Treatment of school refusal: One-year follow-up

Objective: To conduct a 1-year follow-up of anxious-depressed school-refusi ng adolescents who participated in an 8-week study of imipramine versus pla cebo each in combination with cognitive-behavioral therapy. Method: Sixty-f ive percent(41 of 63) of the randomly assigned subjects returned for follow -up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questi onnaire regarding interim treatments and school programs. Results: From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety di sorder and 33.3% met criteria for a depressive disorder. Remission rates an d acquisition rates for specific anxiety and depressive disorders were dete rmined. In the follow-up period, 67.5% received at least one psychotropic m edication trial and 77.5% had outpatient therapy. Higher level of somatic c omplaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p =.029). Conclusions: In this naturalis tic follow-up study, there was high utilization of mental health interventi ons. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. investigation of durat ion of acute treatments and evaluation of maintenance treatments for school refusal is needed.