Background:Adolescent depression and school refusal(SR)are prevalent and important global concerns that need to be understood and addressed.Cross-sectional associations have been reported but prospective relationships...Background:Adolescent depression and school refusal(SR)are prevalent and important global concerns that need to be understood and addressed.Cross-sectional associations have been reported but prospective relationships between them remain unclear.This longitudinal study investigated the bidirectional relationships between these two problems among Chinese adolescents.Methods:A longitudinal study was conducted in Taizhou,China,surveying students of three junior high schools,three senior high schools,and one vocational high school.A total of 3882 students completed the questionnaire at baseline(T1);3167 of them completed an identical follow-up questionnaire after 6 months(T2).Depression was assessed via the Patient Health Questionnaire(PHQ-9)and SR via the modified Chinese version of The School Refusal Assessment Scale-Revised(SRAS-R).Cross-lagged panel modeling(CLPM)analysis was conducted to test the reciprocal relationships,adjusting for socio-demographic factors.Multiple group analysis was conducted to test whether the CLPM differed by gender and grade.Results:Statistically significant bidirectional relationships were found.A higher level of SR assessed at T1 is prospectively associated with a higher level of depression at T2(β=0.07,p=0.006);a higher level of depression at T1 also is prospectively associated with a higher level of SR at T2(β=0.14,p<0.001).Such models differed significantly by neither gender nor grade.Conclusion:SR and depression should be seen as each other’s mutually reinforcing association.The bidirectional relationships potentially result in a vicious cycle.Early interventions may target both problems concurrently.Future studies may involve more time points and test some mediators.展开更多
基金funded by Science and Technology Program of Wenzhou(Y20220843).
文摘Background:Adolescent depression and school refusal(SR)are prevalent and important global concerns that need to be understood and addressed.Cross-sectional associations have been reported but prospective relationships between them remain unclear.This longitudinal study investigated the bidirectional relationships between these two problems among Chinese adolescents.Methods:A longitudinal study was conducted in Taizhou,China,surveying students of three junior high schools,three senior high schools,and one vocational high school.A total of 3882 students completed the questionnaire at baseline(T1);3167 of them completed an identical follow-up questionnaire after 6 months(T2).Depression was assessed via the Patient Health Questionnaire(PHQ-9)and SR via the modified Chinese version of The School Refusal Assessment Scale-Revised(SRAS-R).Cross-lagged panel modeling(CLPM)analysis was conducted to test the reciprocal relationships,adjusting for socio-demographic factors.Multiple group analysis was conducted to test whether the CLPM differed by gender and grade.Results:Statistically significant bidirectional relationships were found.A higher level of SR assessed at T1 is prospectively associated with a higher level of depression at T2(β=0.07,p=0.006);a higher level of depression at T1 also is prospectively associated with a higher level of SR at T2(β=0.14,p<0.001).Such models differed significantly by neither gender nor grade.Conclusion:SR and depression should be seen as each other’s mutually reinforcing association.The bidirectional relationships potentially result in a vicious cycle.Early interventions may target both problems concurrently.Future studies may involve more time points and test some mediators.
