Skip to main content

Advertisement

SpringerLink
Log in

Association of School Engagement, Academic Difficulties and School Avoidance with Psychological Difficulties Among Adolescents Admitted to a Psychiatric Inpatient Unit

  • Published:
Child and Adolescent Social Work Journal Aims and scope Submit manuscript

Abstract

Mental illness is a pressing public health concern, particularly when the onset is during childhood or adolescence. Many youth admitted to hospital-based psychiatric care experience school-related difficulties. The purpose of this report was to explore the associations of academic difficulties, school avoidance and school engagement to total psychological difficulties and emotional problems. Youth completed surveys that included standardized measures of school-related factors and the Strengths and Difficulties Questionnaire while in hospital. Psychiatrists provided the primary diagnosis and diagnosis most responsible for the current admission. In total, 161 patients participated in this study (mean age 15 years, SD 1.4; 75% female). All three school-related variables were significantly associated with emotional problems; however, only school avoidance and academic difficulties were associated with total difficulties. School-related concerns were significantly associated with the severity of mental health symptoms. Patients may benefit from attention to school-related difficulties before discharge from psychiatric care that continues beyond school reintegration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ablow, J. C., Measelle, J. R., Kraemer, H. C., Harrington, R., Luby, J., Smider, N., … Kupfer, D. J. (1999). The MacArthur Three-City Outcome Study: Evaluating multi-informant measures of young children’s symptomatology. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1580–1590.

    Article  PubMed  Google Scholar 

  • Angold, A., & Costello, E. J. (1995). Developmental epidemiology. Epidemiologic Reviews, 17, 74–82.

    Article  PubMed  Google Scholar 

  • Armstrong, J. M., Goldstein, L. H., & the MacArthur Working Group on Outcome Assessment (2003). Manual for the MacArthur Health and Behavior Questionnaire (HBQ1.0). Pittsburgh: University of Pittsburgh.

    Google Scholar 

  • Blizzard, A. M., Weiss, C. L., Wideman, R., & Stephan, S. (2016). Caregiver perspectives during the post inpatient hospital transition: A mixed methods approach. Child & Youth Care Forum, 45, 759–780.

    Article  Google Scholar 

  • Brière, F. N., Janosz, M., Fallu, J. S., & Morizot, J. (2015). Adolescent trajectories of depressive symptoms: mirror co-development of academic and behavioral adjustment. Journal of Adolescent Health, 57, 313–319.

    Article  Google Scholar 

  • Buckle, S. K., Lancaster, S., Powell, M. B., & Higgins, D. J. (2005). The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients. Child Abuse & Neglect, 29, 1031–1047.

    Article  Google Scholar 

  • Chun, T. H., Mace, S. E., & Katz, E. R. (2016). Evaluation and management of children and adolescents with acute mental health or behavioral problems. Part I: Common clinical challenges of patients with mental health and/or behavioral emergencies. Pediatrics, 138, e20161570.

    Article  PubMed  Google Scholar 

  • Clemens, E. V., Welfare, L. E., & Williams, A. M. (2010). Tough transitions: Mental health care professionals’ perception of the psychiatric hospital to school transition. Residential Treatment for Children & Youth, 27, 243–263.

    Article  Google Scholar 

  • Egger, H. L., Costello, J. E., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 797–807.

    Article  Google Scholar 

  • Esch, P., Bocquet, V., Pull, C., Couffignal, S., Lehnert, T., Graas, M., … Ansseau, M. (2014). The downward spiral of mental disorders and educational attainment: A systematic review on early school leaving. BMC Psychiatry, 14, 1–13.

    Article  Google Scholar 

  • Essex, M. J., Kraemer, H. C., Armstrong, J. M., Boyce, T. M., Goldsmith, H. H., Klein, M. H., … Kupfer, D. J. (2006). Exploring risk factors for the emergence of children’s mental health problems. Archives of General Psychiatry, 63, 1246–1256.

