叙事治疗对青少年抑郁症患者非自杀性自伤的干预效果：一项前瞻性随机对照研究

目的 探讨叙事治疗对青少年抑郁症患者非自杀性自伤和焦虑、抑郁情绪的干预效果。方法 采用抛掷硬币法将60例伴非自杀性自伤(non-suicidal self-injury, NSSI)的青少年抑郁症患者随机分配至干预组和对照组。对照组给予常规心理支持,干预组在常规心理支持的基础上进行个体叙事治疗(每周2次,每次60 min,共计3周)。采用青少年自我伤害问卷、儿童抑郁量表、儿童焦虑情绪筛查量表在干预前、干预结束时和干预结束后1个月对两组患者进行疗效评估。结果 干预组26例、对照组29例患者参与全程研究。干预结束时和干预结束后1个月,干预组NSSI次数得分、NSSI水平、焦虑得分和抑郁得分均较干预前显著减少(P<0.017)。干预结束时和干预结束后1个月,干预组NSSI次数得分、NSSI程度得分、NSSI水平、焦虑得分和抑郁得分均显著低于对照组(P<0.05)。结论 叙事治疗能有效减少青少年抑郁症患者的NSSI次数,缓解NSSI程度,且有助于缓解青少年抑郁症患者的焦虑和抑郁情绪。[中国当代儿科杂志,2024,26 (2):124-130]     

非自杀性自伤青少年神经认知功能相关电生理研究进展北大核心CSCD

非自杀性自伤(non-suicidal self-injury,NSSI)在青少年中越来越多见,严重影响着青少年的身心健康,是引发青少年自杀行为的重大隐患。NSSI已成为当前普遍关注的公共精神卫生问题。目前,NSSI认知功能障碍的识别仍基于神经心理认知测量和主观问卷量表评估,缺乏客观的评估指标。脑电生理作为研究NSSI认知神经机制的方法之一,也是寻找NSSI客观生物标志物的可靠工具。该文就青少年NSSI认知功能障碍相关电生理的研究进展进行综述。     

上海市中小学生自杀行为及心理社会相关因素的研究

目的 了解上海市中小学生自杀行为的现状，探索自杀行为的相关危险因素。方法 采用分级整群随机抽样方法，选取上海市9所学校：小学5年级、预备初中（预初）、初一、初二、高一和高二年级学生进行匿名自评问卷调查。问卷包括一般情况问卷、流行病学调查中心用抑郁量表、焦虑自评量表、青少年生活事件量表和贝克绝望量表，根据美国疾病控制预防中心（CDC）青少年危险行为调查所采用的方式设置最近12个月的自杀意念、自杀计划和自杀未遂行为调查。自杀行为的年级和性别差异用卡方检验，自杀意念的相关因素分析采用单因素和多因素Logistic回归模型。结果 ①发放问卷2 513份，当场收回有效问卷2 416份，其中男1 190份，女1 226份；调查人群年龄10~17岁；②调查人群中有自杀意念者368名（15.23%，368/2 416），有自杀计划者141名（5.84%，141/2 416），自杀未遂者42名（1.74%，42/2 416）；③自杀行为的性别差异：男生有自杀意念者178名（14.96%,178/1 190），有自杀计划者80名(6.72%，80/1 190)，自杀未遂者24名(2.02%，24/1 190)；女生有自杀意念者190名（15.50%，190/1 226），自杀计划者61名(4.98%，61/1 226)，自杀未遂者18名(1.47%，18/1 226)。男、女生自杀行为差异无统计学意义（P>0.05）；④自杀意念的发生随年级上升而升高（P<0.05）。调查显示高二年级学生自杀未遂的发生率最高（5.17%，6/116）,其次为预初年级（2.52%，13/516）, 小学5年级最低（0.86%，3/347）（P<0.05）。自杀计划的发生率各年级间差异无统计学意义（P>0.05）；⑤小学生自杀意念与所在学校、家庭住房条件显著相关；初中生的自杀意念与同伴关系、父亲文化水平和母子沟通显著相关；高中生的自杀意念与学习成绩、自由支配空余时间和父子沟通显著相关。所有年级学生的自杀意念均与青少年生活事件量表、抑郁量表、焦虑自评量表和贝克绝望量表分呈显著相关。结论 ①上海市中小学生自杀行为状况不容乐观，必须引起高度重视；②不同学习阶段学生的自杀行为影响因素有所不同，干预措施应有所侧重；③应及时发现和积极治疗情绪障碍，努力培养青少年应对不良生活事件的能力，以降低自杀行为发生。     

