School Refusal in Adolescents: Characteristics and Follow-Up 27‑60 Months After Their Admission to a Day Hospital

Abstract

Introduction: School refusal is defined as absenteeism from school by emotional distress and is the most common reason for referral to the Day Hospital Youth Clinic.

Objectives: The purpose of this article was to characterize the patients admitted for school refusal and to evaluate its situation after 27-60 months of their admission to the Day Hospital Youth Clinic.

Methods: This study was a retrospective review of clinical records of all patients assisted by Day Hospital Youth Clinic concerning to admission reason, gender, age, school retention, diagnosis, parental psychopathology and intervention intensity, between 1st January 2010 and 31st July 2012. This study also included a telephonic questionnaire with 27-60 months follow-up in order to evaluate school/employment status, psychiatric treatment needs and current emotional and behavioural difficulties.

Results: School refusal is associated with mood and anxiety disorders but also with behavioural disorders. Patients with school refusal need more intensive interventions than other patients. In this study, interventions with fewer than 25 sessions had worse outcomes than interventions with more than 100 sessions. Twenty seven to sixty months after admission to the Day Hospital, 15% of patients had no occupation, 50% had significant emotional and behavioural distress and 38.5% required psychiatric treatment, particularly if they had been diagnosed with affective disorders.

Conclusion: School refusal is associated with negative short and long-term outcomes; therefore a comprehensive and intensive intervention is essential particularly in patients with affective disorder.