SCHOOL ABSENTEEISM

– what patients from Viersen (D) - Nijmegen (NL) – Essen (D) may tell us …

Volker Reissner, Bas deVeen, Martin Knollmann, Alexandra Wühl, Ingo Spitczok von Brisinski, Freia Hahn, Wouter Staal, Johannes Hebebrand

Department of Child and Adolescent Psychiatry, LVR-Clinic Essen, University of Duisburg-Essen

EuRegio Symposium 2019 DGKJP (3/2009) Kleve, 11.12.2019 Agenda

1. School absenteeism

2. Comparison: Viersen – Nijmegen – Essen

3. Preliminary Results

4. Discussion

Zur Verfügung gestellt von Hr. Plassmann School absenteeism Paul, 302 years later …

By Thomas Plassmann School absenteeism Differentiation of School absenteeism

School absenteeism

Disengagement School avoidance School- withdrawal (Schulmüdigkeit) (Vermeidung) (Fernhalten)

School refusal School truancy (Schulverweigerung) (Schulschwänzen) School absenteeism Prevalence of school absenteeism

Smoky Mountains Study, USA: N=4,500 children (9 – 13 years)

3-month- % with Associated symptoms / prevalence mental mental disorders disorder School 1.5% 25% Depression refusal Separation anxiety disorder etc. School 5.8% 25% Conduct disorder truancy Oppositional-defiant disorder etc.

Mixed group 0.5% 88% Separation anxiety disorder & Conduct disorder etc.

Egger et al., 2003 School absenteeism Prevalence of school absenteeism

60% „Staying away from school …“ for some lessons or some days during their time at primary and secondary school

8.9 % Percentage of German students reported that they skipped a day of school at least once in the two weeks prior to the PISA test

5.3 % Percentage of Dutch students reported that they skipped a day of school at least once in the two weeks prior to the PISA test

z.B. Oberwittler et al. 2001; Wagner et al. 2004; Weiss, 2007; OECD, 2016 (PISA 2015) 6 Agenda

1. School absenteeism

2. Comparison: Viersen – Nijmegen – Essen

3. Preliminary Results

4. Discussion Comparison Study aims: Differences & Predictors?

Three clinical samples of children/adolescents with mental disorders from LVR, Viersen – Karakter, Nijmegen – LVR, Essen: Are there differences in … Age & Gender

Diagnoses

School absenteeism

Severity of psychopathology

Which of these factors predict school absenteeism? Comparison Questionnaires / Assessment

Age & Gender

Diagnoses ICD-10 / DSM-5

School absenteeism School Non-Attendence ChecKlist (SNACK)

Severity of psychopathology Strengths and Difficulties Questionnaire (SDQ)

 Cross-sectional design: One measurement Comparison Patient-Recruitment

2019 Jan. Feb. Mar. Apr. May Jun.

LVR In-p. Viersen Out-p.

Karakter, „In-p.“ Nijmegen Out-p.

LVR In-p. Essen Out-p.

Viersen - Total 4 month: N=102 patients Nijmegen - N=159 Essen - N=101 Agenda

1. School absenteeism

2. Comparison: Viersen – Nijmegen – Essen

3. Preliminary Results

4. Discussion Results Age & Gender

Age *** N Mean Standard Deviation (SD) Viersen 102 13.2 3.5 Nijmegen 153 12.0 3.5 Essen 101 13.8 3.3

Females * N % out of sample Viersen 41 40.2 % Nijmegen 63 39.6 % Essen 58 57.4 % Results (multiple) Diagnoses (ICD-10)

Viersen

Organic Substance Schizo- Mood Neurotic Eating Person- Mental Develop- Childhood use phrenia disorder ality retard. mental adolescence

Nijmegen

Organic Substance Schizo- Mood Neurotic Eating Person- Mental Develop- Childhood use phrenia disorder ality retard. mental adolescence

