School Refusal and Parental Illness: A Narrative Review.
Salomé Villetorte, Bruno Dauvier, Basilie Chevrier
PMID 42322075WHAT IT FOUND
Children who refuse school are more likely to have a parent with a mental illness, usually depression or anxiety, and where it has been measured that link looks strong.
But only 18 studies mention it, most in passing, and none followed families over time.
Key findings
01A link between parental illness and school refusal turns up repeatedly, and it is reported far more often for parental mental illness (13 studies) than for physical illness or illness not specified (5 studies).
02The two studies that compared children with school refusal against a control group found large differences in how many parents were ill: the review authors converted the reported correlations into effect sizes of d = 1.10 (r = 0.48, p < 0.001) and d = 1.08 (r = 0.46, p < 0.001), which they call strong.
03Across the 18 studies, parental illness was the main topic in only 2 and was mentioned only in passing in 11, so the association rests on very few pieces of original work.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a narrative review, not a systematic one, so the selection of studies was a judgement call rather than a protocol. Several reviews were included alongside primary studies, and the same primary studies appear in more than one of them, so the same findings are counted more than once and the conclusions rest on a smaller pool of original work than the numbers suggest. Every quantitative study included was cross-sectional. None followed families forward in time, so the review cannot say whether parental illness comes before the school refusal or after it. Parental illness was usually a side note in the original studies, so the numbers come from a handful of studies rather than a body of evidence built to answer this question. The effect sizes in the review were calculated by the review authors from correlations reported elsewhere, not reported by the original study teams. School refusal was usually diagnosed by the clinical team without stated criteria, and how the parent's illness was diagnosed was unspecified in half the studies, so both sides of the association are loosely defined. The review excluded the COVID period and excluded parental anxiety and depression judged to be below the illness threshold, which limits how far the findings generalise. Only three studies said which parent was ill, and mental illness was narrowed to depression and anxiety, so the review says little about other diagnoses or about fathers.
Declared interests
Funded by Aix-Marseille Université through a PhD grant. The authors declare no conflicts of interest. The review is part of the TOBIAS project, which holds ethics committee approval. No commercial sponsor was involved in designing or writing the work.
The easy way to misread this
Do not read this as evidence that a parent's illness causes school refusal. Every quantitative study included was cross-sectional, so the review cannot tell you which came first, and its own explanation for the link, the child taking on a young carer role, was never tested in any included study.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →