{"paper_id":"1c8089f4-e957-478e-990e-e3f3a5b012d0","body_text":"The Association Between Social Outsiderhood and School Absence is Mediated by Internalizing Symptoms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Association Between Social Outsiderhood and School Absence is Mediated by Internalizing Symptoms Katarina Alanko, Patrik Söderberg, Martin Lagerström, Mikko-Jussi Laakso, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5402404/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Internalizing psychiatric symptoms and school absenteeism often co-occur. This study explores their detailed associations and examines whether internalizing symptoms (depression and anxiety) mediate the relationship between social outsiderhood (loneliness and ostracism) and school absence. It also investigates the links between various types of school absence (truancy, emotion-basedabsence, school withdrawal, and school exclusion) and experiences of loneliness and/or ostracism. Data were collected from 1,866 Finnish middle school adolescents (M age = 14.95, SD = 0.86). Findings indicate that both loneliness and ostracism are associated with school absenteeism, with internalizing symptoms serving as a mediator, however, with a low effect size. Students experiencing school exclusion reported the highest levels of social outsiderhood. These results underscore the importance of addressing students' social situations when assessing school absence and developing preventive interventions within the school context. Figures Figure 1 INTRODUCTION School Attendance Problems ‘School attendance problems’ (SAP) is an umbrella term for the difficulties youths can experience when it comes to getting to school or staying in school (Heyne et al., 2019 ; Kearney, 2016 ; Kearney & Graczyk, 2020 ). SAPs range from verbally expressing distress for going to school, to occasional school avoidance, to continuous periods of longer absences (Kearney, 2016 ). SAPs have been related to a range of both short- and long-term negative problems, including academic-, and mental health problems, social isolation and difficulties completing secondary education (Heyne et al., 2019 ; Kearney, 2016 ). It is often difficult to separate pre-existing symptoms from symptoms arising as a consequence of SAPs. School attendance problems (SAPs) are often operationalized as absence from school, which can include partial days, full days, or extended periods of time away from school. Heyne et al. ( 2019 ) outlined four main types of SAPs, namely school refusal (hereafter referred to as emotion-based absence), truancy, school withdrawal, and school exclusion. Emotion-based absence (EBSA) refers to when a young person is reluctant or refuses to attend school because of emotional distress. Truancy (T) refers to being absent without the permission of parents or school. School withdrawal (SW) refers to a situation in which a parent directly or indirectly supports absence and school exclusion (SE) to a situation in which school directly or indirectly supports the absence of a student. Our approach to understand SAPs builds on Bronfenbrenner’s ecological systems model, and Heyne’s typological approach. Factors related to SAPs may be detected on all system levels, including that of the individual (such as individual needs, and internalized symptoms), the family (such as parental psychopathology and family socioeconomic situation), the school (such as bullying and dislike of a specific school), as well as community (such as school policies) and factors related to the socio-historical context (such as impact of pandemics) (Bronfenbrenner & Morris, 2006; Melvin et al., 2019 ). Besides types and symptoms, researchers have also pinpointed functions associated with SAPs. Based on learning theory, Kearney ( 2007 ) first distinguished between functions tied to negative reinforcement, like evading negative emotions or evaluative circumstances, and positive reinforcement, such as gaining attention from important adults or participating in more enjoyable activities outside of school, as functions maintaining SAPs (Kearney, 2007 ). Later, Knollman et al (2019) equalled the function with the reason for SAP, such as internalizing symptoms, family or school context. The association between symptoms and functions generally appears strong (Knollmann et al., 2019 ), however, it's theoretically possible for them to diverge. For instance, a young person might suffer substantial symptoms of depression, but having problems with parents could be the underlying reason (i.e., function) for their school absence. Maintaining the difference between symptom and function may give further insight into how adolescents perceive their situation, and in a previous study, some differences were found between symptom and function in analyses on how adolescents with ADHD perceived their SAPs (Niemi et al., 2023). Loneliness and ostracism Loneliness can be described as a discrepancy between actual and desired feelings of belonging, companionship and social acceptance (Favotto et al., 2019 ; Stoeckli, 2009 ; Weiss, 1973 ). Loneliness is known to activate behavioral, cognitive and emotional maladaptive processes, leading to a vicious cycle in which the child is not given the opportunity to practice important social skills in peer interactions and, thus, cannot correct dysfunctional perceptions of oneself and others (Qualter et al., 2015 ). A wide range of negative concomitants, such as anxiousness, social anxiety, depression, self-harm, suicide attempts, school drop-out and lower perceived general health have been linked with continuous feelings of loneliness during childhood and adolescence (S. Cacioppo et al., 2015 ; Heinrich & Gullone, 2006 ). It is also notable that increasing levels of loneliness among adolescents has been reported worldwide, with a particularly steep increase in the last decade (Twenge et al., 2021 ) A related concept to loneliness is ostracism, which has been defined as the experience or perception of being intentionally kept apart from other people either psychologically (e.g., being ignored) or physically (e.g., social isolation) (Arslan & Yıldırım, 2022 ; Williams, 2007 ). Perceived by the victim as an insidious form of social aggression, experiences of ostracism has been found to activate social pain reactions in the brain (Macdonald & Leary, 2005 ), and if prolonged, to have adverse consequences on the person´s well-being and health, including e.g. increased risk for psychiatric disorders, impaired immune functioning and even the risk for radicalization and violence (Baumeister et al., 2005 ; Williams, 2007 ). In the school setting, ostracism is often referred to as indirect aggression, peer victimization, social exclusion or rejection. Despite the strong overlap between the two concepts of social outsiderhood, loneliness and ostracism may be viewed as unique concepts with different operationalizations. Ostracism is used to describe the social context or the behaviors of the people surrounding the individual, whereas loneliness refers to the inner experience of the individual. The association between SAP, loneliness, ostracism, and internalizing symptoms A few studies have examined the association between ostracism, feeling lonely at school and being absent from school, generally finding a significant association between them (Egger et al., 2003 ; Havik et al., 2015 ; Leduc et al., 2022 ). In a recent study by Kiuru et al ( 2024 ) the highest prevalence for school absence due to truancy, sickness or other reasons, as well as internalized and externalized problems and intentions for school dropout was found among the adolescents who had chronical feelings of being ostracized or excluded by their peers. Also, compared to the adolescents with no peer problems, the adolescents with chronic feelings of loneliness generally had more absence from school, and/or internalized or externalized symptoms. Internalized symptom increased in middle school, especially among students with profiles of high and increasing social loneliness (Kiuru et al., 2024 ) Further, studies have linked internalizing symptoms, such as depression and anxiety, to both school absence (Finning, Ukoumunne, Ford, Danielson-Waters, et al., 2019 ; Finning, Ukoumunne, Ford, Danielsson-Waters, et al., 2019 ), as well as loneliness (Gijzen et al., 2021 ; Mullarkey et al., 2019 ) and ostracism (Stillman et al., 2009 ). Besides the risk posed by loneliness and ostracism as causes of school absenteeism (Kearney 2022), students who frequently miss school tend to encounter challenges in social interactions, particularly in the realms of forming and maintaining friendships (Carroll et al., 2022 ; Egger et al., 2003 ; Wilson et al., 2003 ), and therefore experience higher levels of loneliness (Havik et al., 2015 ; Place et al., 2002 ). Bidirectional causality is thus suggested, as there is a possibility that depression and anxiety can contribute to school absences and social outsiderhood, and conversely, that school absence, loneliness, and ostracism might lead to the development of depression and anxiety. In the longitudinal study by Kiuru et al. ( 2024 ) social outsiderhood preceeded internalizing symptoms. However, up until now, no research has delved into the potential role of symptoms related to depression and anxiety as mediators in the connection between loneliness and school absenteeism. Loneliness and Ostracism According to Type of SAP While the general association between SAP and maladaptive functioning and ill-health is well established, the four types of SAP (emotion-based absence, truancy, school withdrawal, and school exclusion), have also been associated with different risk factors and consequences (reviewed in Heyne et al., 2019 ). Below, we will shortly review findings on type of SAP and loneliness and ostracism. The first type, emotion-based absence (EBSA) has been connected to social isolation (Granell de Aldaz et al., 1987 ; Havik et al., 2015 ), especially in middle school (Granell de Aldaz et al., 1987 ; Havik et al., 2015 ). EBSA has been linked to socially withdrawn temperament, anxiousness, as well as poor interpersonal skills (Carpentieri et al., n.d.). Furthermore, comparing anxious children who were attending school, with anxious non-attenders, Ingul et al. (2013) found that school attenders had more friends, but also that non-attenders had more severe psychiatric problems, comorbid behavioral problems and negative personality traits (Ingul & Nordahl, 2013 ). Arguably, EBSA could be related to both feeling lonely, having few friends, as well as being ostracized, when compared to youth not reporting EBSA. For the second type, truancy (T), a qualitative study found that truant youth reported feeling as “strangers” in the classroom, and having poor peer relationships within school, while at the same time having friendships with other truant youth outside of school (Strand, 2014 ). In two quantitative studies by the same research group, an association was found between social isolation and truancy in one of the studies (Havik et al., 2015 b), but not in the other (Havik et al., 2015 ). However, a number of studies report bullying victimization and perpetration among truant youth, implying difficulties in the social sphere (Alanko et al., 2023 ; Havik et al., 2015 ). For the third type, school withdrawal (SW), the association to loneliness or ostracism has not been established directly, but it has been noted, for instance, that the group of SW students that withdraw from school in order to care for a family member or close person may experience consequences on their social life due to the caretaking (Casu et al., 2021 ; Leu & Becker, 2017 ). The fourth type of SAP, school exclusion (SE), has been linked to behavioral problems (Heyne et al., 2019 ). Students with behavioral problems often also experience problems in peer relationships (Schwartz-Mette et al., 2020 ), and difficulties in school (Greene et al., 2002 ), as well as increased comorbidities such as anxiety disorders, mood disorders and language disorder (Greene et al., 2002 ). While there is various evidence of a connection between different types of SAP and loneliness and ostracism, no study to date has explicitly compared these connections within the same sample to disentangle the differences in experienced social outsiderhood between the types. Aims of the present study The aim of the present study was to examine the relationship between school attendance problems, social outsiderhood (loneliness and ostracism), and internalizing symptoms. Specifically, the study seeks to: Investigate the associations between school absence, internalizing symptoms and feelings of loneliness and ostracism. Explore how different types of school attendance problems (emotion-basedabsence, truancy, school withdrawal and school exclusion) relate to social outsiderhood. Based on previous research, our hypotheses were: H1a: Loneliness and ostracism are associated