Abstract
BackgroundArmed conflicts and natural disasters are common. Millions of people, including children are killed, injured, disabled and displaced as a result. The effects of conflict and natural disaster on mental health, especially of children are well established but effects on education have received less attention. This study investigated associations between conflict and/or tsunami exposure in Sri Lanka and their associations with absenteeism in a national sample of school children.MethodsA cross-sectional survey was conducted in 2006–7 among 1,505 randomly selected school children aged 12–17 years attending government schools in 17 districts. The hypotheses were that absenteeism would be more common in children previously affected by conflict or the 2004 tsunami and that at least part of this effect would be accounted for by mental disorders. Survey information included socio-demographic, conflict and tsunami exposure, mental health status (Strengths and Difficulties Questionnaire) and information on absenteeism (defined as 20% or greater non-attendance over one year).ResultsThe total sample of consisted of 1,505 students aged 12–17 years with a mean age of 13.7 years. 120 children reported at least one conflict exposure and 65 reported at least one tsunami exposure while only 15 reported exposure to both conflict and tsunami. Prevalence of emotional disorder caseness was 2.7%, conduct disorder caseness 5.8%, hyperactivity disorder caseness 0.6%, and 8.5% were identified as having any psychiatric disorder. Absenteeism was present in 26.8%. Overall, previous exposure to tsunami (OR 2.29 95% CI 1.36-3.84) was significantly associated with absenteeism whereas exposure to conflict was not (OR 1.32 95% CI 0.88-1.97), although some specific conflict-related exposures were significant risk factors. Mental disorder was strongly associated with absenteeism but did not account for its association with tsunami or conflict exposure.ConclusionsExposure to traumatic events may have a detrimental effect on subsequent school attendance. This may give rise to perpetuating socioeconomic inequality and needs further research to inform policy and intervention.
Highlights
Armed conflicts and natural disasters are common
The effects of exposure to conflict and natural disaster on health, especially mental health, are well established [1,2,3,4] and international studies report high prevalence of mental disorders among children and adolescents exposed to conflicts and natural disasters [5,6,7,8,9]
A school survey was built into this project, the main objectives of which were to estimate the prevalence of conduct and behavioral disorders among school children, describing associated demographic and socioeconomic characteristics, potential social and environmental risk factors
Summary
Armed conflicts and natural disasters are common. Millions of people, including children are killed, injured, disabled and displaced as a result. The effects of conflict and natural disaster on mental health, especially of children are well established but effects on education have received less attention. Armed conflicts and recurring natural disasters are common and the damaging effects are especially salient in developing countries, compounded by poverty. Exposure to these events can create lasting detrimental effects on physical and mental health of both adult and child populations. An array of psychiatric co-morbidities, such as depression, anxiety, oppositional defiant disorder, conduct disorder and behavioral disorder has been found to precipitate and exacerbate absenteeism but the role of mental disorder in the relationship between traumatic events and school attendance is less well studied [11,13,14,15,16,17]
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