Examining the Association Between School Absences and Unmet Need for Mental Health Care Due to Cost among U.S. Children.

OBJECTIVE: Prior research demonstrates associations between experiencing mental illness and school absenteeism, which leads to adverse financial and health consequences later in life. One of the starkest barriers to mental healthcare access faced by children in the United States is cost. This study aimed to examine the association between unmet need for mental healthcare and school attendance. METHODS: We analyzed 2010-2018 National Health Interview Survey data to examine the relationship between unmet need for mental healthcare due to cost and missing >4 days of school due to illness/injury in children aged 5-17. We also included measures of the abbreviated Strengths and Difficulties Questionnaire (SDQ) to account for prevalence of mental health symptomology. RESULTS: Nearly half (47.73%) of children who reported unmet need for mental health care due to cost during the past 12 months missed >4 school days, compared to only 28.23% of children without unmet need for mental healthcare (p<0.001). In adjusted logistic regression models, children with unmet need for mental healthcare due to cost had 2.18 (95% CI:1.80-2.64; p<0.01) higher odds of missing >4 days of school than children whose guardians did not report unmet need for mental healthcare due to cost. Even when including the SDQ score in our models, the association between being unable to access mental healthcare and increased school absence remained (OR=1.38 (95% CI:1.13-1.69; p=0.002)). CONCLUSION: Our study demonstrates that unmet need for mental healthcare due to cost is associated with missed school days due to illness/injury.