Group 1 - The core issue of school refusal among adolescents is increasingly prevalent, with 14.8% of surveyed youth showing varying degrees of depression risk according to the "China National Mental Health Development Report (2021-2022)" [1] - The report indicates that adolescents with depression or anxiety risks have a significantly higher tendency to express school refusal thoughts, with 20.2% and 45.4% of those at mild and high risk respectively frequently not wanting to attend school [1] - A global phenomenon, school refusal is not limited to East Asia or specific academic performance levels, as even high-achieving students in prestigious universities experience mental health issues [7][8] Group 2 - The underlying causes of school refusal are multifaceted, including peer bullying, poor relationships with teachers, sensitivity to evaluation systems, and potential family trauma [5] - Research shows that school refusal behavior can be a normal response to unpleasant or hostile environments, highlighting the need for a broader understanding of the issue [13][20] - A model of factors influencing school refusal includes academic pressure, negative home environments, and external influences like gaming and idol selection competitions [20] Group 3 - The COVID-19 pandemic has exacerbated issues of anxiety and depression among students, with reports indicating a significant increase in disruptive behaviors and absenteeism since the pandemic began [23][24] - The pandemic has led to a decrease in parental support and limited social interactions, contributing to feelings of loneliness and academic decline among students [25][27] - The mental health impact of the pandemic on adolescents is profound, with many experiencing heightened anxiety and depression due to disrupted developmental processes [27][28] Group 4 - The perception of school refusal often carries stigma, with adults frequently attributing it to personal failings of the child rather than considering environmental and familial factors [10][12] - Many parents may not recognize their role in their child's mental health struggles until the child exhibits severe refusal behaviors, indicating a need for greater awareness and understanding [29][40] - The complexity of school refusal necessitates a holistic approach that considers the emotional needs of both the child and the parents, rather than viewing the child solely as a problem to be solved [38][39]