青少年自杀意念与家庭环境和心理弹性之间的关联研究

目的 探讨青少年自杀意念与家庭环境因素和心理弹性之间的关系。方法 采用整群抽样法,于2014年12月对河南省新乡市3 230名初高中生进行一般社会资料问卷及Kutcher青少年抑郁量表（11项）（KADS-11）、家庭环境量表中文版（FES-CV）、中文版心理弹性量表（CD-RISC）评估测评后,采用多因素logistic回归分析和病例对照研究探讨青少年家庭环境和心理弹性与自杀意念之间的关联。结果 有效问卷为2 960份,有自杀意念者247例（8.50%）,其中男性98例,女性149例。多因素logistic回归分析显示,控制了年龄和性别因素后,单亲/再婚家庭模式与青少年自杀意念风险增加有关（OR=2.655）。男性青少年的自杀意念与家庭亲密度（OR=0.750,P < 0.001）及组织性（OR=0.855,P=0.036）呈明显负关联,与家庭矛盾性呈明显正关联（OR=1.159,P=0.017）。女性青少年的自杀意念与家庭亲密度（OR=0.771,P < 0.001）、情感表达（OR=0.815,P=0.001）及知识性（OR=0.915,P=0.037）存在负性关联。CD-RISC量表评估显示,有自杀意念的青少年心理弹性总得分明显低于无自杀意念的青少年（P < 0.05）,有自杀意念青少年该量表中的能力、忍受消极情感、接受变化和控制4个维度的得分均比无自杀意念青少年低（P < 0.05）。结论 青少年家庭环境亲密度是青少年自杀意念的保护因素;男性青少年的家庭组织性和女性青少年家庭情感表达与降低自杀风险有关;增强心理弹性可能有助于降低青少年的自杀意念。     

情绪障碍患儿家庭环境父母心理状况及养育方式的研究

目的探讨家庭心理环境因素对情绪障碍患儿的影响。方法采用家庭环境量表(中文版)、症状自评量表(SCL90)和父母养育方式量表,对82例情绪障碍患儿及82例健康对照组家庭特征进行调查。结果情绪障碍患儿家庭的亲密度、情感表达、娱乐性的评分低于对照组(P<001),而矛盾性评分高于对照组(P<001);情绪障碍患儿父母心理健康水平较对照组为低(P<001);患儿父母在养育方式上“惩罚严厉,过度保护”两维度得分显著高于对照组父母(P<001)。结论情绪障碍患儿处在一个相对不良的家庭心理环境中,提示在矫治情绪障碍时应对家庭心理环境进行干预。     

沙盘游戏对7～14岁焦虑性情绪障碍儿童的疗效

目的 探讨沙盘游戏对7～14岁儿童焦虑性情绪障碍的疗效.方法 20例7～14岁焦虑性情绪障碍儿童随机分为治疗组和对照组,每组各10例.治疗组接受8次沙盘游戏治疗,1次/周,50 min/次;对照组不接受沙盘游戏治疗.治疗前后均采用儿童焦虑性情绪障碍筛查(SCARED)表、艾森克人格问卷儿童版(EPQ)量表等心理测验工具进行评估,比较2组儿童的焦虑情绪和人格结构的差异,对沙盘游戏治疗儿童焦虑性情绪障碍的疗效进行评价.结果 沙盘游戏治疗后,治疗组SCARED焦虑总分(17.30±4.47)和EPQ情绪稳定性N量表得分(50.80±5.77)均低于对照组SCARED焦虑总分(34.30±4.47)和EPQ情绪稳定性N量表得分(65.50±3.47)(Pa=0);治疗组治疗后SCARED焦虑总分和EPO情绪稳定性N量表得分均明显低于治疗前的SCARED焦虑总分(35.70±8.06)和EPQ情绪稳定性N量表得分(68.70±7.51)(Pa=0);而对照组在治疗后SCABED焦虑总分及EPQ情绪稳定性N量表得分与治疗前SCARED焦虑总分(35.60±4.67)和EPQ情绪稳定性N量表得分(67.10±4.72)比较,均无显著差异(P=0.096,0.078).结论 沙盘游戏疗法能够明显缓解焦虑性情绪障碍儿童的焦虑情绪,可作为治疗儿童焦虑性情绪障碍的方法之一.     