with number of days absent from school. H1b: The relationship between loneliness/ostracism and school absenteeism is mediated by internalizing symptoms. H2: Different types of school attendance problems (e.g., emotion-based absence, truancy, school withdrawal, and school exclusion) are associated with loneliness and ostracism. METHOD 2.1 Participants, Sampling, and Process Survey data were collected from 2,137 youths. Data from 271 youths were excluded due, for example, to lack of consent, implausible reported age, and missing responses on the relevant study variables. After this, the sample comprised 1,866 youths. The average age was 14.95 years ( SD = 0.86). Participant gender was male (44.4%), female (48.9%), or missing (6.6%). The respondents reported on their parent’s highest educational level: 45% reported university or higher education, 26% upper secondary school or vocational studies, 3% on comprehensive school or equivalent and 0.9% none of the above or unknown, the rest having no answer (25.9%). Almost three quarters (72%) lived with both parents, 12% interchangeably with two parents, 9% with one parent, 0.6% in residential child care and 0.6% with other arrangements. The current study is based on data from the project ‘School Absence in Finland’ (described in Niemi et al., 2022). Participants were recruited by a two-step process. First, school principals and teachers were contacted with information about the study, and an invitation to participate in an online seminar on school absenteeism. Information about the study, and the invitation to the seminar was shared by email as well as via social media by teacher organizations and various Facebook groups for school professionals. The seminar was conducted in January 2021 and included, in addition to lectures about school absenteeism, information about the upcoming study. A total of 15 upper primary schools, all located in southern and western Finland, decided to participate in the project. Next, participating schools emailed parents with information about the study and to gain consent for their child’s participation. In accordance with the Finnish guidelines on research integrity (TENK), parents of youths below 15 years were asked to complete an informed consent for their child’s participation in the study. In addition, all youths provided informed written consent at the time of data gathering. Survey data were collected from youths during school time, in May 2021. A research assistant or teacher was present in class during the data collection, so that they could clarify questions and help if technical assistance was needed. To obtain data from persistently absent students, school personnel contacted absent students, went to their house if needed, and filled in the questionnaire with the students, if the student needed help. In total, 42 responses were collected this way. The study was approved by the research ethics committee of Åbo Akademi University (2020/06/26). 2.2 Measures 2.2.1 Absence from School To assess absence from school, participants were asked to estimate how many days they had been absent from school during the prior 12 school weeks, for whatever reason. Responses were given on a scale from 1–6, where 1 = Not at all, 2 = Sometimes (up to 4 days), 3 = Often (5–12 days absent), 4 = Very often (13–36 days absent), 5 = Mostly (37–48 days absent), and 6 = Always (more than 48 days absent). This item is included in the ISAP questionnaire (see below). 2.2.2 Typology of School Attendance Problems To assess different types of SAP, definitions of types according to Heyne et al. ( 2019 ) were provided (see Appendix 1). All respondents, regardless of amount of absence, could choose one or several options among the provided descriptions to describe their own SAP. Participants could also choose not to select any type of SAP. Each typological group consisted of yes-replies to the specific item. The control group consisted of those with a no-response to the typological item. This means, that in the control group, some participants could have indicated another type of SAP. This choice was due to the low number of yes-responses to the typological questions. 2.2.3 Loneliness and Ostracism To assess loneliness and ostracism, participants were administered the Inventory of School Attendance Problems (ISAP; Knollmann et al., 2019 ). The questionnaire was constructed as a screening tool for identifying problems linked to emerging and existing SAPs. The ISAP contains 13 symptom subscales (ISAP-S) and13 function subscales (ISAP-F). Questions are presented on the same line, so that the first part relates to the symptoms and the second to the impact (= function) the symptoms hold on absence. Factor structure, convergent and divergent validity, as well as internal consistency of the subscales has been found to be adequate or good, in previous studies on the same sample (Laine 2023 ), or different samples (Knollman et al., 2019, Strömbeck et al. 2023). In the present study, we used two two-part items, measuring the symptoms of loneliness or ostracism, and the function these symptoms hold on absence. Participants were asked to rate, on a 4-point Likert scale (from 1 = never to 4 = most of the time), to what extent they agreed with the statements “Before or at school I feel excluded by my classmates” (ostracism) and “Before or at school I feel unhappy because I don’t have friends at school” (loneliness). To assess the function of loneliness and ostracism, the same descriptions were used, and participants indicated on a similar 4-pont Likert scale to what extent they experienced that the symptoms impacted school attendance. 2.2.4 Internalizing Symptoms To assess internalizing symptoms, participants completed the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ; (Goodman, 1997 ). The items were answered on a 3-point Likert scale from 0 (not true) to 2 (certainly true), which yielded a summary score ranging from 0 to10. Cronbach’s alpha for the Emotional symptoms’ subscale was acceptable, α = .77. 2.3 Data Analysis All data preparation and analyses were performed in R version 4.2.0. The following R packages were used for data analysis and plotting: tidyverse (data cleaning; Wickham et al., 2019 ), lavaan (mediation analysis; Rosseel, 2012 ) and psych (significance testing of correlation coefficients; Revelle, 2015 ). Analyses were independent t-tests, Pearson product moment correlations and mediation models. 2.4 Transparency and openness Materials and analysis code for this study are available upon request from the first author. RESULTS 3.1. Descriptive Statistics of Internalizing Symptoms, Loneliness and Ostracism, and Gender Differences Among the respondents, 54.3% reported absence from school at least once during the last 12 weeks. Girls reported more absence than boys (girls: M = 1.96, SD = 0.92, boys M = 1.82, SD = 0.87, t (1607.8) = 3.15, p = .002, d = 0.16). Mean level of internalizing symptoms was relatively low, however, more internalizing symptoms were reported by girls ( M = 4.15, SD = 2.50) than boys ( M = 2.20, SD = 2.12, t (1552.8) = 16.61, p < .001, d = 0.84). Respondents could indicate whether they experienced loneliness and ostracism (symptom), and in addition, if this impacted their absence from school (= function, see Appendix 2). In total, 19% reported experiencing loneliness and 30% reported experiencing ostracism. Both symptom and function of loneliness was reported by 8%, and ostracism by 11%. In other words, about one in ten of the students both felt lonely or ostracized at school and felt that this impacted their school attendance When comparing mean levels of loneliness and ostracism, the differences were not statistically significant, neither for symptom, nor function (See Appendix 3), when the participant had reported a score higher than one on the scale (range 1–4). The results indicate that boys and girls experience similar levels of loneliness and ostracism and that loneliness and ostracism affect their school attendance in a similar way. One of the analyses was close to significant, implying that girls more often see ostracism as a reason for not attending school than boys. 3.2. Correlations between symptoms of internalizing problems, loneliness, ostracism, and school absence The correlations between loneliness and ostracism were large (Table 1 ). Loneliness and ostracism correlated moderately with internalizing symptoms, and to a small degree with days absent. Table 1 Bivariate correlations between study variables, separate for boys and girls 1. 2. 3. 4. 1. Ostracism - . 59 .34 .09 2. Loneliness . 68 - .27 .08 3. Internalizing symptoms .39 .35 - .19 4. School absence .14 .17 .15 - Note. Correlations for boys below the diagonal, correlations for girls above the diagonal. All correlations are significant at p < .05. Bolded numbers indicate significant differences in correlation for boys and girls at p < .001 3.3. The mediating role of internalizing symptoms for the effect of loneliness and ostracism on school absence The direct effects were modeled in a linear regression, both symptoms of ostracism and loneliness had significant direct effects on missed school days (β = 0.08, p = .020 and β = 0.07, p = .036 respectively). A saturated, just-identified path model was fit to estimate if the effect of symptoms of loneliness and ostracism on days absent were mediated by internalizing problems. All reported regression coefficients are standardized. The complete path model can be found in Fig. 1. Figure 1 Path Model of Symptoms Note Standardized estimates of the path model. *** p < .001. The results indicated that being ostracized had a stronger predictive effect on having more internalized problems compared to loneliness. The indirect effect of ostracism on school absence was β = 0.05, p < .001 and of loneliness on days absent β = 0.02, p = .003, implying no or extremely low meaningful effects. Table 2 Path model parameter estimates symptoms Path B SE Beta p Direct effect Ostracism → School absence 0.04 0.04 0.04 .301 Loneliness → School absence 0.08 0.05 0.06 .065 Internalizing symptoms → School absence 0.06 0.01 0.16 < .001 Ostracism → Internalizing symptoms 1.12 0.11 0.32 < .001 Loneliness → Internalizing symptoms 0.42 0.12 0.11 < .001 Indirect effects Ostracism → Internalizing symptoms → School absence 0.05 0.01 0.05 < .001 Loneliness → Internalizing symptoms → School absence 0.02 0.01 0.02 .003 Note. N = 1,451. Goodness-of-fit: R 2 School absence = .04, R 2 Internalizing symptoms = .16. 3.4 Typology of School Attendance Problem, Loneliness and Ostracism In order to answer research question two, we explored how students classified their absence in terms of SAP typology. Most absences did not fall under any specific type, as the percentage reporting any of the four types of SAP was 14.8. In other words, most absences were likely unproblematic. Prevalence of types of SAPs, when participants had read the definition provided and checked if they agreed, were: Emotion-based absence (6.6%), Truancy (2.6%), School Withdrawal (3.9%), and School Exclusion (1.7%). Welch’s t-test were done to find if those who had a particular school absence typology differed on loneliness/ostracism from those who did not have the typology. Group comparisons can be found in Table 5 . All comparisons of typologies were significant and had large effect sizes, indicating that any type of absence is associated with more loneliness/ostracism. The strongest association of typology with both ostracism and loneliness was school exclusion ( d = 1.04 and 0.91 respectively), although the effect sizes did not significantly differ based on bootstrapped confidence intervals. Table 5 Loneliness and Ostracism according to SAP Typology Typology present Typology not present Group comparison M (SD) M (SD) t df p d [95% CI] Emotion-based absence Ostracism 2.15 (1.05) 1.35 (0.66) 7.95 121,50 < .001 0.91 [0.87, 1.44] Loneliness 1.81 (1.05) 1.24 (0.60) 5.68 119,03 < .001 0.67 [0.59, 1.19] Truancy Ostracism 2.09 (1.06) 1.39 (0.71) 4.36 45,20 < .001 0.78 [0.58, 1.46] Loneliness 1.78 (1.00) 1.27 (0.64) 3.42 45,13 < .001 0.61 [0.36, 1.25] School withdrawal Ostracism 2.14 (1.02) 1.38 (0.70) 5.94 67,78 < .001 0.87 [0.73, 1.46] Loneliness 1.74 (0.93) 1.26 (0.64) 4.25 67,82 < .001 0.60 [0.42, 1.12] School exclusion Ostracism 2.37 (1.11) 1.40 (0.71) 4.52 26,38 < .001 1.04 [0.77, 1.94] Loneliness 2.08 (1.08) 1.27 (0.64) 3.76 24,29 < .001 0.91 [0.62, 1.93] Note. N = 1518 for Ostracism (ISAP 22) and N = 1508 for Loneliness (ISAP 26) due to dropout. CI = percentile bootstrapped confidence interval using 1000 samples, LL = lower limit and UL = upper limit. Typology based on responses to description of the SAP (present = yes, not present = no). DISCUSSION The present study aimed to explore the relationships between school absences, internalizing symptoms and social outsiderhood among adolescents. All three variables were associated. Furthermore, internalizing symptoms were