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HNUE JOURNAL OF SCIENCE Educational Sciences, 2021, Volume 66, Issue 4AB, pp 39-47 This paper is available online at http://stdb.hnue.edu.vn DOI: 10.18173/2354-1075.2021-0059 CORRELATION BETWEEN COGNITIVE EVALUATION, COPING, AND STRESS RESPONSE OF STUDENTS WITH MEDICAL NEEDS RELATED WITH PSYCHOSOMATIC DISORDERS Kimie Tagawa1, Taishi Takezawa2 and Tetsuro Takeda2 Wakayama prefectural Wakayama Sakura special Needs School, 2Wakayama University Abstract The purpose of this study was to examine specific factors of students with medical needs related with psychosomatic disorders in the junior high school and high school sections of special needs schools, was to compare factors including stressor, stress response, cognitive appraisal, coping, and source of social support between students with and without disabilities, and was to clarify interactions among these factors Results revealed that 74.13% of the students with disabilities experienced school non-attendance, received a diagnosis of psychosomatic disorders, and showed characteristics on developmental disabilities as their basic disabilities It was also found there was strongly positive correlations between stress response and factors including “depression/anxiety,” “grumpy/angry,” and “physical symptoms” in the students with medical needs, compared to those without disabilities, which seemed to be specifically related to psychosomatic disorders It was clarified that junior high school and high school students with psychosomatic disabilities could experience physical symptoms when trying to cope with stressful situations, and they also could easily become anxious when trying to ask others for assistance, which could result in conditions where they cannot achieve an appropriate stress-buffering effect Keywords: psychosomatic disorders, stress coping process, cognitive appraisal, stress response, coping Introduction The Ministry of Education, Culture, Sports, Science and Technology (MEXT) announced that the number of elementary and junior high school students not attending school in year 2019 was 181,272 (up by 167,44 from the previous fiscal year) [1] This figure has reached a record high, with the number of those students increasing for seven years in a row, consecutively Some children who not attend school show significant somatic and psychiatric symptoms and require hospitalization and treatment The number of children with psychosomatic disorders and medical needs who are receiving treatment enrolled in special support schools for vulnerable children is increasing Takeda & Takeda (2017) extracted only the proportion of children with Learning Disabilities (LD) and Attention Deficit/Hyperactivity Disorders (ADHD) with psychosomatic and adjustment disorders in junior and senior high school sections of special support schools for vulnerable children [2] They compared the trends of such children in 2002, 2005, and 2012 In junior high schools, the ratio increased by 1.8 times from Received July 21, 2021 Revised August 14, 2021 Accepted September 2, 2021 Contact Kimie Tagawa E-mail address: hina311hiyo@icloud.com 39 Kimie Tagawa, Taishi Takezawa and Tetsuro Takeda 6.1% in 2002, to 10.9% in 2005, and to 27.2% in 2012, which represents an increase of 4.5 times in 10 years In high schools, the ratio increased from 2.3% in 2002, to 7.0% in 2005, which was three times higher, and in 2012 it increased to 27.7%, which was 12 times higher [2] It is presumed that children with medical needs, such as psychosomatic disorders, have been subjected to continuous stressors and display abnormal physical symptoms, psychological symptoms, and behaviors if they are not resolved Figure illustrates the relationship between cognitive assessment, coping, and social support in the process of coping with stress [3] There is a stressor which causes the stress, where “cognitive appraisals” are carried out for the stressor Cognitive appraisal is an assessment of the threat or significance of a stressor, and cognitive appraisal determines subsequent coping (coping behavior) Cognitive appraisal consists of primary appraisal and secondary appraisal The primary appraisal is to regard stressors as “very troublesome” and the secondary appraisal is an assessment of the actions taken to deal with stressors If they perceive that “something can be done” or “let’s solve problems” they will take positive action to resolve the problems If they perceive that “there is nothing I can do” or there is “no option other than giving up” they may take it out on others or escape from or avoid a stressor Perceived social support is “an expectation about the likelihood of being assisted by others or a subjective assessment of support” and it implies a subjective perception that one is supported by the people around him/her or there is an expectation that one will be supported This is negatively correlated with the stress response and perceived social support It is known that children with high support expectations are less stressed, and on the contrary, children with low support expectations are more stressed It is important to clarify the features of the stress coping process of children with medical needs such as psychosomatic disorder to better understand and support them Therefore, the purpose of this study is to examine and discuss the characteristics of “stress response”, “cognitive appraisal”, “coping” and “social support” for stressors in the process of coping with stress, while comparing junior high and senior high school students at special