School refusal and its relationship with anxiety, depression and stress
DOI:
https://doi.org/10.21814/rpe.32839Keywords:
School refusal, Anxiety, Depression, Stress.Abstract
Attending school favours the student´s formative, social and personal development. However, not all students show a positive attitude towards the obligation to attend school regularly. The aim of the present study was twofold: (1) to examine the mean differences in Depression, Anxiety and Stress scores based on school refusal and (2) to analyse the predictive capability of presenting high scores in Depression, Anxiety and Stress depending on school refusal factors. The sample consisted of 1455 Spanish students (M= 14.85; SD= 1.56). The School Refusal Assessment Scale-Revised was used (I. Avoidance of negative affectivity, II. Escape from aversive social/evaluative situations, III. Pursuit from attention and IV. Pursuit of external tangible reinforcements) and the Depression, Anxiety and Stress Scale. Results indicated that those students with high levels of Depression, Anxiety and Stress, obtained higher scores in school refusal behaviour. Furthermore, school refusal behaviour was a positive and statistically significant predictor of Depression, Anxiety and Stress in most cases. The role of Depression, Anxiety and Stress is discussed as a risk factor for school refusal behaviour.
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Aparicio-Flores, M.P., Cargua-García, N., Giménez- Ayala, C.E., & García-Fernández, J.M. (2020). School refusal and cognitive anxiety. European Journal of Health Research, 6(1), 75-84. https://doi.org/10.30552/ejhr.v6i1.203
Baskerville, D. (2020). Truancy begins in class: Students perspectives of tenuous peer relationships. Pastoral Care in Education, 39(2), 108-124. https://doi.org/10.1080/02643944.2020.1788125
Chewerik, M., Dalh, R.E., Bertomen, S., Hipp, E., Shreedar, P., Njau, P.F., & Leiferman, J.E. (2023). Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychology and Behavioral Medicine, 11(1), 2219299. https://doi.org/10.1080/21642850.2023.2219299
Elliot, J.G., & Palace M. (2019). Practicioner review: School Refusal: Developments in conceptualization and treatment since 2000. The Journal of Child Psychology and Psychiatry, 60(1), 4-15. https://doi.org/10.1111/jcpp.12848
Finning, K., Okoumunne, O.C., Ford, T., Danielson-Waters, E., Romero de Jager, I., Stentiford, L., & Moore, D.A. (2019). Review: The association between anxiety and poor attendance at school – a systematic review. Child and Adolescents Mental Health, 24(3), 205-216. https://doi.org/10.1111/camh.12322
Fornander, M.J., & Kearney, C.A. (2019). Family environment variables as predictor of school absenteeism severity at multiple levels: Enssemble and classification and regression tree analysis. Frontiers in Psychology, 10: 2381 https://doi.org/10.3389/fpsyg.2019.02381
Gómez-Núñez, M.I., García-Fernández, J.M., Vicent, M., Sanmartín, R., Gonzálvez, C., Aparisi-Sierra, D. e Inglés, C.J. (2017). Influencia del rechazo escolar sobre la alta ansiedad ante el castigo escolar en educación primaria. European Journal of Education and Psychology,10(2), 68-74. https://doi.org/10.1016/j.ejeps.2017.08.001
Gubbels, J., Van der Put, C. E., & Assink, M. (2019). Risk factors for school absenteeism and dropout: A Meta-Analytic Review. Journal of Youth Adolescents, 48, 1637–1667. https://doi.org/10.1007/s10964-019-01072-5
Fernández Hermida, J.R., & Villamarín Fernández, S. (Eds.). (2021). Libro Blanco de la Salud Mental Infanto-Juvenil. Volumen 1. Consejo General de la Psicología de España.