found to mediate the association between social outsiderhood and school absence. In addition, the aim was to explore how different SAP types were related to social outsiderhood. All four types of school attendance problems (SAPs) were linked to experiences of ostracism and loneliness. Thus, the findings supported all proposed hypotheses (H1a, H1b, and H2). Both ostracism and loneliness were significantly associated with school absenteeism (H1a), and internalizing symptoms mediated this relationship (H1b). This finding aligns with a robust body of literature suggesting that social exclusion is a precursor of internalizing symptoms such as depression and anxiety (Mullarkey et al., 2019 ). For instance, in a longitudinal study, increased internalizing symptoms were detected in middle school, especially among those students with profiles of high and increasing social loneliness (Kiuru et al., 2024 ). The moderate-sized correlations observed in our data may also be understood in terms of a bidirectional relationship between social exclusion and internalizing symptoms, reinforcing the theoretical framework that social isolation exacerbates emotional distress, and even neural pain reactions (J. T. Cacioppo et al., 2006 ; Macdonald & Leary, 2005 ) while individuals experiencing internalizing symptoms may also be more prone to perceiving or experiencing social exclusion (Beeson et al., 2020 ; Finning, Ukoumunne, Ford, Danielsson-Waters, et al., 2019 ). Subsequent analysis aimed to determine whether the associations between loneliness, ostracism, and school absenteeism were direct or mediated by internalizing symptoms. While both symptoms of ostracism and loneliness were associated with days absent in the linear regressions, the path model showed that these effects were mediated by internalizing symptoms. The results suggest that while loneliness and ostracism are important precursors to absenteeism, their impact is indirect, operating primarily through the development of internalizing symptoms such as anxiety and depression. Internalizing symptoms may affect youth well-being on a functional level, for some, leading to difficulties in attending school. The symptoms disrupt daily functioning by generating intense emotional and psychological distress that interferes with a student’s ability to engage in routine activities, including academic responsibilities (Avenevoli et al., 2008 ). For example, anxiety can manifest as overwhelming fears or worries about social interactions or academic performance, making the school environment feel intimidating and unsafe (Egger et al., 2003 ). This heightened emotional state can lead to avoidance behaviors, where students may choose to stay home to escape the perceived stress of attending school (Kearney, 2007 ). Similarly, depression can sap motivation, energy, and concentration, making it difficult for students to complete schoolwork, participate in classroom activities, or even find the strength to get out of bed (Kessler et al., 2012 ). As internalizing symptoms escalate, students may struggle with a sense of hopelessness or worthlessness, which further isolates them from their peers and the learning environment (Rubin et al., 2009 ). The results of the path model, which showed that the effects of loneliness and ostracism on absenteeism were mediated by internalizing symptoms, underscored how deeply these emotional challenges can impair youth’s functional capacity, making regular school attendance difficult or even impossible. The distinct relationships observed between loneliness, ostracism, and internalizing symptoms suggest that these experiences may have unique emotional consequences, highlighting the importance of distinguishing them as qualitatively different phenomena. While both loneliness and ostracism can lead to internalizing symptoms, the mechanisms by which they impact individuals may differ. Ostracism, as an explicit form of exclusion, involves a clear, direct rejection by others, which may trigger more immediate and acute psychological distress. This overt social exclusion could evoke a stronger emotional response because it directly challenges an individual's sense of belonging and acceptance (Macdonald & Leary, 2005 ). The experience of ostracism may also be more difficult to rationalize or dismiss, leading to heightened feelings of shame, rejection, and even anger (Williams, 2007 ). In contrast, loneliness is a broader, more subjective experience characterized by a perceived lack of meaningful connections, even in the absence of explicit exclusion. It is possible to feel lonely even while surrounded by others, making it a more generalized and diffuse emotional state that may build gradually over time (Cacioppo et al., 2006 ; Cacioppo et al., 2015 ) Despite these differences, the high correlation between loneliness and ostracism suggests significant overlap between the two constructs. Loneliness may often be a byproduct of ostracism, as individuals who are socially excluded are likely to experience feelings of isolation and disconnection. However, ostracism may exert a more immediate and powerful influence on behavior. Ostracism's direct link to school absence, as demonstrated by Kiuru et al. ( 2024 ), suggests that being actively excluded from peer interactions may create a hostile or unwelcoming school environment, prompting students to disengage or avoid attendance. In contrast, loneliness, while emotionally distressing, may not have as strong of an impact on school absence because it is less tied to specific social dynamics and may not immediately compel avoidance behaviors. Ultimately, these findings support the idea that ostracism and loneliness, while related, operate differently in their influence on emotional well-being and school attendance. All four types of school attendance problems (SAPs) were linked to experiences of ostracism and loneliness (Hypothesis 2), with those reporting school exclusion exhibiting the highest levels of both. The associations between each type of school attendance problem (SAP)—emotion-based absence, truancy, school withdrawal, and school exclusion—and experiences of ostracism and loneliness were significant. This indicates that all respondents with problematic school absence, regardless of the type, also struggled with social relationships, manifested here as loneliness or ostracism. These social challenges could be both a cause and a consequence of their absenteeism. Regardless of the direction of causality, it is crucial to address the social relationships of young individuals facing attendance issues. The association between social exclusion and attendance issues align with models of school engagement that emphasize the importance of belongingness and peer acceptance (Allen et al., 2018 ; Caldwell et al., 2019 ). Furthermore, the negative impact of these emotions, compounded by the shame often associated with being unable to attend school, may make it difficult for students to continue at, or return to, their original school. This could explain why many students with complex SAPs opt to change schools as part of their effort to return, potentially seeking a fresh start in a new social environment (Kearney, 2016 ). Participants who reported school exclusion also tended to report higher levels of loneliness and ostracism. This finding is novel, as school exclusion has not previously been examined in a community study of adolescents, nor has its association with loneliness and ostracism been established. It is perhaps unsurprising that students experiencing school exclusion struggle the most, as they are directly and actively excluded by the school. Importantly, such exclusion does not necessarily stem from disciplinary actions but may reflect instances where the school unfairly excludes the student (Heyne et al., 2019 ). Heyne et al. ( 2019 , p. 16) outline that SE as problematic school-based decision making may revolve around: “the use of disciplinary measures; the allocation of resources for students in need; and the need to satisfy school-based performance requirements”. A notable finding, beyond our research questions, was that 27% of participants reported feeling lonely, and 30% reported experiencing ostracism. Among them, loneliness was cited as the reason for absence by 8% and ostracism by 11%. These findings suggest that loneliness and ostracism are impactful enough to disrupt daily functioning, raising concerns about the number of students who are affected by the emotional and functional challenges posed by social outsiderhood. Gender differences were observed across the entire sample, with more girls reporting feelings of loneliness and ostracism. This finding is consistent with previous Finnish studies (Lyyra et al., 2022 ), highlighting the particular vulnerability of Finnish girls to social exclusion, especially in the form of ostracism. However, among participants who reported experiencing symptoms, there were no significant gender differences in the intensity of loneliness or ostracism. This suggests that when such symptoms are present, both boys and girls experience them at similar levels. Additionally, there were no gender differences in the frequency with which these symptoms impacted school attendance, indicating that the functional consequences of loneliness and ostracism on school absenteeism are comparable between genders. Future studies Given the cross-sectional nature of this study, causal inferences cannot be drawn. Future research should employ longitudinal designs to explore the temporal relationships between loneliness, ostracism, internalizing symptoms, and school absenteeism. This would help to determine whether feelings of ostracism and loneliness are consequences of school absence or if they contribute to the development of absenteeism over time. The current findings suggest that school attendance problems might evolve from social exclusion and lack of friendships, which can lead to internalizing symptoms and reduced motivation or ability to attend school. Therefore, interventions aiming to improve school attendance should focus on enhancing student relationships and fostering a supportive school community, as these factors are crucial for maintaining attendance. It's worth noting that this situation may differ in clinical samples, where higher symptom levels might be more common. Future studies should consider the experiences of groups at risk to experience social outsiderhood or internalizing symptoms, such as ethnic, sexual, and gender identity minorities, students with learning difficulties or physical disability, to provide a more comprehensive understanding of school-related issues across different groups at risk. Strengths and limitations A key strength of this study is its large sample size from Finnish schools, which enhances the generalizability of the findings. However, a limitation is the operationalization of loneliness and ostracism. The measures used are indirect, which may impact the results and their comparability with other studies. The items focused on feelings of unhappiness due to a lack of friends and social exclusion within the school context, which aligns with the study's main aim. However, the impact of loneliness or exclusion outside of school on overall well-being and school attendance remains unclear. Additionally, the measure of loneliness did not explicitly use the term \"lonely,\" which could both mitigate stigma but also affect validity and comparability. It is important to acknowledge the potential for self-report bias in this study, particularly given the adolescent population. Adolescents may have varying levels of self-awareness and may be influenced by social desirability or fear of stigma when reporting sensitive issues such as loneliness, ostracism, and internalizing symptoms. Self-report measures rely on individuals’ perceptions and willingness to disclose their experiences, which can introduce biases affecting the accuracy of the data. Furthermore, memory bias may have affected responding to the question about number of days absent from school. In addition, our questionnaire was lengthy, which might have affected the motivation to respond. Data collection occurred during the COVID-19 pandemic, which likely exacerbated feelings of social exclusion and internalizing symptoms, as indicated by previous research (Racine et al., 2021), and may have contributed to increased school absenteeism. CONCLUSION This study established significant associations between loneliness, ostracism, internalizing symptoms, and school absenteeism, applicable to all types of school attendance problems: emotion-based absence, truancy, school withdrawal, and school exclusion. The highest levels of ostracism and loneliness were reported by those experiencing school exclusion. The relationship between loneliness, ostracism, and school absenteeism was mediated by internalizing symptoms, highlighting the interplay of these factors. Future research should further investigate these dynamics and explore effective interventions to support students in overcoming social and emotional challenges, ultimately promoting better attendance and overall well-being. Declarations Ethical Approval The study was approved by the research ethics committee of Åbo Akademi University (2020/06/26). Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Authors' contributions All authors whose names appear on the submission 1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; 2) drafted the work or revised it critically for important intellectual content; 3) approved the version to be published; and 4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding The first author was funded by C.G. Sundell foundation. XX was funded by Strategic Research Council 352648. The present study is also part of the EDUCA Flagship project funded by the Research Council of Finland (#358924, #358947), for authors XX. Availability of data and materials Data may be made available upon requests from the first author. References Alanko K, Melander K, Ranta K, Engblom J, Kosola S (2023) Time trends in adolescent school absences and associated bullying involvement between 2000 and 2019: A nationwide study [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-2651595/v1 Allen K, Kern ML, Vella-Brodrick D, Hattie J, Waters L (2018) What Schools Need to Know About Fostering School Belonging: A Meta-analysis. Educational Psychol Rev 30(1):1–34. https://doi.org/10.1007/s10648-016-9389-8 Arslan G, Yıldırım M (2022) Psychological Maltreatment and Loneliness in Adolescents: Social Ostracism and Affective Experiences. Psychol Rep 125(6):3028–3048. https://doi.org/10.1177/00332941211040430 Avenevoli S, Knight E, Kessler RC, Merikangas KR (2008) Epidemiology of depression in children and adolescents. In Handbook of depression in children and adolescents (pp. 6–32). The Guilford Press. https://doi.org/10.1007/978-1-4899-1510-8 Baumeister RF, DeWall CN, Ciarocco NJ, Twenge JM (2005) Social exclusion impairs self-regulation. J Personal Soc Psychol 88(4):589–604. https://doi.org/10.1037/0022-3514.88.4.589 Beeson CML, Brittain H, Vaillancourt T (2020) The Temporal Precedence of Peer Rejection, Rejection Sensitivity, Depression, and Aggression Across Adolescence. Child Psychiatry Hum Dev 51(5). Article 5. https://doi.org/10.1007/s10578-020-01008-2 Bronfenbrenner U (1979) The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA (2006) Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychol Aging 21(1):140–151. https://doi.org/10.1037/0882-7974.21.1.140 Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT (2015) Loneliness: Clinical Import and Interventions. Perspect Psychol Science: J Association Psychol Sci 10(2):238–249. https://doi.org/10.1177/1745691615570616 Caldwell DM, Davies SR, Hetrick SE, Palmer JC, Caro P, López-López JA, Gunnell D, Kidger J, Thomas J, French C, Stockings E, Campbell R, Welton NJ (2019) School-based interventions to prevent anxiety and depression in children and young people: A systematic review and network meta-analysis. Lancet Psychiatry 6(12). Article 12. https://doi.org/10.1016/S2215-0366(19)30403-1 Carpentieri R, Iannoni ME, Curto M, Biagiarelli M, Listanti G, Andraos MP, Mantovani B, Farulla C, Pelaccia S, Grosso G, Speranza AM, Sarlatto C (n.d.). School Refusal Behavior: Role of Personality Styles, Social Functioning, and Psychiatric Symptoms in a Sample of Adolescent Help-Seekers. Clin Neuropsychiatry, 19 (1), 20–28. https://doi.org/10.36131/cnfioritieditore20220104 Carroll E, Ye K, McCoy S (2022) Educationally maintained inequality? The role of risk factors and resilience at 9, 13 and 17 in disabled young people’s post-school pathways at 20. Ir Educational Stud 41(3):573–594 a9h Casu G, Hlebec V, Boccaletti L, Bolko I, Manattini A, Hanson E (2021) Promoting Mental Health and Well-Being among Adolescent Young Carers in Europe: A Randomized Controlled Trial Protocol. International Journal of Environmental Research and Public Health , 18 (4), 2045. https://doi.org/10.3390/ijerph18042045 Egger HL, Costello JE, Angold A (2003) School Refusal and Psychiatric Disorders: A Community Study. J Am Acad Child Adolesc Psychiatry 42(7):797–807. https://doi.org/10.1097/01.CHI.0000046865.56865.79 Favotto L, Michaelson V, Pickett W, Davison C (2019) The role of family and computer-mediated communication in adolescent loneliness. PLoS ONE 14(6):e0214617. https://doi.org/10.1371/journal.pone.0214617 Finning K, Ukoumunne OC, Ford T, Danielson-Waters E, Shaw L, Jager IRD, Stentiford L, Moore DA (2019) Review: The association between anxiety and poor attendance at school – a systematic review . 12 Finning K, Ukoumunne OC, Ford T, Danielsson-Waters E, Shaw L, De Jager R, Stentiford I, L., Moore DA (2019) The association between child and adolescent depression and poor attendance at school: A systematic review and meta-analysis. J Affect Disord 245:928–938. https://doi.org/10.1016/j.jad.2018.11.055 Gijzen MWM, Rasing SPA, Creemers DHM, Smit F, Engels RC, M. E, De Beurs D (2021) Suicide ideation as a symptom of adolescent depression. A network analysis. J Affect Disord 278:68–77. https://doi.org/10.1016/j.jad.2020.09.029 Goodman R (1997) The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry Allied Discip 38(5):581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x Granell de Aldaz E, Feldman L, Vivas E, Gelfand DM (1987) Characteristics of Venezuelan school refusers. Toward the development of a high-risk profile. J Nerv Ment Dis 175(7):402–407. https://doi.org/10.1097/00005053-198707000-00003 Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV (2002) Psychiatric Comorbidity, Family Dysfunction, and Social Impairment in Referred Youth With Oppositional Defiant Disorder. Am J Psychiatry 159(7):1214–1224. https://doi.org/10.1176/appi.ajp.159.7.1214 Havik T, Bru E, Ertesvåg SK (2015) Assessing Reasons for School Non-attendance. Scandinavian J Educational Res 59(3):316–336. https://doi.org/10.1080/00313831.2014.904424 Heinrich LM, Gullone E (2006) The clinical significance of loneliness: A literature review. Clin Psychol Rev 26(6):695–718. https://doi.org/10.1016/j.cpr.2006.04.002 Heyne D, Gren-Landell M, Melvin G, Gentle-Genitty C (2019) Differentiation Between School Attendance Problems: Why and How? Cogn Behav Pract 26(1):8–34. https://doi.org/10.1016/j.cbpra.2018.03.006 Ingul JM, Nordahl HM (2013) Anxiety as a risk factor for school absenteeism: What differentiates anxious school attenders from non-attenders? Ann Gen Psychiatry 12(1):25–33 a9h Kearney CA (2007) Forms and functions of school refusal behavior in youth: An empirical analysis of absenteeism severity. J Child Psychol Psychiatry Allied Discip 48(1):53–61. https://doi.org/10.1111/j.1469-7610.2006.01634.x Kearney CA (2016) Managing School Absenteeism at Multiple Tiers: An Evidence-Based and Practical Guide for Professionals. Oxford University Press Kearney CA, Graczyk PA (2020) A multidimensional, multi-tiered system of supports model to promote school attendance and address school absenteeism. Clin Child Fam Psychol Rev 23(3):316–337. https://doi.org/10.1007/s10567-020-00317-1 Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, He J, Koretz D, McLaughlin KA, Petukhova M, Sampson NA, Zaslavsky AM, Merikangas KR (2012) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 69(4):372–380. https://doi.org/10.1001/archgenpsychiatry.2011.160 Kiuru N, Salmela-Aro K, Laursen B, Vasalampi K, Beattie M, Tunkkari M, Junttila N (2024) Profiles of Loneliness and Ostracism During Adolescence: Consequences, Antecedents, and Protective Factors. Child Psychiatry Hum Dev. https://doi.org/10.1007/s10578-024-01664-8 Knollmann M, Reissner V, Hebebrand J (2019) Towards a comprehensive assessment of school absenteeism: Development and initial validation of the inventory of school attendance problems. Eur Child Adolesc Psychiatry 28(3):399–414. https://doi.org/10.1007/s00787-018-1204-2 Laine C (2023) The psychometric properties of the Inventory of school attendance problems in a Finnish sample. Unpublished Master's thesis. Åbo Akademi University Leduc K, Tougas A-M, Robert V, Boulanger C (2022) School Refusal in Youth: A Systematic Review of Ecological Factors. Child Psychiatry Hum Dev. https://doi.org/10.1007/s10578-022-01469-7 Leu A, Becker S (2017) A cross-national and comparative classification of in-country awareness and policy responses to ‘young carers’. J Youth Stud 20(6):750–762. https://doi.org/10.1080/13676261.2016.1260698 Lyyra N, Junttila N, Tynjälä J, Villberg J, Välimaa R (2022) Loneliness, subjective health complaints, and medicine use among Finnish adolescents 2006–2018. Scand J Public Health 50(8) Article 8. https://doi.org/10.1177/14034948221117970 Strand M, A.-S (2014) School – no thanks – it ain’t my thing’: Accounts for truancy. Students’ perspectives on their truancy and school lives. Int J Adolescence Youth 19(2):262–277. https://doi.org/10.1080/02673843.2012.743920 Macdonald G, Leary MR (2005) Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull 131(2). Article 2. https://doi.org/10.1037/0033-2909.131.2.202 Melvin GA, Heyne D, Gray KM, Hastings RP, Totsika V, Tonge BJ, Freeman MM (2019) The Kids and Teens at School (KiTeS) Framework: An Inclusive Bioecological Systems Approach to Understanding School Absenteeism and School Attendance Problems. Frontiers in Education , 4 . https://www.frontiersin.org/articles/ 10.3389/feduc.2019.00061 Mullarkey MC, Marchetti I, Beevers CG (2019) Using Network Analysis to Identify Central Symptoms of Adolescent Depression. J Clin Child Adolesc Psychology: Official J Soc Clin Child Adolesc Psychol Am Psychol Association Div 53(4):656–668. https://doi.org/10.1080/15374416.2018.1437735 . 48 Place M, Hulsmeier J, Davis S, Taylor E (2002) The coping mechanisms of children with school refusal. J Res Special Educational Needs 2(2). https://doi.org/10.1111/j.1471-3802.2002.00167.x . psyh Qualter P, Vanhalst J, Harris R, Van Roekel E, Lodder G, Bangee M, Maes M, Verhagen M (2015) Loneliness across the life span. Perspect Psychol Science: J Association Psychol Sci 10(2):250–264. https://doi.org/10.1177/1745691615568999 Revelle W (2015) Package ‘Psych.’ The Comprehensive R Archive Network , December 12, 2023. https://cran.r-project.org/web/packages/psych/psych.pdf Rosseel Y (2012) lavaan: An R Package for Structural Equation Modeling. J Stat Softw 48(2). https://doi.org/10.18637/jss.v048.i02 Rubin K, Coplan R, Bowker J (2009) Social Withdrawal in Childhood. Ann Rev Psychol 60:141–171. https://doi.org/10.1146/annurev.psych.60.110707.163642 Schwartz-Mette RA, Shankman J, Dueweke AR, Borowski S, Rose AJ (2020) Relations of friendship experiences with depressive symptoms and loneliness in childhood and adolescence: A meta-analytic review. Psychol Bull 146(8):664–700. https://doi.org/10.1037/bul0000239 Stillman TF, Baumeister RF, Lambert NM, Crescioni AW, DeWall CN, Fincham FD (2009) Alone and without purpose: Life loses meaning following social exclusion. J Exp Soc Psychol 45(4):686–694. https://doi.org/10.1016/j.jesp.2009.03.007 Stoeckli G (2009) The Role of Individual and Social Factors in Classroom Loneliness. J Educational Res 103(1):28–39. https://doi.org/10.1080/00220670903231169 Twenge JM, Haidt J, Blake AB, McAllister C, Lemon H, Le Roy A (2021) Worldwide increases in adolescent loneliness. J Adolesc 93:257–269. https://doi.org/10.1016/j.adolescence.2021.06.006 Weiss RS (1973) Loneliness: The experience of emotional and social isolation (pp. xxii, 236). The MIT Press Wickham H, Averick M, Bryan J, Chang W, McGowan LD, François R, Grolemund G, Hayes A, Henry L, Hester J, Kuhn M, Pedersen TL, Miller E, Bache SM, Müller K, Ooms J, Robinson D, Seidel DP, Spinu V, Yutani H (2019) Welcome to the Tidyverse. J Open Source Softw 4(43):1686. https://doi.org/10.21105/joss.01686 Williams KD (2007) Ostracism. Ann Rev Psychol 58(1):425–452. https://doi.org/10.1146/annurev.psych.58.110405.085641 Wilson SJ, Lipsey MW, Derzon JH (2003) The effects of school-based intervention programs on aggressive behavior: A meta-analysis. J Consult Clin Psychol 71(1):136–149. https://doi.org/10.1037/0022-006X.71.1.136 Additional Declarations No competing interests reported. Supplementary Files Appendix1Definitions.docx Appndeix2Tablefrequenciesoutsiderhood.docx Appendix3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5402404\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":379052725,\"identity\":\"4a836b00-2271-403e-8b2f-abf1594aaf01\",\"order_by\":0,\"name\":\"Katarina Alanko\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIie3PMYvCMBTA8ScBXQJdKwX7FVIKheMqfhVDQJcTOjo+KXR1Lfgp7hukBJwKrhUdlMLNgtNxDhd7KC6NjjfkP4Rk+JH3AGy2fxiTzXk9CAJIGICr73PWTgIkN9JpSNiQ0kBCILfrH+HYEMNgUW9TnOfJ3odesTgnZTxdrlIJMmknMRWkX7KvAClPvbyazPL9egzSMFgMAvrIlJ6Ko0dPaobVByMnA4mcmnxrMkLnmP5oMvU1Mf4SuqJ7/UVvzTOPVmrMnpEgr6M3TUTmHrN3Wk6CT72LNBG24fUWL2q4dITa0XXsD3ZpcZCXdnKv+/iQLwCbzWazGfoF+1FYqyBtAFMAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"University of Turku\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Katarina\",\"middleName\":\"\",\"lastName\":\"Alanko\",\"suffix\":\"\"},{\"id\":379052726,\"identity\":\"538ce585-39a7-4e4e-8c62-d397650f22e1\",\"order_by\":1,\"name\":\"Patrik Söderberg\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Åbo Akademi University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Patrik\",\"middleName\":\"\",\"lastName\":\"Söderberg\",\"suffix\":\"\"},{\"id\":379052727,\"identity\":\"7f171abb-4c59-4f32-b7c5-dfbc89659543\",\"order_by\":2,\"name\":\"Martin Lagerström\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Åbo Akademi University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Martin\",\"middleName\":\"\",\"lastName\":\"Lagerström\",\"suffix\":\"\"},{\"id\":379052728,\"identity\":\"815e070d-7ecd-43b7-ab6d-cafe972d75b0\",\"order_by\":3,\"name\":\"Mikko-Jussi Laakso\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Turku\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mikko-Jussi\",\"middleName\":\"\",\"lastName\":\"Laakso\",\"suffix\":\"\"},{\"id\":379052729,\"identity\":\"1ff03262-7180-44d7-8179-efcaf3b618aa\",\"order_by\":4,\"name\":\"Niina Junttila\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Turku\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Niina\",\"middleName\":\"\",\"lastName\":\"Junttila\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-11-06 11:38:27\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5402404/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5402404/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":69782049,\"identity\":\"10bd7b76-d190-440b-bd17-4bb000a61008\",\"added_by\":\"auto\",\"created_at\":\"2024-11-25 08:15:02\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":160385,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003ePath Model of Symptoms\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNote.