Back to Journals » Neuropsychiatric Disease and Treatment » Volume 16

Influence of Self-Esteem and Psychiatric Diagnosis on Health-Related Quality of Life in Children and Adolescents with School Refusal Behavior

Authors Matsuura H, Iwasaka H, Nezu S, Ota T, Okazaki K, Yamamuro K, Nakanishi Y, Kishimoto N, Iida J, Kishimoto T

Received 20 January 2020

Accepted for publication 12 March 2020

Published 31 March 2020 Volume 2020:16 Pages 847—858


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Taro Kishi

Hiroki Matsuura,1 Hidemi Iwasaka,2 Satoko Nezu,3 Toyosaku Ota,4 Kosuke Okazaki,4 Kazuhiko Yamamuro,4 Yoko Nakanishi,5 Naoko Kishimoto,4 Junzo Iida,6 Toshifumi Kishimoto4

1Department of Psychiatry, Nara Prefecture General Rehabilitation Center, Shiki-Gun, Nara, Japan; 2Developmental Center for Child and Adult, Shigisan Hospital, Ikoma-Gun, Nara, Japan; 3Department of Epidemiology, Nara Medical University, Kashihara, Nara, Japan; 4Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan; 5Department of Psychiatry, Akitsu Kounoike Hospital, Gose, Nara, Japan; 6Faculty of Nursing, Nara Medical University, Kashihara, Nara, Japan

Correspondence: Toyosaku Ota
Department of Psychiatry, Nara Medical University, 840 Shijyo-Cho, Kashihara, Nara 634-8522, Japan
Tel +81-744-22-3051
Fax +81-744-22-3854

Background: School refusal behavior (SRB), which is the refusal to attend or remain in school, has been associated with emotional, psychological, and other behavioral problems, as well as a lower health-related quality of life (HRQOL). However, the effects of self-esteem and a psychiatric diagnosis in students with SRB on HRQOL are not yet known. Understanding these relationships could help to develop more effective therapeutic interventions.
Methods: A total of 175 young people (aged 8– 18 years old) who visited our medical centers and outpatient clinics participated in the study. This comprised the SRB group (n = 70) and an age- and sex-matched control group (n = 105). Information about any psychiatric diagnosis was collected from medical records, HRQOL was measured using the J-KIDSCREEN-52, SRB was assessed using the School Refusal Assessment Scale-Revised for Japanese Attendance at School, self-esteem was measured using the Rosenberg Self-Esteem Scale, children’s mental health status was measured using the Strengths and Difficulties Questionnaire, and social support was measured using the Oslo 3-item Social Support Scale. We performed between-group comparisons and multiple regression analysis.
Results: The SRB had a significantly lower HRQOL than the control group in several of the KIDSCREEN-52 dimensions. In the SRB group, 35.7% had chronic disease and 35.7% of their parents had health problems and were receiving treatment. The multiple regression analysis revealed that, within the SRB group, a psychiatric diagnosis was associated with a lower HRQOL. However, this was not the case for a diagnosis of autistic spectrum disorder. Self-esteem positively affected HRQOL in six dimensions of the KIDSCREEN-52 within the SRB group.
Conclusion: Our results could inform the development of support strategies for young people with SRB. Namely, support that enhances self-esteem could be used to increase HRQOL in young people with SRB. Furthermore, the presence of psychiatric disorders should be assessed as early as possible.

Keywords: school refusal behavior, health-related quality of life, KIDSCREEN, Rosenberg self-esteem scale, autism spectrum disorder

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]