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ORIGINAL RESEARCH article
Front. Public Health
Sec. Children and Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1466209
Association between COVID-19 pandemic and school refusal among elementary school children in Japan: Difference-in-differences analysis
Provisionally accepted- Tokyo Medical and Dental University, Tokyo, Japan
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The coronavirus disease 2019 (COVID-19) pandemic has been reported to have affected children's mental health. However, the impact of the COVID-19 pandemic on school refusal remains unclear. This study examined the association between the early stage of the COVID-19 pandemic and school refusal among elementary school children in Japan using the difference-in-differences approach.: Data from the Adachi Child Health Impact of Living Difficulty study were used. We followed up with children without COVID-19 pandemic experience in the fourth grade in 2016 and the sixth grade in 2018 (control group, n = 449) and children with COVID-19 pandemic experience in the fourth grade in 2018 and the sixth grade in 2020 (COVID-19 group, n = 3,733).Results: Approximately 3.8% and 4.0% of students in the sixth grade in the control and COVID-19 groups, respectively, were school refusal. Change in the prevalence of school refusal from the fourth to the sixth grade in the control and COVID-19 groups was 2.4% and 2.0%, respectively. The difference-in-differences approach showed that the experience of the COVID-19 pandemic did not increase the risk of school refusal, which remained consistent even after performing propensity score matching.The early stage of the COVID-19 pandemic may not be associated with the risk of school refusal in elementary school children in Japan. A more long-term and comprehensive analysis is required to examine the full impact of the pandemic on 3 school refusal.
Keywords: COVID-19, school refusal, Difference in difference analysis, longitudinal study, Mental Health, Japan
Received: 17 Jul 2024; Accepted: 08 Apr 2025.
Copyright: © 2025 Mizuno, Nawa, Isumi, Doi, Morio and Fujiwara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Takeo Fujiwara, Tokyo Medical and Dental University, Tokyo, Japan
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