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Barriers to School Reintegration in Students with Chronic Illnesses Following Discharge from the Intensive Care Unit
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Narges Zamani *    |
| PhD in Health Psychology, Department of Psychology, Faculty of Medical Sciences, Hamedan Branch, Islamic Azad University, Hamedan, Iran & PhD in Health Psychology, Department of Psychology, Faculty of Medical Sciences, Hamedan Branch, Islamic Azad University, Hamedan, Iran , n.zamani1367@yahoo.com |
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Abstract: (20 Views) |
Background & aim: Recent advances in pediatric critical care have significantly improved survival rates among children with chronic illnesses. However, biological survival does not necessarily translate into successful recovery of academic and social functioning. School reintegration is considered one of the most important indicators of functional recovery in children following discharge from the Intensive Care Unit (ICU). The present study aimed to investigate barriers to school reintegration and develop a structural model of factors predicting academic adjustment among students with chronic illnesses.
Methods: This cross-sectional descriptive-analytical study was conducted in 2024. The target population included all students aged 7 to 12 years old with chronic illness residing in Mashhad who had experienced ICU hospitalization during the first six months of 2024. A total of 212 students selected from three teaching hospitals and 28 elementary schools using convenience sampling. Data collection tools included the Children's Health-Related Quality of Life Questionnaire (PedsQL), Spence Children's Anxiety Scale (SCAS), and the Academic Adjustment Questionnaire. The data were analyzed using descriptive statistics, independent t-test, analysis of variance, multiple regression, and structural equation modeling.
Results: The mean age of participants was 10.2 ± 1.9 years, and 53.8% were male. A total of 63.7% of students experienced substantial difficulties in school reintegration during the first six months after discharge. Multiple regression analysis identified three significant predictors of academic adjustment: chronic fatigue (β = 0.41, P<0.001), academic anxiety (β = 0.35, P<0.001), and inadequate school support (β = 0.29, P = 0.002). The regression model explained 52% of the variance in academic adjustment (R² = 0.52). Structural equation modeling indicated that physical health status exerted a significant indirect effect on academic adjustment through psychological variables (indirect effect = 0.27, P<0.01). Model fit indices indicated acceptable model fit (χ²/df = 2.14; CFI = 0.94; TLI = 0.92; RMSEA = 0.05; SRMR = 0.04). The overall model effect size was moderate to large.
Conclusion: School reintegration among students with chronic illnesses following ICU discharge is a multidimensional process influenced by the interaction of physical, psychological, and institutional factors. Chronic fatigue and academic anxiety emerged as the most important individual barriers, and inadequate structured school support as the primary institutional barrier. Developing hospital-to-school transition programs, implementing individualized educational plans, and providing targeted psychological interventions may improve academic adjustment and reduce educational disruption in this population. |
Article number: 6 |
| Keywords: Chronic Illness, Intensive Care Unit, School Reintegration, Academic Adjustment, Hospitalized Children |
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Type of Study: Research |
Subject:
General
Received: 2026/06/16 | Accepted: 2026/06/27 | Published: 2026/07/11
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