Associations of somatic and internalising symptoms with school absences: a national survey from Finland.

Objective: To examine associations of somatic and internalising mental health symptoms with school absences and how experiencing multiple symptoms influences the risk of school absences compared to single symptoms. Methods: The School Health Promotion study is a national survey conducted biennially in Finland by the Finnish Institute of Health and Welfare. We used data collected between 1996 and 2019. Each survey included between 32 439 and 92 227 participants from grades eight and nine (ages 13-17 years). Five somatic symptoms (neck pain, back pain, stomach ache, headache and sleep issues) and symptoms of anxiety and depression were assessed. School absences were reported as excused absences due to an illness and unexcused absences. Results: Somatic symptoms correlated with each other (0.27-0.46), with internalising symptoms (0.20-0.34) and both types of school absences (0.09-0.25). An increasing number of reported somatic symptoms was associated with higher odds for both types of school absences (cumulative OR (COR) 1.73-6.55 for excused and 1.49-4.28 for unexcused absences when students exhibited 1-5 somatic symptoms). Symptoms of depression showed a stronger association with unexcused absences than excused absences (COR 2.37 vs 1.50). Experiencing one somatic symptom or symptoms of anxiety was equally associated with excused and unexcused absences (interaction effect coefficients 0.95 and 0.94, respectively). When both somatic and internalising symptoms were present, COR was highest for excused absences (11.29). Experiencing two somatic symptoms increased the odds of weekly excused absences significantly (OR 9.60). Conclusions: Accumulation of somatic and internalising symptoms is associated with an increased risk of both excused and unexcused school absences. These results warrant multidisciplinary co-operation when planning and implementing interventions for absences.