Effects of the healing movie programs on post-traumatic stress syndrome, resilience, and cognitive emotional control strategies of Korean cancer survivors: a non-equivalent control group pretest-postt

School refusal behavior (SRB) refers to severe difficulty attending school or remaining in class due to emotional distress [, ], often accompanied by anxiety, depression, social avoidance, and academic impairment. It represents a significant educational and public mental health concern globally [, ]. Estimates suggest that approximately 16% of children and adolescents experience school refusal or related problems. In China, SRB is particularly salient in contexts of educational disparity and socioeconomic transition, with survey data indicating that 22.5% of students in major cities exhibit SRB []. In rural and ethnic minority border regions, adolescents face compounded risks including cultural adaptation stress, limited educational resources, parents working away from home, and the digital divide. These factors may not only impede academic achievement but also undermine confidence in social mobility through education, posing long-term risks to human capital and social stability []. Cumulative ecological risk refers to the multiple, additive social and ecological environmental factors that have negative impacts on individuals []. Based on the cumulative ecological risk model, current research generally suggests that SRB is not caused by a single factor, but is the result of the interaction of multiple levels of risk factors, including individual psychological factors and mental health issues, family factors, and the social environment, and that the interactions among these factors influence SRB [, ]. At the individual level, pathological internet use (PIU) and non-suicidal self-injury (NSSI) are closely linked to SRB. PIU refers to excessive, poorly controlled internet use that leads to significant functional impairment. Non-suicidal self-injury (NSSI) is defined as the deliberate, self-inflicted destruction of body tissue without suicidal intent, often serving as a maladaptive emotion regulation strategy. They often operate through mechanisms of emotional dysregulation and avoidance [–]. Subjective well-being is closely related to an individual’s adaptive functioning, therefore, there may be a strong negative correlation between subjective well-being and SRB []. Social mobility belief refers to the extent to which an individual identifies with the belief that they can improve their socio-economic status through their own efforts. A lack of belief in social mobility can significantly reduce adolescents’ perseverance in academics and sense of purpose, the deeper cognitive motivations behind SRB []. At the family level, harsh parenting is a robust risk factor for SRB [, ], while at the social environment level, the quality of friendship, as a key interpersonal protective factor, has been shown to protect against SRB. Low friendship quality can exacerbate adolescents’ SRB []. Notably, the aforementioned factors do not exist in isolation; rather, they form a dynamic network of mutual influence and reinforcement. For example, harsh parenting may not only directly exacerbate adolescents’ anxiety and school avoidance but may also significantly increase the likelihood of self-injury by impairing impulse control - a maladaptive strategy for regulating emotional distress []. Harsh parenting has been shown to positively predict adolescents’ pathological internet use [, ], which in turn may influence SRB. Among individuals from lower socioeconomic backgrounds, stronger beliefs in social mobility can enhance one’s sense of control, thereby contributing to higher subjective well-being []. Similarly, higher friendship quality among adolescents is associated with lower levels of pathological internet use [] and positively correlated with subjective well-being []. These complex interrelations underscore the need for an integrative approach that can simultaneously capture the co-occurrence and structural connectivity among multiple variables in understanding the development and maintenance of SRB.