初诊及长期无病生存白血病儿童情绪、自我意识及个性特征的调查分析

目的了解初诊及长期无病生存5年以上白血病儿童的情绪、自我意识特征及个性特征。方法选用儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表、Piers-Harris儿童自我意识量表和儿童版艾森克个性问卷分别对30例初诊白血病、20例长期无病生存5年以上白血病和50例正常对照儿童进行心理评估。结果三组儿童的焦虑总分以及躯体化/惊恐、广泛性焦虑、社交恐怖分量表评分差异有统计学意义(P均0.05),其中长期无病生存组患儿的焦虑总分以及躯体化/惊恐、广泛性焦虑和社交恐怖分量表评分均显著高于正常对照组(P均0.05);而初诊组患儿的社交恐怖分量表得分显著高于正常对照组(P0.05),学校恐怖分量表得分显著低于正常对照组(P0.05)。在抑郁评分方面,白血病患儿和正常对照组比较以及组间比较均无统计学意义(P均0.05)。三组儿童的自我意识总分以及行为、智力与学校情况和焦虑分量表评分差异有统计学意义,其中长期无病生存组患儿的自我意识总分及各分量表得分与正常对照组比较差异无统计学意义(P均0.05),而初诊组患儿的自我意识总分以及行为、智力与学校情况、焦虑分量表得分均显著低于正常对照组(P均0.05);总体白血病患儿与正常对照组比较,自我意识总分以及行为、焦虑分量表得分显著低于正常对照组(P均0.05)。长期无病生存组与初诊组患儿及正常对照组比较,性格普遍偏于内向(P0.01)。结论白血病儿童较正常儿童有更多的焦虑情绪,其自我意识降低,具有内向性格特征。在治疗儿童躯体疾病的同时,对白血病儿童进行社会心理干预非常必要。     

高功能孤独症青少年健康相关危险行为分析

目的探讨高功能孤独症青少年健康相关危险行为特点。方法 2017年4月至11月于北京大学第六医院门诊或病房诊治的高功能孤独症患儿50例,均符合《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)孤独症诊断标准,年龄12～18岁,智商均≥70分。选取同性别、年龄相匹配的正常青少年50名作为对照组。两组均完成青少年健康相关危险行为问卷(AHRBI)评定,同时由孤独症组家长完成青少年健康相关危险行为问卷父母版的评定。结果高功能孤独症组AHRBI自评问卷总分与自杀自伤行为、健康妥协行为、攻击与暴力行为及破坏纪律行为4项因子评分均高于正常对照组(P均0.05)。在所有条目中,高功能孤独症组欺负、威胁、恐吓伙伴,故意对他人打、挤、推、踢,不喝牛奶或豆浆,不参加任何体育活动,逃课或逃学,离家出走,伤害自己项目评分高于正常对照组(P均0.05)。高功能孤独症组健康妥协行为总分、自杀自伤行为总分以及不喝牛奶或豆浆行为、因节食而出现躯体不适、斗殴、随身携带武器、饮酒作乐或喝醉酒条目自评分均高于家长评定结果(P均0.05)。结论高功能孤独症青少年存在较多健康相关危险行为,除吸烟、饮酒和无保护性行为较少外,其他健康相关危险行为均多于正常青少年。     

Association between maternal job burnout and adolescent depression: the chain mediating effect of maternal depression and parenting style北大核心CSCD

