Trajectories of school absenteeism in adolescents with recurrent pain: predictors and distal outcomes.

Introduction: A sizeable number of adolescents with recurrent pain frequently miss school, yet the trajectories of absenteeism and their correlates remain unclear. We aimed to explore trajectories of school absenteeism due to pain among adolescents with recurrent pain, and predictors and correlates of the trajectories. Methods: A prospective cohort design with 3 yearly measurement points between 2016 and 2018 was used. The sample included 873 Swedish upper secondary school adolescents (mean age = 16.5 years; 60.8% girls; 11.7% immigrants) with recurrent pain (headache, abdominal and/or musculoskeletal pain ≥1/wk for 6 months). Predictors were sociodemographic variables, pain characteristics, depressive symptoms, and stressors in the school context. Distal outcomes were perceived future work ability and overall future expectancy. Results: We identified 3 trajectories of absenteeism through latent class growth analysis: persistently high absenteeism (18.1%), persistently low absenteeism (49.4%), and persistently no absenteeism (32.5%). Pain intensity and school-related stressors independently predicted absenteeism trajectories. Compared with the other trajectories, the persistently high absenteeism subgroup had more negative perceived future work ability and overall future expectancy. Conclusion: A substantial subgroup of adolescents showed a stable pattern of high absenteeism across their upper secondary education, which was associated with overall negative expectancies for the future and specifically future work ability. Therefore, there is a need to identify this subgroup and intervene early in the life course to prevent long-term disadvantages in education, employment, and overall well-being.