
container_volume 385
container_issue 119394
container_start_page 119394
publishDate 2025
institution Swansea University
issn 0165-0327
doi_str_mv 10.1016/j.jad.2025.119394
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundEvidence of the negative impact of school absence and exclusion on children and young people's life trajectories has been growing but relevant population-based studies including suicide adjusted for history of mental health conditions are scarce. We aimed to examine the associations between suicide and school absence and exclusion.MethodsWe linked routinely collected electronic education and health data for pupils in Wales, UK during 2012/13–2018/19 school years. We identified pupils who were persistently absent or excluded from school and followed them up to identify suicide deaths to 31/12/2021. Firth logistic regression was used to evaluate adjusted odd ratios (aORs) of suicide mortality.ResultsRespectively, 8.6 % and 4.3 % of pupils (N = 584,394) had records of persistent absence and exclusion from school. 123 pupils died by suicide in the cohort (21.0 per 100,000 persons). Adjusted odds ratios for suicide were 2.3 (95 % CI: 1.5–3.7) following exclusion but non- significant for persistent absence (1.0; 95 % CI: 0.6–1.7). Other indicators for suicide were male sex, age ≥ 10 years, history of self-harm, high levels mental health comorbidity, autistic spectrum disorders and drug use.LimitationsRelatively low numbers of suicide deaths reduced statistical power. There was no stratification of absence and exclusions into categories based on their nature or causes.ConclusionsLong-term strategies to support those excluded from school, addressing their social, emotional and medical, needs should be implemented given their heightened risk of future suicide. Attendance data, routinely collected by schools, has potential to be developed as an indicator of unmet need.
published_date 2025-09-15T17:56:25Z
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