    Article  PubMed  Google Scholar 

  • Fagel, S., de Sonnevile, L., van Engeland, H., & Swaab, H. (2014). School-associated problems behaviour in children and adolescence and development of adult schizotypical symptoms: A follow up of a clinical cohort. Journal of Abnormal Child Psychology, 42, 813–823.

    PubMed  Google Scholar 

  • Fergusson, F. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59, 225–231.

    Article  PubMed  Google Scholar 

  • Forchuk, C., Russell, G., Kingston-MacClure, S., Turner, K., & Dill, S. (2011). From psychiatric ward to the streets and shelters. In C. Forchuk, R. Csiernik & E. Jensen (Eds.), Homelessness, Housing, and Mental Health: Finding Truths—Creating Change (pp. 167–178). Toronto: Canadian Scholars’ Press.

    Google Scholar 

  • Fredericks, J. A., Blumenfeld, P., Friedel, J., & Paris, A. (2005). School engagement. In K. A. Moore & L. Lippman (Eds.), What do children need to flourish?: Conceptualizing and measuring indicators of positive development. New York: Springer Science and Business Media.

    Google Scholar 

  • Gandhi, S., Chiu, M., Lam, K., Cairney, J. C., Guttmann, A., & Kurdyak, P. (2016). Mental health service use among children and youth in Ontario: Population-based trends over time. Canadian Journal of Psychiatry, 61, 119–124.

    Article  PubMed  PubMed Central  Google Scholar 

  • Garland, E. J. (2001). Rages and refusals: Managing the many faces of adolescent anxiety. Canadian Family Physician, 47, 1023–1030.

    PubMed  PubMed Central  Google Scholar 

  • Goodman, R. (1997). Strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586.

    Article  PubMed  Google Scholar 

  • Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345.

    Article  PubMed  Google Scholar 

  • Greenham, S., & Persi, J. (2014). The state of inpatient psychiatry for youth in Ontario: Results of the ONCAIPS benchmarking survey. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23, 31–37.

    PubMed  PubMed Central  Google Scholar 

  • Hale, D. R., Bevilacqua, L., & Viner, R. M. (2015). Adolescent health and adult education and employment: A systematic review. Pediatrics, 136, 128–140.

    Article  PubMed  Google Scholar 

  • Hammen, C., & Brennan, P. A. (2000). Depressed adolescents of depressed and nondepressed mothers: Tests of an interpersonal impairment hypothesis. Journal of Consulting and Clinical Psychology, 69, 284–294.

    Article  Google Scholar 

  • Henry, K. L., Knight, K. E., & Thornberry, T. P. (2012). School disengagement as a predictor of dropout, delinquency, and problem substance use during adolescence and early adulthood. Journal of Youth and Adolescence, 41, 156–166.

    Article  PubMed  Google Scholar 

  • Herman, K. C., Cho, E., Marriott, B. R., & Walker, L. Y. (2018). Bridging the gap in psychiatric care for children with a school-based psychiatry program. School Mental Health, 10, 181–189.

    Article  Google Scholar 

  • Kaushik, A., Kostaki, E., & Kyriakopoulos, M. (2016). The stigma of mental illness in children and adolescents: A systematic review. Psychiatry Research, 243, 469–494.

    Article  PubMed  Google Scholar 

  • Kearney, C. A. (2008). School absenteeism and school refusal behavior in youth: A contemporary review. Clinical Psychology Review, 28, 451–471.

    Article  PubMed  Google Scholar 

  • Kern, L., Mathur, S. R., Albrecht, S. F., Poland, S., Rozalski, M., & Skiba, R. J. (2017). The Need for school-based mental health services and recommendations for implementation. School Mental Health, 9, 205–217.

    Article  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merrikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026–1032.