\\u003c/em\\u003e Standardized estimates of the path model. *** \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5402404/v1/4a87f4ab412d551e79c76bc9.jpeg\"},{\"id\":69992792,\"identity\":\"74457844-c835-43e2-97dc-336269f9344b\",\"added_by\":\"auto\",\"created_at\":\"2024-11-27 09:39:45\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":917569,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5402404/v1/ceb8d674-bc9d-4bda-b4ef-ff063e9b703d.pdf\"},{\"id\":69782045,\"identity\":\"619b45ca-d3af-49ae-8d25-1726aeefd6f7\",\"added_by\":\"auto\",\"created_at\":\"2024-11-25 08:15:02\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":12729,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Appendix1Definitions.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5402404/v1/cdb117845ecf656ffa76c4c5.docx\"},{\"id\":69782046,\"identity\":\"578a7886-4802-4c81-af40-583285aafcfb\",\"added_by\":\"auto\",\"created_at\":\"2024-11-25 08:15:02\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":14436,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Appndeix2Tablefrequenciesoutsiderhood.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5402404/v1/8d8d91f925fd16732b5d01c1.docx\"},{\"id\":69782047,\"identity\":\"a1c87245-dc68-45c6-b30c-d6af7f8213cf\",\"added_by\":\"auto\",\"created_at\":\"2024-11-25 08:15:02\",\"extension\":\"docx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":14503,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Appendix3.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5402404/v1/4d5061188462c8d4b3a0220f.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"The Association Between Social Outsiderhood and School Absence is Mediated by Internalizing Symptoms\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cdiv id=\\\"Sec2\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSchool Attendance Problems\\u003c/h2\\u003e \\u003cp\\u003e‘School attendance problems’ (SAP) is an umbrella term for the difficulties youths can experience when it comes to getting to school or staying in school (Heyne et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Kearney, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e; Kearney \\u0026amp; Graczyk, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e). SAPs range from verbally expressing distress for going to school, to occasional school avoidance, to continuous periods of longer absences (Kearney, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e). SAPs have been related to a range of both short- and long-term negative problems, including academic-, and mental health problems, social isolation and difficulties completing secondary education (Heyne et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Kearney, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e). It is often difficult to separate pre-existing symptoms from symptoms arising as a consequence of SAPs. School attendance problems (SAPs) are often operationalized as absence from school, which can include partial days, full days, or extended periods of time away from school.\\u003c/p\\u003e \\u003cp\\u003eHeyne et al. (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) outlined four main types of SAPs, namely school refusal (hereafter referred to as emotion-based absence), truancy, school withdrawal, and school exclusion. Emotion-based absence (EBSA) refers to when a young person is reluctant or refuses to attend school because of emotional distress. Truancy (T) refers to being absent without the permission of parents or school. School withdrawal (SW) refers to a situation in which a parent directly or indirectly supports absence and school exclusion (SE) to a situation in which school directly or indirectly supports the absence of a student.\\u003c/p\\u003e \\u003cp\\u003eOur approach to understand SAPs builds on Bronfenbrenner’s ecological systems model, and Heyne’s typological approach. Factors related to SAPs may be detected on all system levels, including that of the individual (such as individual needs, and internalized symptoms), the family (such as parental psychopathology and family socioeconomic situation), the school (such as bullying and dislike of a specific school), as well as community (such as school policies) and factors related to the socio-historical context (such as impact of pandemics) (Bronfenbrenner \\u0026amp; Morris, 2006; Melvin et al., \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eBesides types and symptoms, researchers have also pinpointed functions associated with SAPs. Based on learning theory, Kearney (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e) first distinguished between functions tied to negative reinforcement, like evading negative emotions or evaluative circumstances, and positive reinforcement, such as gaining attention from important adults or participating in more enjoyable activities outside of school, as functions maintaining SAPs (Kearney, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e). Later, Knollman et al (2019) equalled the function with the reason for SAP, such as internalizing symptoms, family or school context. The association between symptoms and functions generally appears strong (Knollmann et al., \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e), however, it's theoretically possible for them to diverge. For instance, a young person might suffer substantial symptoms of depression, but having problems with parents could be the underlying reason (i.e., function) for their school absence. Maintaining the difference between symptom and function may give further insight into how adolescents perceive their situation, and in a previous study, some differences were found between symptom and function in analyses on how adolescents with ADHD perceived their SAPs (Niemi et al., 2023).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLoneliness and ostracism\\u003c/h2\\u003e \\u003cp\\u003eLoneliness can be described as a discrepancy between actual and desired feelings of belonging, companionship and social acceptance (Favotto et al., \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Stoeckli, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e2009\\u003c/span\\u003e; Weiss, \\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e1973\\u003c/span\\u003e). Loneliness is known to activate behavioral, cognitive and emotional maladaptive processes, leading to a vicious cycle in which the child is not given the opportunity to practice important social skills in peer interactions and, thus, cannot correct dysfunctional perceptions of oneself and others (Qualter et al., \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e). A wide range of negative concomitants, such as anxiousness, social anxiety, depression, self-harm, suicide attempts, school drop-out and lower perceived general health have been linked with continuous feelings of loneliness during childhood and adolescence (S. Cacioppo et al., \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e; Heinrich \\u0026amp; Gullone, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e2006\\u003c/span\\u003e). It is also notable that increasing levels of loneliness among adolescents has been reported worldwide, with a particularly steep increase in the last decade (Twenge et al., \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eA related concept to loneliness is ostracism, which has been defined as the experience or perception of being intentionally kept apart from other people either psychologically (e.g., being ignored) or physically (e.g., social isolation) (Arslan \\u0026amp; Yıldırım, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e; Williams, \\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e). Perceived by the victim as an insidious form of social aggression, experiences of ostracism has been found to activate social pain reactions in the brain (Macdonald \\u0026amp; Leary, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e2005\\u003c/span\\u003e), and if prolonged, to have adverse consequences on the person´s well-being and health, including e.g. increased risk for psychiatric disorders, impaired immune functioning and even the risk for radicalization and violence (Baumeister et al., \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e2005\\u003c/span\\u003e; Williams, \\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e). In the school setting, ostracism is often referred to as indirect aggression, peer victimization, social exclusion or rejection.\\u003c/p\\u003e \\u003cp\\u003eDespite the strong overlap between the two concepts of social outsiderhood, loneliness and ostracism may be viewed as unique concepts with different operationalizations. Ostracism is used to describe the social context or the behaviors of the people surrounding the individual, whereas loneliness refers to the inner experience of the individual.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eThe association between SAP, loneliness, ostracism, and internalizing symptoms\\u003c/h3\\u003e\\n\\u003cp\\u003eA few studies have examined the association between ostracism, feeling lonely at school and being absent from school, generally finding a significant association between them (Egger et al., \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e; Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e; Leduc et al., \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). In a recent study by Kiuru et al (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e) the highest prevalence for school absence due to truancy, sickness or other reasons, as well as internalized and externalized problems and intentions for school dropout was found among the adolescents who had chronical feelings of being ostracized or excluded by their peers. Also, compared to the adolescents with no peer problems, the adolescents with chronic feelings of loneliness generally had more absence from school, and/or internalized or externalized symptoms. Internalized symptom increased in middle school, especially among students with profiles of high and increasing social loneliness (Kiuru et al., \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eFurther, studies have linked internalizing symptoms, such as depression and anxiety, to both school absence (Finning, Ukoumunne, Ford, Danielson-Waters, et al., \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Finning, Ukoumunne, Ford, Danielsson-Waters, et al., \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e), as well as loneliness (Gijzen et al., \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e; Mullarkey et al., \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) and ostracism (Stillman et al., \\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e2009\\u003c/span\\u003e). Besides the risk posed by loneliness and ostracism as causes of school absenteeism (Kearney 2022), students who frequently miss school tend to encounter challenges in social interactions, particularly in the realms of forming and maintaining friendships (Carroll et al., \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e; Egger et al., \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e; Wilson et al., \\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e), and therefore experience higher levels of loneliness (Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e; Place et al., \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e2002\\u003c/span\\u003e). Bidirectional causality is thus suggested, as there is a possibility that depression and anxiety can contribute to school absences and social outsiderhood, and conversely, that school absence, loneliness, and ostracism might lead to the development of depression and anxiety. In the longitudinal study by Kiuru et al. (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e) social outsiderhood preceeded internalizing symptoms. However, up until now, no research has delved into the potential role of symptoms related to depression and anxiety as mediators in the connection between loneliness and school absenteeism.