School Disengagement Among Children With Mental Health Conditions Pre- and Intra-COVID-19 Pandemic

Abstract

Objectives: School disengagement (SD) is associated with mental health, educational, and behavioral challenges. This study explored temporal changes in SD and SD rates among children with mental health conditions (MHCs) in a representative sample of US children aged 6 to 17 years from 2018 to 2022 and identified SD correlates.

Methods: We analyzed cross-sectional National Survey of Children's Health (NSCH) data from 2018 and 2019 (pre-pandemic), 2020 (lockdown), and 2021 and 2022 (intra-pandemic) (N = 136 576). We defined SD using an NSCH-developed measure based on parent responses regarding caring about school and completing homework. MHCs included anxiety, depression, behavioral/conduct problems, or attention-deficit/hyperactivity disorder. We adjusted for complex sampling and calculated weighted prevalence estimates for all variables and assessed for monotonic trends. χ2 and logistic regression assessed the relationships among SD, year, and MHCs, controlling for covariates.

Results: The 5-year cohort was composed of 51.1% boys, 51% 12- to 17-year-old children, 11.1% children who had a special education plan (SEP), 5.2% children who had missed at least 11 school days, and 6.1% children who had repeated a grade. SD rates were higher during pandemic years compared with 2018 (P < .001), especially for children with MHCs. Higher SD odds were seen in 2020, 2021, and 2022 compared with 2018 (2020, adjusted odds ratio [aOR]: 1.30, 99% CI: 1.1-1.54; 2021, aOR: 1.27, 99% CI: 1.08-1.49; 2022, aOR: 1.28, 99% CI: 1.1-1.49); no differences were observed between 2018 and 2019. Children with MHCs, overall health status that was very good or lower, food insecurity, a total of 4 or more lifetime moves, an SEP, and incidence of repeating a grade had higher SD odds.

Conclusions: SD rates have been higher since 2020 for children with MHCs and remain above pre-pandemic levels. MHCs and social and educational factors influence SD odds. These findings have implications for identifying children who are at risk for SD, particularly those with MHCs.