    Article  Google Scholar 

  • Knollmann, M., Knoll, S., Reissner, V., Metzelaars, J., & Hebebrand, J. (2010). School avoidance from the point of view of child and adolescent psychiatry: Symptomatology, development, course and treatment. Deutshces Arzteblatt International, 107, 43–49.

    Google Scholar 

  • Lemery-Chalfant, K., Schreiber, J. E., Schmidt, N. L., Van Hulle, C. A., Essex, M. J., & Goldsmith, H. H. (2007). Assessing internalizing, externalizing, and attention problems in young children: Validation of the MacArthur HBQ. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 1315–1323.

    Article  Google Scholar 

  • Lyons, M. D., Huebner, E. S., & Hills, K. J. (2013). The dual-factor model of mental health: A short-term longitudinal study of school related outcomes. Social Indicators Research, 114, 549–565.

    Article  Google Scholar 

  • Maughan, B., & Rutter, M. (2001). Antisocial children grown up. In J. Hill & B. Maughan (Eds.), Conduct disorders in childhood and adolescence (pp. 507–552). Cambridge: Cambridge University Press.

    Google Scholar 

  • McLeod, J. D., Uemura, R., & Rohrman, S. (2012). Adolescent mental health, behavior problems, and academic achievement. Journal of Health and Social Behavior, 53, 482–497.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mental Health Commission of Canada. (2017). About MHCC. Retrieved from http://www.mentalhealthcommission.ca/English/who-we-are.

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ministry of Education. (2011). Mental health and addictions supports for district school boards. Retrieved from http://www.edu.gov.on.ca/eng/policyfunding/memos/nov2011/MentalHealthMemo.pdf.

  • Offord, D. R., & Lipman, E. L. (1996). Emotional and behavioural problems: Frequency by age, gender and income level and co-occurrence with other problems. In Growing Up in Canada. National Longitudinal Survey of Children and Youth (Catalogue No. 89-550-MPE). Ottawa: Canada.

    Google Scholar 

  • Preyde, M., Parekh, S., Warne, A., & Heintzman, J. (2017). School reintegration and perceived needs: The perspectives of child and adolescent patients during psychiatric hospitalization. Child and Adolescent Social Work Journal, 34, 517–526.

    Article  Google Scholar 

  • Preyde, M., Vanderkooy, J., Chevalier, P., Heintzman, J., Warne, A., & Barrick, K. (2014). The psychosocial characteristics associated with NSSI and suicide attempt of youth admitted to an inpatient psychiatric unit. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23, 100–111.

    PubMed  PubMed Central  Google Scholar 

  • Reid, R., Gonzalez, J., Nordness, P. D., Trout, A., & Epstein, M. H. (2004). A meta-analysis of the academic status of students with emotional/behavioral disturbance. The Journal of Special Education, 38, 130–143.

    Article  Google Scholar 

  • Riglin, L., Petrides, K. V., Frederickson, N., & Rice, F. (2014). The relationship between emotional problems and subsequent school attainment: A meta-analysis. Journal of Adolescence, 37, 335–346.

    Article  PubMed  Google Scholar 

  • Rotgans, J. I., Schmidt, H. G., Rajalingam, P., Wong Ying Hao, J., Canning, C. A., Ferenczi, M. A., & Low-Beer, N. (2018). How cognitive engagement fluctuates during a teambased learning session and how it predicts academic achievement. Advances in Health Sciences Education, 23, 339–351.

    Article  PubMed  Google Scholar 

  • Roy, L., Rousseau, J., Fortier, P., & Mottard, J. P. (2016). Postsecondary academic achievement and first-episode psychosis: A mixed-methods study. Canadian Journal of Occupational Therapy, 83, 42–52.

    Article  Google Scholar 

  • Shirtcliff, E. A., & Essex, M. J. (2008). Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence. Developmental Psychobiology, 50, 690–703.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simon, J. B., & Savina, E. A. (2007). Facilitating hospital to school transitions: Practice of hospital-based therapists. Residential Treatment for Children and Youth, 22, 29–66.