\\u003c/p\\u003e\\n\\u003ch3\\u003eLoneliness and Ostracism According to Type of SAP\\u003c/h3\\u003e\\n\\u003cp\\u003eWhile the general association between SAP and maladaptive functioning and ill-health is well established, the four types of SAP (emotion-based absence, truancy, school withdrawal, and school exclusion), have also been associated with different risk factors and consequences (reviewed in Heyne et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). Below, we will shortly review findings on type of SAP and loneliness and ostracism.\\u003c/p\\u003e \\u003cp\\u003eThe first type, emotion-based absence (EBSA) has been connected to social isolation (Granell de Aldaz et al., \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e1987\\u003c/span\\u003e; Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e), especially in middle school (Granell de Aldaz et al., \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e1987\\u003c/span\\u003e; Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e). EBSA has been linked to socially withdrawn temperament, anxiousness, as well as poor interpersonal skills (Carpentieri et al., n.d.). Furthermore, comparing anxious children who were attending school, with anxious non-attenders, Ingul et al. (2013) found that school attenders had more friends, but also that non-attenders had more severe psychiatric problems, comorbid behavioral problems and negative personality traits (Ingul \\u0026amp; Nordahl, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e2013\\u003c/span\\u003e). Arguably, EBSA could be related to both feeling lonely, having few friends, as well as being ostracized, when compared to youth not reporting EBSA.\\u003c/p\\u003e \\u003cp\\u003eFor the second type, truancy (T), a qualitative study found that truant youth reported feeling as “strangers” in the classroom, and having poor peer relationships within school, while at the same time having friendships with other truant youth outside of school (Strand, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e2014\\u003c/span\\u003e). In two quantitative studies by the same research group, an association was found between social isolation and truancy in one of the studies (Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003eb), but not in the other (Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e). However, a number of studies report bullying victimization and perpetration among truant youth, implying difficulties in the social sphere (Alanko et al., \\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e; Havik et al., \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFor the third type, school withdrawal (SW), the association to loneliness or ostracism has not been established directly, but it has been noted, for instance, that the group of SW students that withdraw from school in order to care for a family member or close person may experience consequences on their social life due to the caretaking (Casu et al., \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e; Leu \\u0026amp; Becker, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e2017\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe fourth type of SAP, school exclusion (SE), has been linked to behavioral problems (Heyne et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). Students with behavioral problems often also experience problems in peer relationships (Schwartz-Mette et al., \\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e), and difficulties in school (Greene et al., \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e2002\\u003c/span\\u003e), as well as increased comorbidities such as anxiety disorders, mood disorders and language disorder (Greene et al., \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e2002\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eWhile there is various evidence of a connection between different types of SAP and loneliness and ostracism, no study to date has explicitly compared these connections within the same sample to disentangle the differences in experienced social outsiderhood between the types.\\u003c/p\\u003e\\n\\u003ch3\\u003eAims of the present study\\u003c/h3\\u003e\\n\\u003cp\\u003eThe aim of the present study was to examine the relationship between school attendance problems, social outsiderhood (loneliness and ostracism), and internalizing symptoms. Specifically, the study seeks to:\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eInvestigate the associations between school absence, internalizing symptoms and feelings of loneliness and ostracism.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eExplore how different types of school attendance problems (emotion-basedabsence, truancy, school withdrawal and school exclusion) relate to social outsiderhood.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eBased on previous research, our hypotheses were: H1a: Loneliness and ostracism are associated with number of days absent from school. H1b: The relationship between loneliness/ostracism and school absenteeism is mediated by internalizing symptoms. H2: Different types of school attendance problems (e.g., emotion-based absence, truancy, school withdrawal, and school exclusion) are associated with loneliness and ostracism.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"METHOD\",\"content\":\"\\u003cp\\u003e2.1 Participants, Sampling, and Process\\u003c/p\\u003e\\u003cp\\u003eSurvey data were collected from 2,137 youths. Data from 271 youths were excluded due, for example, to lack of consent, implausible reported age, and missing responses on the relevant study variables. After this, the sample comprised 1,866 youths. The average age was 14.95 years (\\u003cem\\u003eSD\\u003c/em\\u003e = 0.86). Participant gender was male (44.4%), female (48.9%), or missing (6.6%). The respondents reported on their parent’s highest educational level: 45% reported university or higher education, 26% upper secondary school or vocational studies, 3% on comprehensive school or equivalent and 0.9% none of the above or unknown, the rest having no answer (25.9%). Almost three quarters (72%) lived with both parents, 12% interchangeably with two parents, 9% with one parent, 0.6% in residential child care and 0.6% with other arrangements.\\u003c/p\\u003e\\u003cp\\u003eThe current study is based on data from the project ‘School Absence in Finland’ (described in Niemi et al., 2022). Participants were recruited by a two-step process. First, school principals and teachers were contacted with information about the study, and an invitation to participate in an online seminar on school absenteeism. Information about the study, and the invitation to the seminar was shared by email as well as via social media by teacher organizations and various Facebook groups for school professionals. The seminar was conducted in January 2021 and included, in addition to lectures about school absenteeism, information about the upcoming study. A total of 15 upper primary schools, all located in southern and western Finland, decided to participate in the project. Next, participating schools emailed parents with information about the study and to gain consent for their child’s participation. In accordance with the Finnish guidelines on research integrity (TENK), parents of youths below 15 years were asked to complete an informed consent for their child’s participation in the study. In addition, all youths provided informed written consent at the time of data gathering. Survey data were collected from youths during school time, in May 2021. A research assistant or teacher was present in class during the data collection, so that they could clarify questions and help if technical assistance was needed. To obtain data from persistently absent students, school personnel contacted absent students, went to their house if needed, and filled in the questionnaire with the students, if the student needed help. In total, 42 responses were collected this way.\\u003c/p\\u003e\\u003cp\\u003e The study was approved by the research ethics committee of Åbo Akademi University (2020/06/26).\\u003c/p\\u003e\\u003cp\\u003e2.2 Measures\\u003c/p\\u003e\\u003ch3\\u003e2.2.1 Absence from School\\u003c/h3\\u003e\\u003cp\\u003eTo assess absence from school, participants were asked to estimate how many days they had been absent from school during the prior 12 school weeks, for whatever reason. Responses were given on a scale from 1–6, where 1 = Not at all, 2 = Sometimes (up to 4 days), 3 = Often (5–12 days absent), 4 = Very often (13–36 days absent), 5 = Mostly (37–48 days absent), and 6 = Always (more than 48 days absent). This item is included in the ISAP questionnaire (see below).\\u003c/p\\u003e\\u003ch2\\u003e2.2.2 Typology of School Attendance Problems\\u003c/h2\\u003e\\u003cp\\u003eTo assess different types of SAP, definitions of types according to Heyne et al. (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e) were provided (see Appendix 1). All respondents, regardless of amount of absence, could choose one or several options among the provided descriptions to describe their own SAP. Participants could also choose not to select any type of SAP. Each typological group consisted of yes-replies to the specific item. The control group consisted of those with a no-response to the typological item. This means, that in the control group, some participants could have indicated another type of SAP. This choice was due to the low number of yes-responses to the typological questions.\\u003c/p\\u003e\\u003ch3\\u003e2.2.3 Loneliness and Ostracism\\u003c/h3\\u003e\\u003cp\\u003eTo assess loneliness and ostracism, participants were administered the Inventory of School Attendance Problems (ISAP; Knollmann et al., \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). The questionnaire was constructed as a screening tool for identifying problems linked to emerging and existing SAPs. The ISAP contains 13 symptom subscales (ISAP-S) and13 function subscales (ISAP-F). Questions are presented on the same line, so that the first part relates to the symptoms and the second to the impact (= function) the symptoms hold on absence. Factor structure, convergent and divergent validity, as well as internal consistency of the subscales has been found to be adequate or good, in previous studies on the same sample (Laine \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e), or different samples (Knollman et al., 2019, Strömbeck et al. 2023).\\u003c/p\\u003e\\u003cp\\u003eIn the present study, we used two two-part items, measuring the symptoms of loneliness or ostracism, and the function these symptoms hold on absence. Participants were asked to rate, on a 4-point Likert scale (from 1 = never to 4 = most of the time), to what extent they agreed with the statements “Before or at school I feel excluded by my classmates” (ostracism) and “Before or at school I feel unhappy because I don’t have friends at school” (loneliness). To assess the function of loneliness and ostracism, the same descriptions were used, and participants indicated on a similar 4-pont Likert scale to what extent they experienced that the symptoms impacted school attendance.\\u003c/p\\u003e\\u003ch3\\u003e2.2.4 Internalizing Symptoms\\u003c/h3\\u003e\\u003cp\\u003eTo assess internalizing symptoms, participants completed the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ; (Goodman, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e1997\\u003c/span\\u003e). The items were answered on a 3-point Likert scale from 0 (not true) to 2 (certainly true), which yielded a summary score ranging from 0 to10. Cronbach’s alpha for the Emotional symptoms’ subscale was acceptable, \\u003cb\\u003eα\\u003c/b\\u003e = .77.