Essen

Organic Substance Schizo- Mood Neurotic Eating Person- Mental Develop- Childhood use phrenia disorder ality retard. mental adolescence Results Number of Diagnoses

Number of N Mean SD diagnoses * Viersen 102 2.6 1.6 Nijmegen 159 2.1 1.1 Essen 101 1.8 0.8 Results School Absenteeism

Absent from N % out of school *** sample Viersen 74 72.5 % Nijmegen 71 44.7 % Essen 95 94.1 % Results School Absenteeism: Total number of days

Number of N Mean SD days absent*** Viersen 102 7.5 8.0 Nijmegen 159 3.4 6.1 Essen 101 9.8 7.5 Results School Absenteeism: Refusal & Truancy

School N % refusal *** Viersen 28 27.5 % Nijmegen 20 12.6 % Essen 30 29.7 %

School N % truancy *** Viersen 16 15.7 % Nijmegen 0 0 Essen 10 9.9 % Results School Absenteeism: Family & School

Family N % „withdrawal“ Viersen 4 3.9 % Nijmegen 14 8.8 % Essen 5 5.0 %

School N % „exclusion“ *** Viersen 13 12.7 % Nijmegen 18 11.3 % Essen 45 44.6 % Results Psychopathology

Strengths & N Mean SD Difficulties Question. Total difficulties * Viersen 97 34.0 5.8 Nijmegen 154 31.4 5.1 Essen 100 33.2 5.4

Differences between Nijmegen & Viersen** and between Nijmegen & Essen* SDQ Total difficulties score >15 clinically relevant. Results What predicts the number of days absent?

B P Lower CI Upper CI

Age .298 .016 .056 .539

Gender -1.549 .040 -3.029 -.069

Living in Essen (compared to Nijmegen) 4.018 .000 2.151 5.886

Severity of psychopathology (SDQ) .139 .031 .013 .265 Schizophrenia, schizotypal … 5.911 .049 .024 11.798 disorders (F2) Neurotic, stress-related, somatoform 2.146 .031 .194 4.098 disorders (F4) Behavioral & emotional disorders in -2.851 .006 -4.879 -.822 childhood/adolescence (F9) Corrected R2 = 0.31

B – Regression Coefficent; p – probability; CI – Confidence Interval Agenda

1. School absenteeism

2. Comparison: Viersen – Nijmegen – Essen

3. Preliminary Results

4. Discussion

Curtesy of INSA Summary & Discussion

Comparison of patients from 3 child-&adolescent clinics with different concepts:

Differences with regard to diagnoses (Viersen: F1, Nijmengen: F8, Essen: F3)

Severity of school absenteeism: Essen > Viersen > Nijmegen

Severity of psychopathology: Viersen/Essen > Nijmegen

Keep an eye on severely affected males with schizophrenia and anxiety?

Are children / adolescents in D more severely affected than in NL?

Are we comparing tulip bulbs and potatoes – or which additional information do we need? Paul again …

Curtesy of T. Plassmann That´s what we strive for …

Thank´s to the Viersen team, the Nijmegen team, the Essen team, and thank you very much for your attention.

Curtesy of T. Plassmann 25 With ≥ 3 N % diagnoses Viersen 48 47.1 % Nijmegen 45 28.4 % Essen 19 18.9 %

26 Results School Absenteeism: Refusal & Truancy

School N Mean SD refusal *** Viersen 102 3.5 6.8 Nijmegen 159 1.2 4.1 Essen 101 3.0 6.1

School N Mean SD truancy *** Viersen 102 1.5 4.6 Nijmegen 159 0 0 Essen 101 0.8 3.7 Results School Absenteeism: Family & School

Family N Mean SD „withdrawal“ Viersen 102 0.1 0.9 Nijmegen 159 0.4 1.9 Essen 101 0.1 0.4

School N Mean SD „exclusion“ *** Viersen 102 0.9 3.5 Nijmegen 159 0.4 1.8 Essen 101 1.7 3.4