Heyne, D. (2022). Practicioner review: Singpost for Enhancing Cognitive-Behavioral Therapy for School Refusal in Adolescence. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 51(1), 61-76. https://doi.org/10.1024/1422-4917/a000899
Heyne, D., Gren-Landell, M., Melvin, G., & Gentle-Genitty, C. (2018). Differentiation Between School Attendance Problems: Why and How? Cognitive And Behavioral Practice, 26(1), 8-34. http://doi:10.1016/j.cbpra.2018.03.006
Jörns-Presentati, A., Napp, A. K., Dessauvegie, A. S., Stein, D. J., Jonker, D., Breet, E., Charles, W., Swart, R.L., Lahti, M., Suliman, S., Jansen, R., van der Heuvel, L.L., Seedat, S., & Groen, G. (2021). The prevalence of mental health problems in sub-Saharan adolescents: a systematic review. PLOS ONE, 16(5), e0251689. https://doi: 10.137/journal.pone.0251689
Kawsar M. D. S., Yilanli M., & Marwaha R. (2022). School Refusal. StatPearls publishing. https://www.ncbi.nlm.nih.gov/books/NBK534195/
Kearney, C. A. (2002). Identifying the function of school refusal behavior: A revision of the School Refusal Assessment Scale. Journal of Psychopathology and Behavioral Assessment, 24(4), 235-245. https://doi:10.1023/A:1020774932043
Kearney, C.A., Childs, J., & Burke, S. (2023). Social forces, social justice and school attendance problems in young people. Contemporary School Psychology, 27, 136-151. https://doi.org/10.1007/s40688-022-00425-5
Kearney, C.A., Gonzálvez, C., Gracziyk, P.A. & Fornander, M.J. (2019). Reconciling Contemporany Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability. Frontiers in Psychology, 10:2222. https://doi.org/10.3389/fpsyg.2019.02222Kearney, C. A., & Silverman, W. K. (1990). A preliminary analysis of a functional model of assessment and treatment for school refusal behavior. Behavior Modification, 14(3), 340-366. https://doi.org/10.1177/01454455900143007
Leigh, E., & Clark, D. M. (2018). Understanding social anxiety disorder in adolescents and improving treatment outcomes: Applying the cognitive model of Clark and Wells (1995). Clinical Child and Family Psychology Review, 21, 388-414. https://doi.org/10.1007/s10567-018-0258-5
Lovibond, S.H., & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia.
Martel, S.R., Falcone, M.M., Etkins, R.G., Marin, C.E., Lebowitz, E.R., & Silverman, W.K. (2022). Do School-Based Accommodations Mitigate Anxiey-Related School Impairment for Socially Anxious Youth? European Journal of Education and Psychology, 15(2), 7-21. https://doi.org/10.32457/ejep.v15i2.1965
Nayak, A., Sangoi, B., & Nachane, H. (2018). School refusal behavior in Indian children: Analysis of Clinical Profile, Psychopathology and Development of a Best-fit Risk Assessment Model. The Indian Journal of Pediatrics, 85(12), 1073-1078. https://doi.org/10.1007/s12098-018-2631-2
Nickerson, A., Liddell, B.J., Keegan, D., Edwards, B., Felmingham, K.L., Forbes, D., Hadzi-Pavlovic, D., McFarlane, A.C., O´Donnell, M., Silove, D., Steel, Z., van Hoof, M., & Bryant, R.A. (2018). Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees. Psychological Medicine, 49, 1661-1669. https://doi.org/10.1017/S0033291718002246
Read, D.L., Clark, G.I., Rock, A.J., & Coventry, W.L. (2018) Adult attachment and social anxiety: The mediating role of emotion regulation strategies. PLoS ONE 13(12), e0207514. https://doi.org/10.1371/journal.pone.0207514
Seçer, İ., & Ulaş, S. (2020). The Mediator Role of Academic Resilience in the Relationship of Anxiety Sensitivity, Social and Adaptive Functioning, and School Refusal with School Attachment in High School Students. Frontiers in Psychology, 11:557. https://doi:10.3389/fpsyg.2020.00557
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Copyright (c) 2026 Miriam Martín Galán, Carolina Gonzálvez Maciá, Ricardo Sanmartín López, María Vicent Juan

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