[School refusal: Psychopathological profiles of adolescents followed in a day hospital setting]

Introduction: School refusal appeared when formal education became compulsory in 1882, with the Jules Ferry laws. In international psychiatric classifications, school refusal does not appear as a diagnosis by itself, but it co-exists and is inherent to the symptoms of other psychiatric conditions, in particular of anxiety and depressive disorders. The main goal of this study was to describe psychopathological disorders in teenagers presenting school refusal followed in a day hospital setting. The second goal was to measure the level of anxiety, depressive emotion, self-esteem, loneliness, attachment to parents and peers, as well as quality of life, and to compare these with teenagers in school.

Material and methods: Two groups of individuals participated in this study. The first group consisted of 22 adolescents presenting school refusal followed in the Espace Arthur day hospital in Marseille. The control group included 23 teenagers in school. The psychopathological profile of teenagers with school refusal was defined using the semi-directed KIDDIE-SADS questionnaire. The level of psychopathology was assessed in the two groups through self-evaluation scales.

Results: The results showed that among teenagers with school refusal, four main diagnoses were found: social phobia (59%), separation anxiety disorder (50%), depression (32%), and generalized anxiety disorder (18%). Compared to teenagers in school, those with school refusal had significantly higher levels of anxiety, depression, and loneliness. In addition, they had low self-esteem, and the perception of attachment to their mother and to peers was also less secure. In line with this, they also showed poor quality of life.

Conclusion: Adolescents with school refusal show a wide variety of psychopathological symptoms, mainly inherent to anxiety and depressive disorders. These difficulties have an impact on the quality of life, loneliness, and self-esteem. Moreover, attachment to parents and peers seems to play an important role in this condition.