support schools with medical needs, such as mental and physical disorders with experience of school non-attendance Figure Relationship with cognitive appraisals, coping, stress response, and social support in the stress coping process 40 Correlation between cognitive evaluation, coping, and stress response of students with… Content 2.1 Methods 2.1.1 Survey subjects 28 students in the junior high school and high school sections of three special needs schools for vulnerable children attached to hospitals (hereafter referred to as students with medical needs), and 104 first and second grade students of a high school as a comparison group A total of 109 students were surveyed 2.1.2 Survey period From April to August, year 201X A questionnaire was distributed The subjects completed the questionnaire with the teacher, or they were interviewed by the teacher 2.1.3 Survey contents We asked the subjects to fill in a questionnaire regarding recent stressful situations that they had experienced, their actual situation explaining how they coped, and their actual conditions of social support In addition, we used Okayasu and Takayama (1999)’s Mental Health Checklist for Junior High School Students (stress reaction: four subscales of “physical symptoms”, “depression and anxiety”, “grumpy/angry” and “helplessness”), school stressors (three subscales of “relationship with teachers”, “friendship” and “school industry”), and social support (using four support sources of “father”, “mother”, “assigned teacher” and “friends”) [4] The sources of “father” and “mother” were integrated into “the family” by considering the subject’s recent family composition In addition, the Cognitive Rating Scale for Junior High School Students (“controllable feeling” and “influence”) and the Coping Measurement Scale for Junior High School Students (“positive coping”, “desire for support” and “escape and avoidance”) by Miura (2002) were used [5] In this investigation, the measurement scale for the junior high school subjects was adopted due to considering the burden on them students and the consistency of the questionnaire content, because the subjects included both junior high school and high school students and some of them had medical needs Simultaneously, the investigation was also carried out with teachers in charge of on non-attendance of the subjects and how they coped with stress 2.1.4 Study ethics issues The study purpose and method were explained, and the questionnaire was carried out with permission from the school principal In addition, utmost care was paid to the handling of personal information and the protection of the privacy of subjects by anonymizing the questionnaire 2.2 Results 2.2.1 Grasping actual conditions from the face sheet Among subjects with medical needs, 16 (57.1%) were diagnosed as having psychosomatic disorders or anxiety disorders, (32.1%) were without diagnosis, and (10.7%) did not answer As the background, 16 students (57.1%) had a diagnosis of a developmental disorder, 11 students (39.3%) were without diagnosis, and (3.6%) did not answer There were 20 (71.4%) students with no attendance experience, (17.9%) students without non-attendance experience, and (10.7%) students did not answer A t-test of scores of stress responses (physical symptoms, depression/anxiety, grumpy/angry, powerlessness), stressors (relationships with teachers, relationships with friends, academia), social support (family members, teachers in charge, friends), cognitive appraisal effects (primary appraisal), controllable feeling (secondary appraisal), and coping (active coping, support quest, escape/avoidance) of students with medical needs and the subjects of a high school, the control 41 Kimie Tagawa, Taishi Takezawa and Tetsuro Takeda group, revealed no significant differences Then, each scale was analyzed focusing on the correlation between students with medical needs and high school subjects 2.2.2 Correlation among stress response scales Table shows the result of the calculation of correlation among sub-scales of stress response scales Among high school subjects, there was a moderate positive correlation between “physical symptoms” on the one hand and “depression/anxiety” (r = 0.539), “grumpy/angry” (r = 0.543), and “helplessness” (r = 0.554) on the other, among the subscales of the stress response scale There was a moderate positive correlation between “depression/anxiety” and “grumpy/angry” (r = 0.593) and “feeling of helplessness” (r = 0.484), and there was a moderate correlation between “grumpy/angry” and “helplessness” (r = 0.539) On the other hand, among subjects with medical needs, “depression/anxiety” was strongly positively correlated with “grumpy/angry” (r = 0.778) There was a moderate positive correlation between “physical symptoms” and “depression/anxiety” (r = 0.617), “grumpy/angry” (r = 0.410), and “grumpy/angry” was moderately correlated with “helplessness” (r = 0.453) Compared with high school subjects, it was found that when anxiety was increased, grumpy and angry immediately increased, and that they would indulge in problem behaviors It was also found that when “depression/anxiety” and “grumpy/angry” was increased, physical symptoms such as headaches tended to be exacerbated Table Correlation between each scale of stress response Factor Physical symptoms Physical symptoms Depression/ anxiety Grumpy/ angry Helplessness 0.539** 0.543** 0554** 0.593** 0.484** Depression / anxiety 0.617* Grumpy / angry 0.410* 0.778** Helpless 0.255 0.210 0.539** 0.453** *p
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