Prevalence of psychiatric comorbidity and associated sociodemographic factors in children and adolescents with school refusal

Objective: To examine the sociodemographic and clinical characteristics of children with school refusal, identify accompanying psychopathologies, and investigate the relationship between comorbid psychopathologies and the severity of school refusal and demographic features. Method: The study included 52 children and adolescents aged 7-16 who presented to a child and adolescent psychiatry clinic between November 2023 and November 2024 with reluctance to attend school and a diagnosis of school refusal. The researcher administered a questionnaire to participants that included sociodemographic data and questions related to school refusal. Children were asked to complete a school refusal rating scale. Semi-structured psychiatric interviews were conducted with children and their families to identify psychopathologies accompanying school refusal in children.Results: Of the cases, 48.1% were male, and 51.9% were female. The mean age was 12.31±2.73 years. At the time of referral to the outpatient clinic, more than two-thirds of the children had never attended school. More than two-thirds of the cases were accompanied by at least one psychopathology, and this rate was significantly higher in males. The most common comorbid psychopathologies were generalized anxiety disorder, major depression, and separation anxiety disorder. In the younger age group, somatic complaints were statistically significantly more frequent, and separation anxiety disorder was more commonly comorbid. No significant relationships were found between school refusal rating scale scores and demographic data, clinical characteristics, or comorbid psychopathology.Conclusion: School refusal is one of the child psychiatric emergencies that causes serious academic, social, and psychological problems in children and adolescents in the short and long term. Furthermore, the presence of accompanying psychopathology further worsens the prognosis. Therefore, understanding the demographic and clinical factors in these children, examining their relationship with comorbidity, and addressing these factors in clinical practice will positively influence intervention processes and prognosis.