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 to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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.
Angold, A., & Costello, E. J. (1995). Developmental epidemiology. Epidemiologic Reviews, 17, 74–82.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Garland, E. J. (2001). Rages and refusals: Managing the many faces of adolescent anxiety. Canadian Family Physician, 47, 1023–1030.
Goodman, R. (1997). Strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586.
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345.
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.
Hale, D. R., Bevilacqua, L., & Viner, R. M. (2015). Adolescent health and adult education and employment: A systematic review. Pediatrics, 136, 128–140.
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.
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.
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.
Kaushik, A., Kostaki, E., & Kyriakopoulos, M. (2016). The stigma of mental illness in children and adolescents: A systematic review. Psychiatry Research, 243, 469–494.
Kearney, C. A. (2008). School absenteeism and school refusal behavior in youth: A contemporary review. Clinical Psychology Review, 28, 451–471.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Wang, M., & Peck, S. C. (2013). Adolescent educational success and mental health vary across school engagement profiles. Developmental Psychology, 49, 1266–1276.
Wang, M. T., & Fredricks, J. (2014). The reciprocal links between school engagement and youth problem behavior during adolescence. Child Development, 85, 722–737.
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.
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.
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.
White, H., Langman, N., & Henderson, S. (2006). A school-based transition program for high-risk adolescents. Psychiatric Services, 57, 1211.
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.
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.
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.
The authors are indebted to the patients who participated in this study and the staff who facilitated this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
About this article
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
- Psychiatric illness
- School avoidance
- Academic difficulty
- School engagement