Inpatient with an Anxious School Refusal: A Retrospective Study.

Background: School refusal has an impact on the mental health and on future of young people. This phenomenon cannot only be linked to school dysfunction but must be considered in a larger set of processes. Recent studies propose an understanding of school refusal in terms of psychopathology and individual functioning as well as in terms of associated environmental and family factors.

Subjects And Methods: We conducted a retrospective study on youths admitted in our child psychiatric unit at HUDERF with an anxious school refusal behavior. The medical records of all 442 patients, admitted in the unit between 1996 and 2019, were inspected. It allows the inclusion of 71 patients, aged from 8 to 16 years.

Results: 16% of all patients present an anxious school refusal (ASR). There is a significant difference of sex, in inpatients with anxious school refusal, with 70.42% of male (p<0.0003). Concerning familial and parental characteristics, family separation (56.3%), conflict at home (27%), contact rupture with the father (25.3%) were associated with the onset of the school refusal. Parental psychiatric illness was frequently reported with maternal psychiatric illness (46.5%) and paternal history of psychiatric illness (28.2%). Maltreatment (30.9%) was also frequently observed in our inpatient population of youths with ASR. Concerning school and peers' relationships, we observe relational difficulties with peers (46.5%), bullying (26.7%), academic difficulties (36.6%) or change of school or moving home (19.7%). Mood and adjustment disorder were the most frequent associated diagnosis in our sample.

Conclusion: We confirmed that patient with anxious school refusal that need inpatient care were usually male, with more complex psychopathologies in term of comorbidities and familial maltreatment or psychiatric loading. They also have much more peers and school problems.