<p>Influence of Self-Esteem and Psychiatric Diagnosis on Health-Related Quality of Life in Children and Adolescents with School Refusal Behavior</p>

Abstract

Background: School refusal behavior (SRB), which is the refusal to attend or remain in school, has been associated with emotional, psychological, and other behavioral problems, as well as a lower health-related quality of life (HRQOL). However, the effects of self-esteem and a psychiatric diagnosis in students with SRB on HRQOL are not yet known. Understanding these relationships could help to develop more effective therapeutic interventions. Methods: A total of 175 young people (aged 8-18 years old) who visited our medical centers and outpatient clinics participated in the study. This comprised the SRB group (n = 70) and an age-and sex-matched control group (n = 105). Information about any psychiatric diagnosis was collected from medical records, HRQOL was measured using the J-KIDSCREEN-52, SRB was assessed using the School Refusal Assessment Scale-Revised for Japanese Attendance at School, self-esteem was measured using the Rosenberg Self-Esteem Scale, children's mental health status was measured using the Strengths and Difficulties Questionnaire, and social support was measured using the Oslo 3-item Social Support Scale. We performed between-group comparisons and multiple regression analysis. Results: The SRB had a significantly lower HRQOL than the control group in several of the KIDSCREEN-52 dimensions. In the SRB group, 35.7% had chronic disease and 35.7% of their parents had health problems and were receiving treatment. The multiple regression analysis revealed that, within the SRB group, a psychiatric diagnosis was associated with a lower HRQOL. However, this was not the case for a diagnosis of autistic spectrum disorder. Self-esteem positively affected HRQOL in six dimensions of the KIDSCREEN-52 within the SRB group. Conclusion: Our results could inform the development of support strategies for young people with SRB. Namely, support that enhances self-esteem could be used to increase HRQOL in young people with SRB. Furthermore, the presence of psychiatric disorders should be assessed as early as possible.

A Systematic Review of Somatic Symptoms in School Refusal

“…Multiple studies showed that a pathophysiological organic explanation could not be found to account for the somatic symptoms in school refusers (30,48,51,53–55,58,61,71,73,77–80,87,91,97,100,104,106,107,116,127). Terms such as “hypochondriacal” (26,82,96,128), “psychosomatic” (34,46,49,53,78,82,105,112–114,119,127,129–134), “somatoform disorder” (81,86,135), “somatization” (24,136), and “hysteria” (26,128,137) were used to describe these conditions. Somatic symptoms could be exaggerated (4,56,67,71,106,138,139) or falsely claimed (4,52,53,61,67,96,114,118) by patients (26,46,55,56,61,90,114,118,140,141) possibly to seek attention (71,95) or to remain home and avoid school (53,55,58,99,104,114,142).…”

“…Thirteen studies reported that patients first presented to general practitioners or pediatricians in the context of unexplained somatic symptoms (31,48,53,60,61,68,(80)(81)(82)(83)(84)(85)(86), with parents sometimes not even reporting school absenteeism to their physician (53,66,87). Some doctors justified unnecessary absences (51,61).…”

“…Multiple studies showed that a pathophysiological organic explanation could not be found to account for the somatic symptoms in school refusers (30,48,51,(53)(54)(55)58,61,71,73,(77)(78)(79)(80)87,91,97,100,104,106,107,116,127). Terms such as "hypochondriacal" (26,82,96,128), "psychosomatic" (34,46,49,53,78,82,105,(112)(113)(114)119,127,(129)(130)(131)(132)(133)(134), "somatoform disorder" (81,86,135), "somatization" (24,136), and "hysteria" (26,…”

Problematic Internet use and daily difficulties among adolescents with school refusal behaviors

“…However, school refusal behaviors can lead to social avoidance and family conflicts [33] . Comorbid psychiatric disorders and low self-esteem affect the quality of life among adolescents with school refusal behaviors [34] . In difficult situations, such adolescents may use the Internet excessively to avoid implicit pressure from their stresses.…”

“… [33] Comorbid psychiatric disorders and low self-esteem affect the quality of life among adolescents with school refusal behaviors. [34] In difficult situations, such adolescents may use the Internet excessively to avoid implicit pressure from their stresses. This unfavorable cycle caused by PIU deteriorates family relationships.…”