\\u003c/p\\u003e\\u003ch2\\u003e2.3 Data Analysis\\u003c/h2\\u003e\\u003cp\\u003eAll data preparation and analyses were performed in R version 4.2.0. The following R packages were used for data analysis and plotting: \\u003cem\\u003etidyverse\\u003c/em\\u003e (data cleaning; Wickham et al., \\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e), \\u003cem\\u003elavaan\\u003c/em\\u003e (mediation analysis; Rosseel, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e2012\\u003c/span\\u003e) and \\u003cem\\u003epsych\\u003c/em\\u003e (significance testing of correlation coefficients; Revelle, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e). Analyses were independent t-tests, Pearson product moment correlations and mediation models.\\u003c/p\\u003e\\u003cp\\u003e2.4 Transparency and openness\\u003c/p\\u003e\\u003cp\\u003eMaterials and analysis code for this study are available upon request from the first author.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.1. Descriptive Statistics of Internalizing Symptoms, Loneliness and Ostracism, and Gender Differences\\u003c/b\\u003e\\u003c/h2\\u003e \\u003cp\\u003eAmong the respondents, 54.3% reported absence from school at least once during the last 12 weeks. Girls reported more absence than boys (girls: \\u003cem\\u003eM\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1.96, \\u003cem\\u003eSD\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.92, boys \\u003cem\\u003eM\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1.82, \\u003cem\\u003eSD\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.87, \\u003cem\\u003et\\u003c/em\\u003e(1607.8)\\u0026thinsp;=\\u0026thinsp;3.15, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.002, \\u003cem\\u003ed\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.16). Mean level of internalizing symptoms was relatively low, however, more internalizing symptoms were reported by girls (\\u003cem\\u003eM\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;4.15, \\u003cem\\u003eSD\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;2.50) than boys (\\u003cem\\u003eM\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;2.20, \\u003cem\\u003eSD\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;2.12, \\u003cem\\u003et\\u003c/em\\u003e(1552.8)\\u0026thinsp;=\\u0026thinsp;16.61, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, \\u003cem\\u003ed\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.84).\\u003c/p\\u003e \\u003cp\\u003eRespondents could indicate whether they experienced loneliness and ostracism (symptom), and in addition, if this impacted their absence from school (=\\u0026thinsp;function, see Appendix 2). In total, 19% reported experiencing loneliness and 30% reported experiencing ostracism. Both symptom and function of loneliness was reported by 8%, and ostracism by 11%. In other words, about one in ten of the students both felt lonely or ostracized at school and felt that this impacted their school attendance\\u003c/p\\u003e \\u003cp\\u003eWhen comparing mean levels of loneliness and ostracism, the differences were not statistically significant, neither for symptom, nor function (See Appendix 3), when the participant had reported a score higher than one on the scale (range 1\\u0026ndash;4). The results indicate that boys and girls experience similar levels of loneliness and ostracism and that loneliness and ostracism affect their school attendance in a similar way. One of the analyses was close to significant, implying that girls more often see ostracism as a reason for not attending school than boys.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.2. Correlations between symptoms of internalizing problems, loneliness, ostracism, and school absence\\u003c/h2\\u003e \\u003cp\\u003eThe correlations between loneliness and ostracism were large (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Loneliness and ostracism correlated moderately with internalizing symptoms, and to a small degree with days absent.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eBivariate correlations between study variables, separate for boys and girls\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1. Ostracism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e.\\u003cb\\u003e59\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2. Loneliness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e.\\u003cb\\u003e68\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e3. Internalizing symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e4. School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e.14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003cem\\u003eNote.\\u003c/em\\u003e Correlations for boys below the diagonal, correlations for girls above the diagonal. All correlations are significant at \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.05. Bolded numbers indicate significant differences in correlation for boys and girls at \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003e3.3. The mediating role of internalizing symptoms for the effect of loneliness and ostracism on school absence\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe direct effects were modeled in a linear regression, both symptoms of ostracism and loneliness had significant direct effects on missed school days (β\\u0026thinsp;=\\u0026thinsp;0.08, \\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;.020 and β\\u0026thinsp;=\\u0026thinsp;0.07, \\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;.036 respectively).\\u003c/p\\u003e \\u003cp\\u003eA saturated, just-identified path model was fit to estimate if the effect of symptoms of loneliness and ostracism on days absent were mediated by internalizing problems. All reported regression coefficients are standardized. The complete path model can be found in Fig.\\u0026nbsp;1.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eFigure 1\\u003c/b\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePath Model of Symptoms\\u003c/h2\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eNote\\u003c/strong\\u003e \\u003cp\\u003eStandardized estimates of the path model. *** \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe results indicated that being ostracized had a stronger predictive effect on having more internalized problems compared to loneliness. The indirect effect of ostracism on school absence was β\\u0026thinsp;=\\u0026thinsp;0.05, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001 and of loneliness on days absent β\\u0026thinsp;=\\u0026thinsp;0.02, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.003, implying no or extremely low meaningful effects.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePath model parameter estimates symptoms\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePath\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eB\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSE\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eBeta\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDirect effect\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOstracism \\u0026rarr; School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.301\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLoneliness \\u0026rarr; School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.065\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eInternalizing symptoms \\u0026rarr; School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOstracism \\u0026rarr; Internalizing symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLoneliness \\u0026rarr; Internalizing symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndirect effects\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOstracism \\u0026rarr; Internalizing symptoms \\u0026rarr; School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLoneliness \\u0026rarr; Internalizing symptoms \\u0026rarr; School absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u003cem\\u003eNote. N\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1,451. Goodness-of-fit: \\u003cem\\u003eR\\u003c/em\\u003e\\u003csup\\u003e\\u003cem\\u003e2\\u003c/em\\u003e\\u003c/sup\\u003e\\u003csub\\u003eSchool absence\\u003c/sub\\u003e = .04, \\u003cem\\u003eR\\u003c/em\\u003e\\u003csup\\u003e\\u003cem\\u003e2\\u003c/em\\u003e\\u003c/sup\\u003e\\u003csub\\u003eInternalizing symptoms\\u003c/sub\\u003e = .16.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.4 Typology of School Attendance Problem, Loneliness and Ostracism\\u003c/h2\\u003e \\u003cp\\u003eIn order to answer research question two, we explored how students classified their absence in terms of SAP typology. Most absences did not fall under any specific type, as the percentage reporting any of the four types of SAP was 14.8. In other words, most absences were likely unproblematic. Prevalence of types of SAPs, when participants had read the definition provided and checked if they agreed, were: Emotion-based absence (6.6%), Truancy (2.6%), School Withdrawal (3.9%), and School Exclusion (1.7%).\\u003c/p\\u003e \\u003cp\\u003eWelch\\u0026rsquo;s t-test were done to find if those who had a particular school absence typology differed on loneliness/ostracism from those who did not have the typology. Group comparisons can be found in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e. All comparisons of typologies were significant and had large effect sizes, indicating that any type of absence is associated with more loneliness/ostracism. The strongest association of typology with both ostracism and loneliness was school exclusion (\\u003cem\\u003ed\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1.04 and 0.91 respectively), although the effect sizes did not significantly differ based on bootstrapped confidence intervals.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eLoneliness and Ostracism according to SAP Typology\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTypology present\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTypology not present\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c7\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eGroup comparison\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eM (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eM (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003et\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003edf\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ep\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ed [95% CI]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmotion-based absence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOstracism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.15 (1.05)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.35 (0.66)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e121,50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.91 [0.87, 1.44]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLoneliness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.81 (1.05)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.24 (0.60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e119,03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.67 [0.59, 1.19]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTruancy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOstracism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.09 (1.06)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.39 (0.71)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e45,20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.78 [0.58, 1.46]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLoneliness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.78 (1.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.27 (0.64)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e45,13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.61 [0.36, 1.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSchool withdrawal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOstracism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.14 (1.02)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.38 (0.70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5.94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e67,78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.87 [0.73, 1.46]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLoneliness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.74 (0.93)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.26 (0.64)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e67,82\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.60 [0.42, 1.12]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSchool exclusion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOstracism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.37 (1.11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.40 (0.71)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26,38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.04 [0.77, 1.94]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLoneliness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.08 (1.08)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.27 (0.64)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.76\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24,29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.91 [0.62, 1.93]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003eNote. N\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1518 for Ostracism (ISAP 22) and \\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1508 for Loneliness (ISAP 26) due to dropout. CI\\u0026thinsp;=\\u0026thinsp;percentile bootstrapped confidence interval using 1000 samples, LL\\u0026thinsp;=\\u0026thinsp;lower limit and UL\\u0026thinsp;=\\u0026thinsp;upper limit. Typology based on responses to description of the SAP (present\\u0026thinsp;=\\u0026thinsp;yes, not present\\u0026thinsp;=\\u0026thinsp;no).