心理咨询门诊儿童青少年拒绝上学行为及疾病诊断调查

Survey about school refusal behavior and disease diagnosis in children and adolescents consulted in psychological counseling clinic

目的调查儿童青少年拒绝上学行为发生的性别、发病年龄、发生率、持续时间以及诊断。方法收集2007年1—12月在心理咨询门诊就诊的学龄儿童青少年共2431例，采用自编人口学资料及相关信息调查表，对拒绝上学行为进行调查分析。结果有拒绝上学行为的共207例（8．5％），其中6。10岁53例（25．6％）、11～14岁128例（61．8％）、15～16岁26例（12．6％），男女比为1．72：1，男女生在年龄分布上无显著性差异（X2=1．272，P=0．259）。情绪障碍发生率最高（45．4％），其次为精神分裂症以及心境障碍。三个年龄段均以情绪障碍为主要疾病构成，重性精神疾病如精神分裂症、心境障碍所占比例上升。拒绝上学时间为≤1个月95例（45．9％）、1—6个月62例（30．0％）、〉6个月50例（24．1％）。结论儿童青少年拒绝上学现象的发生及持续时间随人口学特征以及诊断的不同而有所不同。

Objective To investigate the gender, age of onset, prevalence, duration and diagnosis concerning school refusal behavior. Methods School refusal behavior was investigated with self - designed demographic questionnaire and clinic questionnaire in 2431 children and adolescents consulted in Shanghai psychological counseling center from January, 2007 to December, 2007. Results There were 207 cases （8.5 % ） with school refusal behavior, among which 53 cases （25.6%） were in the age grade of 6 to 10 years old, 128 cases （61.8%） were of 11 to 14 years old and 26 cases （ 12.6% ） were of 15 to 16 years old. The ratio of male to female is 1.72 to 1, and there was no significant difference in age distribution between males and females （X2 = 1. 272, P = 0. 259 ）. The prevalence of emotional disorder in 207 cases was 45.4%, followed by schizophrenia and mood disorder. Emotional disorder was the main part of diagnostic composition in all the 3 age grades. The ratio of emotional disorder decreased with the age （from 54.7% to 26.9% ）, while ratios of severe mental disorders such as schizophrenia and mood disorder increased with age. Among 207 cases with school refusal behavior, duration of refusal behavior was less than 1 month in 95 cases （45.9%）, 1 month to 6 months in 62 cases （30.0%）, more than 6 months in 50 cases （24.1% ）. Conclusion The occurrence and duration of school refusal behavior vary in accordance with demography features and clinical diagnosis.