School refusal and psychiatric disorders: A community study
School refusal and psychiatric disorders: A community study
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DOI：
10.1097/01.chi.0000046865.56865.79
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发表时间：
2003-07-01
影响因子：
13.3
通讯作者：
Angold, A
中科院分区：
文献类型：
--
作者：
Egger, HL;Costello, EJ;Angold, A
目的：采用描述性而非病因学的拒绝入学定义，研究社区儿童和青少年样本中焦虑性拒绝入学与逃学和精神疾病之间的关联。方法：对来自大烟山研究的9至16岁儿童及其父母的8次年度结构化精神病学访谈的数据进行了分析。结果如下：单纯焦虑性拒绝上学与抑郁（比值比[OR] = 13，95%置信区间[CI] 3.4，42）和分离焦虑障碍（OR = 8.7，95% CI 4.1，19）相关。单纯旷课与对立违抗性障碍（OR = 22，95%CI 1.2，4.2）、品行障碍（OR = 7.4，95%CI 3.9，14）和抑郁症（OR = 2.6，95%CI 1.2，56）相关。在混合拒绝上学者（既有焦虑性拒绝上学又有逃学的儿童）中，88.2%有精神障碍。他们的情绪和行为障碍率都有所增加。具体的恐惧，睡眠困难，躯体的投诉，在同伴关系的困难，和不良的心理社会变量有不同的协会与三种类型的学校拒绝。结论：拒绝上学和逃学是不同的，但不是相互排斥的，并显着相关的精神病理学，以及在家里和学校的不良经历。这些研究结果的影响评估，识别和干预学校拒绝进行了讨论。
Objective: To examine the association between anxious school refusal and truancy and psychiatric disorders in a community sample of children and adolescents using a descriptive rather than etiological definition of school refusal. Method: Data from eight annual waves of structured psychiatric interviews with 9- to 16-year-olds and their parents from the Great Smoky Mountains Study were analyzed. Results: Pure anxious school refusal was associated with depression (odds ratio [OR] = 13, 95% confidence interval [CI] 3.4, 42) and separation anxiety disorder (OR = 8.7, 95% CI 4.1, 19). Pure truancy was associated with oppositional defiant disorder (OR = 22, 95% CI 1.2, 4.2), conduct disorder (OR = 7.4, 95% CI 3.9, 14), and depression (OR = 2.6, 95% CI 1.2, 56). Of mixed school refusers (children with both anxious school refusal and truancy), 88.2% had a psychiatric disorder. They had increased rates of both emotional and behavior disorders. Specific fears, sleep difficulties, somatic complaints, difficulties in peer relationships, and adverse psychosocial variables had different associations with the three types of school refusal. Conclusions: Anxious school refusal and truancy are distinct but not mutually exclusive and are significantly associated with psychopathology, as well as adverse experiences at home and school. Implications of these findings for assessment, identification, and intervention for school refusal are discussed.