儿童青少年抑郁障碍患者合并拒绝上学行为的相关因素分析

刘艳 王少华 周国岭 周圆月 丁凯景 廖文静 薛闯 朱慧丽

[关键词] 儿童青少年;抑郁障碍;拒绝上学行为;相关性

[中图分类号] R749.94          [文献标识码] A          [文章编号] 1673-9701（2021）29-0008-05

Related factors for children and adolescents with depression disorder combined with refusal to go to school

LIU Yan   WANG Shaohua   ZHOU Guoling   ZHOU Yuanyue   DING Kaijing   LIAO Wenjing   XUE Chuang   ZHU Huili

Department of Child and Adolescent Psychology， Mental Health Center Affiliated to Medical College of Zhejiang University， Hangzhou Seventh People's Hospital， Hangzhou   310007，China

[Abstract] Objective To explore the related factors for children and adolescents with depression disorder combined with refusal to go to school. Methods A total of 84 children and adolescents diagnosed with depression disorder in our hospital from March to December 2019 were selected. The self-made general condition scale， self-rating depression scale （SDS）， and self-rating anxiety scale （SAS） and Family Cohesion and Adaptability Scale （FACESⅡ） were used to assess the demographic characteristics， severity of clinical symptoms， and family functions of patients. Single-and multi-factor analyses were conducted to investigate the influencing factors for children and adolescents with depressive disorder combined with refusal to go to school. Results Single-factor analysis suggested that children and adolescents with gender as female， peer relationship tension， parents with low education level， being non-single child， and severe depression and anxiety had a higher rate of combined refusal to go to school， with statistically significant difference （P<0.05）. Multi-factor analysis indicated that peer relationship tension， fathers′ low education level， being non-single child， and high degree of depression were risk factors for refusal to go to school in children and adolescents with depression disorder（P<0.05）. Conclusion It is common for children and adolescents with depression disorder to refuse to go to school. Peer relationship tension， fathers′ low education level， being non-single child， and high degree of depression are risk factors for refusal to go to school in children and adolescents with depression disorder.

[Key words] Children and adolescents; Depression disorder; Refusal to go to school; Relevance

情緒障碍是世界各地的儿童和青少年最常见的精神疾病，其中抑郁障碍的患病率约为3%[1]。抑郁障碍是儿童青少年疾病负担的主要因素[2]，并导致一系列问题，如受教育问题、家庭或社交关系中的困难、抽烟或药物滥用、身体的健康问题等[3-4]。拒绝上学行为（School refusal，SR）是一个复杂的问题，主要表现为回避上学，延长不上学的时间并伴随情绪问题或躯体症状[5];对儿童青少年心身发展、家庭和学校均有重大影响;长期拒绝上学会增加自杀、危险性行为、辍学和社会适应问题的风险[6-8]。此外，纵向研究发现，拒绝上学行为还会增加未来的就业不足及刑事诉讼的风险[9-10]。

查阅相关文献，目前大量研究聚焦于儿童青少年情绪障碍与拒绝上学行为相关性，关注存在拒绝上学行为儿童青少年的情绪问题，并认为拒绝上学现象是儿童青少年抑郁障碍更易觉察的临床表现[11]。然而，临床发现，合并拒绝上学行为的儿童青少年抑郁障碍患者的临床治疗效果较差，经系统治疗抑郁症状缓解后，也很难再次回归到学校完成学业。本研究旨在通过了解儿童青少年抑郁障碍患者合并拒绝上学行为的相关因素，为该类患者群的个体化治疗方案提供依据，现报道如下。

1 资料与方法

1.1一般资料

本研究为横断面研究。收集2019年3—12月在杭州市第七人民医院儿少心理科就诊的儿童青少年抑郁障碍患者，由一名高年资精神科主治医师及一名副主任医师经过系统精神检查及追问病史判定是否存在拒绝上学行为。……