    Article  Google Scholar 

  • Vander Stoep, A., Weiss, N. S., Kuo, S., Cheney, E., D., & Cohen, P. (2003). What proportion of failure to complete secondary school in the US population is attributable to adolescent psychiatric disorder? The Journal of Behavioral Health Services & Research, 30, 119–124.

    Article  Google Scholar 

  • Veldman, K., Reijneveld, S. A., Ortiz, J. A., Verhulst, F. C., & Bültmann, U. (2015). Mental health trajectories from childhood to young adulthood affect the educational and employment status of young adults: Results from the TRAILS study. Journal of Epidemiological Community Health, 69, 588–593.

    Article  Google Scholar 

  • Waddell, C., McEwan, K., Shephard, C. A., Offord, D. R., & Hua, J. M. (2005). A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry, 50, 226–233.

    Article  PubMed  Google Scholar 

  • Wang, M., & Peck, S. C. (2013). Adolescent educational success and mental health vary across school engagement profiles. Developmental Psychology, 49, 1266–1276.

    Article  PubMed  Google Scholar 

  • Wang, M. T., & Fredricks, J. (2014). The reciprocal links between school engagement and youth problem behavior during adolescence. Child Development, 85, 722–737.

    Article  PubMed  Google Scholar 

  • Waseem, M., Arshad, A., Leber, M., Perales, O., & Jara, F. (2013). Victims of bullying in the emergency department with behavioral issues. Journal of Emergency Medicine, 44, 605–610.

    Article  Google Scholar 

  • Weiss, C. L., Blizzard, A. M., Vaughan, C., Sydnor-Diggs, T., Edwards, S., & Stephan, S. H. (2015). Supporting the transition from inpatient hospitalization to school. Child and Adolescent Psychiatric Clinics of North America, 24, 371–383.

    Article  PubMed  Google Scholar 

  • Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., … Wickramaratne, P. (1999). Depressed adolescents grown up. Journal of American Medical Association, 281, 1707–1713.

    Article  Google Scholar 

  • White, H., Langman, N., & Henderson, S. (2006). A school-based transition program for high-risk adolescents. Psychiatric Services, 57, 1211.

    Article  PubMed  Google Scholar 

  • Yusof, N., Ang, R. P., & Oei, T. P. (2017). The psychometric properties of the school engagement measure in adolescents in Singapore. Journal of Psychoeducational Assessment, 35, 521–533.

    Article  Google Scholar 

  • Zakriski, A. L., & Prinstein, M. J. (2001). Sociometric status of child inpatients in clinical and normative peer groups: Is peer status in a clinical setting a useful measure of adjustment? Applied Developmental Psychology, 22, 157–173.

    Article  Google Scholar 

  • Zimet, S. G., & Farley, G. K. (1993). Academic achievement of children with emotional disorders treated in a day hospital program: An outcome study. Child Psychiatry and Human Development, 23, 183–202.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are indebted to the patients who participated in this study and the staff who facilitated this study.

Author information

Authors and Affiliations

  1. University of Guelph, 133b MINS BLDG, Guelph, ON, N1G 2W1, Canada

    Sonya Ogilvie, Sarah Head & Michèle Preyde

  2. Grand River Hospital, Kitchener, Canada

    Shrenik Parekh & John Heintzman

Authors
  1. Sonya Ogilvie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Head
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shrenik Parekh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Heintzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michèle Preyde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michèle Preyde.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Research Ethics Clearance was provided by Grand River Hospital and the University of Guelph.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogilvie, S., Head, S., Parekh, S. et al. Association of School Engagement, Academic Difficulties and School Avoidance with Psychological Difficulties Among Adolescents Admitted to a Psychiatric Inpatient Unit. Child Adolesc Soc Work J 36, 419–427 (2019). https://doi.org/10.1007/s10560-018-0570-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10560-018-0570-4

Keywords

Search

Navigation