School Absenteeism and Self-Harm or Suicidal Outcomes Among Children, Adolescents, and School-Aged Young People: A Systematic Review and Meta-Analysis

Background: School absenteeism may indicate psychosocial vulnerability among children and adolescents. Although absenteeism, truancy, poor attendance, and school avoidance have been linked with self-harm and suicidal behaviours, the strength and certainty of this association require systematic synthesis. Objective: This systematic review and meta-analysis evaluated the association between school absenteeism and self-harm or suicidal outcomes among children, adolescents, and school-aged young people. Methods: The review was reported using PRISMA 2020 and MOOSE guidance and was registered in PROSPERO before journal submission (CRD420261472681). PubMed/MEDLINE, Web of Science Core Collection, and Scopus were searched for updated records from 7 June 2018 to 27 May 2026. Studies from a previous systematic review were reassessed against the current eligibility criteria. Eligible studies were quantitative observational studies of school-aged populations that measured school absenteeism or related attendance problems and reported self-harm, suicidal ideation, suicide plan, suicide attempt, suicidal behaviour, or suicide death. Risk of bias was evaluated using an adapted observational exposure-study framework, and certainty of evidence was assessed using an adapted GRADE approach. Results: Forty-seven studies were included: 15 newly identified studies and 32 studies retained from the previous review. The evidence was geographically diverse but was dominated by cross-sectional school-based surveys. Random-effects meta-analyses showed that attendance-related problems, particularly truancy, skipped school, or unauthorised absence, were associated with higher odds of suicidal ideation (12 estimates; OR = 1.32, 95% CI: 1.19–1.46; I2 = 63.3%), suicide plan (6 estimates; OR = 1.31, 95% CI: 1.21–1.42; I2 = 0.0%), and suicide attempt (14 estimates; OR = 1.60, 95% CI: 1.41–1.81; I2 = 69.4%). Risk of bias was moderate in 26 studies and serious in 21 studies; no study was rated as having low overall risk of bias. Conclusions: Low-certainty observational evidence suggests that attendance-related problems, particularly truancy, skipped school, or unauthorised absence, are associated with increased odds of suicidal ideation, suicide plan, and suicide attempt. Absenteeism should be interpreted as a potential marker of psychosocial vulnerability rather than as a standalone suicide risk prediction tool or evidence of causality. Evidence for chronic or persistent absence, school refusal, and school avoidance remains more limited.