目的研究母亲职业倦怠与青少年抑郁的关系,以及母亲抑郁、教养方式在其中的中介作用。方法采用横断面研究设计,于2021年4—5月在上海市7所初中进行整群随机抽样,对7所初中2572名青少年及其母亲进行问卷调查。研究工具包括一般资料调查表、职业倦怠量表、流调中心抑郁量表、简式父母教养方式问卷及儿童抑郁量表。建立结构方程模型,使用Bootstrap法进行中介效应检验。结果青少年抑郁症状检出率为12.71%(327/2572)。母亲职业倦怠得分、母亲抑郁得分、消极教养方式得分与青少年抑郁得分呈显著正相关(P<0.05),而积极教养方式得分与青少年抑郁得分呈显著负相关(P<0.05)。母亲抑郁、教养方式在职业倦怠与青少年抑郁间起中介作用,包括母亲抑郁的独立中介、积极教养方式的独立中介及抑郁-消极/积极教养方式的链式中介。结论母亲的职业倦怠可通过抑郁、教养方式、抑郁-教养方式3条中介路径影响青少年抑郁,提示降低母亲职业倦怠、改善母亲的抑郁情绪、增加积极教养行为、减少消极教养行为,有助于减少青少年抑郁症状的发生。     

情绪障碍患儿气质类型的临床研究

目的：　了解儿童情绪障碍的气质类型,探讨其规律性。方法：　采用儿童气质量表家长问卷法(PTQ)对48例儿童情绪障碍(观察组)及60例健康儿童(对照组)进行气质调查研究。结果：　观察组儿童气质类型D型占多数(64.6%),与对照组(30.0%)比较差异有显著性(P<0.01);对照组儿童E型气质占多数(53.3%),观察组(18.7%)与之比较差异有显著性(P<0.01);S型气质类型在两组之间构成比差异不显著(P>0.05)。结论：　儿童情绪障碍气质类型D型占多数,持有此气质儿童容易出现情绪障碍。     

Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness

ObjectiveComprehend the profile and prevalence of non-suicidal self-injury (NSSI) in adolescents and its association with impulsiveness and loneliness.MethodsCross-sectional study carried out in 2017 in Maceió-Alagoas, Northeast Brazil, in the households of 505 adolescents aged 12–17 years, using a sample stratified and randomized by gender and neighborhood. The following instruments were used: a sociodemographic questionnaire, Brazilian version of Functional Assessment of Self-Mutilation (FASM), the Brazilian Barratt Impulsiveness Scale (BIS-11), and the Brazilian Loneliness Scale (UCLA-BR).ResultsA prevalence of 6.53% was found for non-suicidal self-injury disorder (DSM-5). Significant differences ( p ≤ 0.05) were observed regarding: the most frequently used forms of NSSI were the items “cut oneself” and “scratch oneself”; engaging in three or more different forms of self-injurious behavior (66.67%) and, reporting as reasons, “to relieve feelings of emptiness or indifference” and “to stop bad feelings/sensations.” Significance was also related to the sociodemographic profile: 72.73% were females and 63.54% had family income below one minimum wage. Individuals with self-injurious behavior also had higher impulsiveness and loneliness scores (p ≤ 0.05).ConclusionsThe study identified a direct association between NSSI and impulsiveness and loneliness among adolescents, being more prevalent in females and in young individuals with socioeconomic vulnerability. The data provide support for improving public health policies, aimed at education, prevention, and treatment of adolescents with NSSI.     

Factors distinguishing youth who report self-injurious behavior: a population-based sample

ObjectiveTo identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA).MethodsData were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains.ResultsFor male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide.ConclusionsYouth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.     

A review on eating disorders and adolescence

Eating disorders in adolescence are a public health concern with both personal costs and a financial burden for the community health services. This paper is a review of incidence and gender differences of eating disorders; comorbid psychopathology, including substance abuse, mood disorders, anxiety disorders and personality disorders; developmental and intellectual factors; family, socio-cultural functioning and birth order; self-injury and suicidal behaviour with health outcome and therapy success rate. We have also asked several questions from our clinical experience and tried to answer them with our clinical knowledge and based on literature review. Overall, there is an indication that therapy success is significantly correlated with (low) manifestation, specifically for social problems and aggressivity. Due to the complexity of factors involved in the manifestation of eating disorders, the inclusion of cognitive-behavioural therapy as well as family-oriented therapeutic concepts coupled with medical treatment would appear to offer an intervention inventory, which would be most effective in offering adolescents optimal treatment programmes. The implications of our review is discussed in terms of psychotherapeutic treatment plans for adolescents in clinical care.     

儿童功能性消化不良与血清脑-肠肽水平的关系北大核心CSCD

目的 基于脑-肠轴水平探究儿童功能性消化不良(functional dyspepsia,FD)与降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、摄食抑制因子(nesfatin-1)及生长激素释放肽(ghrelin)等脑-肠肽水平的关系。方法 回顾性选取2019年11月至2020年12月就诊于中国医科大学附属盛京医院FD患儿38例纳入FD组,另选取健康儿童34例纳入健康对照组。采集两组患儿的血清标本,应用酶联免疫吸附测定法分别测定两组儿童CGRP、ghrelin及nesfatin-1的血清水平并进行比较。同时对FD患儿FD症状进行评分,采用Spearman秩相关分析症状评分与脑-肠肽血清水平的相关性。结果 FD组患儿血清nesfatin-1和CGRP水平均高于健康对照组(P<0.05);两组血清ghrelin水平差异无统计学意义(P>0.05)。nesfatin-1血清水平与早饱症状评分呈正相关(rs=0.553,P<0.001),与FD总评分未见明显相关性(rs=0.191,P=0.250);CGRP血清水平与腹痛症状评分呈正相关(rs=0.479,P=0.002),与嗳气症状评分呈正相关(rs=0.619,P<0.001),与FD总评分呈正相关(rs=0.541,P<0.001)。结论 CGRP及nesfatin-1在FD的病理生理过程中可能发挥重要作用。     

The PedsQL™ Multidimensional Fatigue Scale in type 1 diabetes: feasibility, reliability, and validity

Background: The Pediatric Quality of Life Inventory (PedsQL™, Mapi Research Trust, Lyon, France; www.pedsql.org ) is a modular instrument designed to measure health-related quality of life and disease-specific symptoms in children and adolescents. The PedsQL Multidimensional Fatigue Scale was designed as a child self-report and parent proxy-report generic symptom-specific instrument to measure fatigue in pediatric patients. The objective of the present study was to determine the feasibility, reliability, and validity of the PedsQL Multidimensional Fatigue Scale in type 1 diabetes.
Methods: The 18-item PedsQL Multidimensional Fatigue Scale (General Fatigue, Sleep/Rest Fatigue, and Cognitive Fatigue domains) and the PedsQL 4.0 Generic Core Scales were administered to 83 pediatric patients with type 1 diabetes and 84 parents.
Results: The PedsQL Multidimensional Fatigue Scale evidenced minimal missing responses (0.3% child report and 0.3% parent report), achieved excellent reliability for the Total Fatigue Scale score (α= 0.92 child report, 0.94 parent report), distinguished between pediatric patients with diabetes and healthy children, and was significantly correlated with the PedsQL 4.0 Generic Core Scales supporting construct validity. Pediatric patients with diabetes experienced fatigue that was comparable to pediatric patients with cancer on treatment, demonstrating the relative severity of their fatigue symptoms.
Conclusions: The results demonstrate the measurement properties of the PedsQL Multidimensional Fatigue Scale in type 1 diabetes. The findings suggest that the PedsQL Multidimensional Fatigue Scale may be utilized in the standardized evaluation of fatigue in pediatric patients with type 1 diabetes.     

三维斑点追踪成像技术对单纯性肥胖儿童左心室收缩功能的评价及其与外周动脉弹性相关性的前瞻性研究北大核心CSCD

目的应用三维斑点追踪成像技术评价单纯性肥胖儿童左心室收缩功能,并探讨其与外周动脉弹性的相关性。方法采用随机结合方便抽样的方法,获取研究样本。将样本分为3组:肥胖组(23例)、超重组(21例)和正常组(24例)。采用三维斑点追踪成像技术测量左心室整体长轴应变(global longitudinal strain,GLS)、整体径向应变(global radial strain,GRS)及整体环向应变(global circumferential strain,GCS),全自动动脉硬化测试仪测量踝臂指数(ankle brachial index,ABI)、脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)。比较3组各参数的差异性并探讨三维斑点追踪各参数与ABI、baPWV的相关性。结果肥胖组与正常组左心室GLS、GRS、GCS差异无统计学意义(P>0.05)。超重组左心室GLS高于正常组[(-24±7)vs(-19±12),P<0.05]。肥胖组ABI(1.00±0.09)、超重组ABI(1.09±0.13)均低于正常组(2.25±0.13)(P<0.05);肥胖组baPWV高于正常组[(978±109)vs(905±22),P<0.05]。肥胖儿童左心室GLS与baPWV呈正相关(r=0.516,P<0.05),与ABI无相关性(P>0.05);左心室GCS、GRS与ABI、baPWV无相关性(P>0.05)。结论单纯性肥胖儿童左心室收缩功能和外周动脉弹性发生不同程度的改变且二者有一定的相关性。     

Effect of parent-child cooperative music therapy on children with autism spectrum disorder and their mothers: a prospective randomized controlled study北大核心CSCD

目的 探讨亲子合作式音乐疗法对孤独症谱系障碍（autism spectrum disorder,ASD）儿童的核心症状及其母亲的影响。 方法 前瞻性采用随机数字表法将112例ASD儿童及其母亲分为音乐疗法组和应用行为分析法（applied behavior analysis,ABA）组,每组各56例。ABA组采用ABA进行干预,音乐疗法组在ABA组基础上采用亲子合作式音乐疗法。2组干预时长均为8周。采用儿童孤独症评估量表（Childhood Autism Rating Scale,CARS）、儿童孤独症家长评定量表（Autism Behavior Checklist,ABC）、亲职压力简表（Parenting Stress Index-Short Form,PSI-SF）、家庭关怀度指数量表（Family APGAR Index,APGAR）和Herth希望量表（Herth Hope Index,HHI）,评估干预前和干预后ASD儿童的核心症状及其母亲的亲职压力、家庭关怀度和希望水平。 结果 共100对母子参与了全程研究（每组各50对）。干预后音乐疗法组ASD儿童ABC量表总分、感觉维度、社交维度、躯体运动维度得分,以及CARS量表总分低于ABA组（P<0.05）。干预后音乐疗法组母亲的PSI-SF总分、亲子互动失调维度得分,HHI量表总分和各维度得分,以及APGAR量表总分、合作度和亲密度得分均高于ABA组（P<0.05）。 结论 在ABA的基础上,加用亲子合作式音乐疗法可改善ASD儿童的核心症状,减轻母亲的亲职压力,提升其家庭关怀度指数和希望水平。 引用格式：中国当代儿科杂志,2022,24（5）：472-481     

Niveau d’anxiété et refus scolaire dans les troubles anxieux chez l’adolescent

ObjectivesThe primary objective was to compare the level of anxiety on the Multidimensional Anxiety Scale for Children in two groups of anxious secondary school children, one group out of school meeting the criteria of School Refusal and the other in school. The secondary objective was to compare these groups on other clinical, sociodemographic and therapeutic parameters.Patient and methodRetrospective observational study of 34 school-going anxious teenagers recruited at the University Hospital of Montpellier, compared with 55 out of school anxious teenagers meeting the criteria of Anxious School Refusal recruited in a multicentre study.ResultsThere was no significant intergroup difference in median scores on the Multidimensional Anxiety Scale for Children (P = 0.49), but a significant intergroup difference in median scores was found on the Behavioural Anxiety and Phobia Scale with higher total scores in the School Refusal group (151.5 [130.5; 169.0] vs. 125.0 [94.0; 139.0], P < 0.01). The School Refusal group was more likely to have a panel of anxiety disorders including agoraphobia, separation anxiety, depressive disorders, more impaired global functioning and more likely to receive psychotropic medication (P < 0.01). There were no significant intergroup differences in sociodemographic characteristics except age.DiscussionThe absence of significant intergroup differences in the level of anxiety measured with the Multidimensional Anxiety Scale for Children could be related to a lower level of anxiety in the school refusal group due to school refusal. The higher anxiety score with the Behavioural Anxiety and Phobia Scale in the refusal group could be related to their better sensitivity. The clinical picture in the refusal group, both more severe and with co-morbidities, is comparable to what is described in the literature.ConclusionA higher level of anxiety was not associated with school refusal according to main endpoints in teenagers with anxiety disorders. However, this group had other criteria of greater clinical severity that justify early identification.