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThe present study aimed to explore the relationships between school absences, internalizing symptoms and social outsiderhood among adolescents. All three variables were associated. Furthermore, internalizing symptoms were found to mediate the association between social outsiderhood and school absence. In addition, the aim was to explore how different SAP types were related to social outsiderhood. All four types of school attendance problems (SAPs) were linked to experiences of ostracism and loneliness. Thus, the findings supported all proposed hypotheses (H1a, H1b, and H2).\\u003c/p\\u003e \\u003cp\\u003eBoth ostracism and loneliness were significantly associated with school absenteeism (H1a), and internalizing symptoms mediated this relationship (H1b). This finding aligns with a robust body of literature suggesting that social exclusion is a precursor of internalizing symptoms such as depression and anxiety (Mullarkey et al., \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). For instance, in a longitudinal study, increased internalizing symptoms were detected in middle school, especially among those students with profiles of high and increasing social loneliness (Kiuru et al., \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e). The moderate-sized correlations observed in our data may also be understood in terms of a bidirectional relationship between social exclusion and internalizing symptoms, reinforcing the theoretical framework that social isolation exacerbates emotional distress, and even neural pain reactions (J. T. Cacioppo et al., \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2006\\u003c/span\\u003e; Macdonald \\u0026amp; Leary, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e2005\\u003c/span\\u003e) while individuals experiencing internalizing symptoms may also be more prone to perceiving or experiencing social exclusion (Beeson et al., \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e; Finning, Ukoumunne, Ford, Danielsson-Waters, et al., \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eSubsequent analysis aimed to determine whether the associations between loneliness, ostracism, and school absenteeism were direct or mediated by internalizing symptoms. While both symptoms of ostracism and loneliness were associated with days absent in the linear regressions, the path model showed that these effects were mediated by internalizing symptoms. The results suggest that while loneliness and ostracism are important precursors to absenteeism, their impact is indirect, operating primarily through the development of internalizing symptoms such as anxiety and depression.\\u003c/p\\u003e \\u003cp\\u003eInternalizing symptoms may affect youth well-being on a functional level, for some, leading to difficulties in attending school. The symptoms disrupt daily functioning by generating intense emotional and psychological distress that interferes with a student\\u0026rsquo;s ability to engage in routine activities, including academic responsibilities (Avenevoli et al., \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e2008\\u003c/span\\u003e). For example, anxiety can manifest as overwhelming fears or worries about social interactions or academic performance, making the school environment feel intimidating and unsafe (Egger et al., \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2003\\u003c/span\\u003e). This heightened emotional state can lead to avoidance behaviors, where students may choose to stay home to escape the perceived stress of attending school (Kearney, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e). Similarly, depression can sap motivation, energy, and concentration, making it difficult for students to complete schoolwork, participate in classroom activities, or even find the strength to get out of bed (Kessler et al., \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e2012\\u003c/span\\u003e). As internalizing symptoms escalate, students may struggle with a sense of hopelessness or worthlessness, which further isolates them from their peers and the learning environment (Rubin et al., \\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e2009\\u003c/span\\u003e). The results of the path model, which showed that the effects of loneliness and ostracism on absenteeism were mediated by internalizing symptoms, underscored how deeply these emotional challenges can impair youth\\u0026rsquo;s functional capacity, making regular school attendance difficult or even impossible.\\u003c/p\\u003e \\u003cp\\u003eThe distinct relationships observed between loneliness, ostracism, and internalizing symptoms suggest that these experiences may have unique emotional consequences, highlighting the importance of distinguishing them as qualitatively different phenomena. While both loneliness and ostracism can lead to internalizing symptoms, the mechanisms by which they impact individuals may differ. Ostracism, as an explicit form of exclusion, involves a clear, direct rejection by others, which may trigger more immediate and acute psychological distress. This overt social exclusion could evoke a stronger emotional response because it directly challenges an individual's sense of belonging and acceptance (Macdonald \\u0026amp; Leary, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e2005\\u003c/span\\u003e). The experience of ostracism may also be more difficult to rationalize or dismiss, leading to heightened feelings of shame, rejection, and even anger (Williams, \\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e2007\\u003c/span\\u003e). In contrast, loneliness is a broader, more subjective experience characterized by a perceived lack of meaningful connections, even in the absence of explicit exclusion. It is possible to feel lonely even while surrounded by others, making it a more generalized and diffuse emotional state that may build gradually over time (Cacioppo et al., \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2006\\u003c/span\\u003e; Cacioppo et al., \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e2015\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eDespite these differences, the high correlation between loneliness and ostracism suggests significant overlap between the two constructs. Loneliness may often be a byproduct of ostracism, as individuals who are socially excluded are likely to experience feelings of isolation and disconnection. However, ostracism may exert a more immediate and powerful influence on behavior. Ostracism's direct link to school absence, as demonstrated by Kiuru et al. (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e), suggests that being actively excluded from peer interactions may create a hostile or unwelcoming school environment, prompting students to disengage or avoid attendance. In contrast, loneliness, while emotionally distressing, may not have as strong of an impact on school absence because it is less tied to specific social dynamics and may not immediately compel avoidance behaviors. Ultimately, these findings support the idea that ostracism and loneliness, while related, operate differently in their influence on emotional well-being and school attendance.\\u003c/p\\u003e \\u003cp\\u003eAll four types of school attendance problems (SAPs) were linked to experiences of ostracism and loneliness (Hypothesis 2), with those reporting school exclusion exhibiting the highest levels of both. The associations between each type of school attendance problem (SAP)\\u0026mdash;emotion-based absence, truancy, school withdrawal, and school exclusion\\u0026mdash;and experiences of ostracism and loneliness were significant. This indicates that all respondents with problematic school absence, regardless of the type, also struggled with social relationships, manifested here as loneliness or ostracism. These social challenges could be both a cause and a consequence of their absenteeism. Regardless of the direction of causality, it is crucial to address the social relationships of young individuals facing attendance issues. The association between social exclusion and attendance issues align with models of school engagement that emphasize the importance of belongingness and peer acceptance (Allen et al., \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2018\\u003c/span\\u003e; Caldwell et al., \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFurthermore, the negative impact of these emotions, compounded by the shame often associated with being unable to attend school, may make it difficult for students to continue at, or return to, their original school. This could explain why many students with complex SAPs opt to change schools as part of their effort to return, potentially seeking a fresh start in a new social environment (Kearney, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e2016\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eParticipants who reported school exclusion also tended to report higher levels of loneliness and ostracism. This finding is novel, as school exclusion has not previously been examined in a community study of adolescents, nor has its association with loneliness and ostracism been established. It is perhaps unsurprising that students experiencing school exclusion struggle the most, as they are directly and actively excluded by the school. Importantly, such exclusion does not necessarily stem from disciplinary actions but may reflect instances where the school unfairly excludes the student (Heyne et al., \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). Heyne et al. (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e, p. 16) outline that SE as problematic school-based decision making may revolve around: \\u0026ldquo;the use of disciplinary measures; the allocation of resources for students in need; and the need to satisfy school-based performance requirements\\u0026rdquo;.\\u003c/p\\u003e \\u003cp\\u003eA notable finding, beyond our research questions, was that 27% of participants reported feeling lonely, and 30% reported experiencing ostracism. Among them, loneliness was cited as the reason for absence by 8% and ostracism by 11%. These findings suggest that loneliness and ostracism are impactful enough to disrupt daily functioning, raising concerns about the number of students who are affected by the emotional and functional challenges posed by social outsiderhood.\\u003c/p\\u003e \\u003cp\\u003eGender differences were observed across the entire sample, with more girls reporting feelings of loneliness and ostracism. This finding is consistent with previous Finnish studies (Lyyra et al., \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e), highlighting the particular vulnerability of Finnish girls to social exclusion, especially in the form of ostracism. However, among participants who reported experiencing symptoms, there were no significant gender differences in the intensity of loneliness or ostracism. This suggests that when such symptoms are present, both boys and girls experience them at similar levels. Additionally, there were no gender differences in the frequency with which these symptoms impacted school attendance, indicating that the functional consequences of loneliness and ostracism on school absenteeism are comparable between genders.\\u003c/p\\u003e \\u003cp\\u003eFuture studies\\u003c/p\\u003e \\u003cp\\u003eGiven the cross-sectional nature of this study, causal inferences cannot be drawn. Future research should employ longitudinal designs to explore the temporal relationships between loneliness, ostracism, internalizing symptoms, and school absenteeism. This would help to determine whether feelings of ostracism and loneliness are consequences of school absence or if they contribute to the development of absenteeism over time. The current findings suggest that school attendance problems might evolve from social exclusion and lack of friendships, which can lead to internalizing symptoms and reduced motivation or ability to attend school. Therefore, interventions aiming to improve school attendance should focus on enhancing student relationships and fostering a supportive school community, as these factors are crucial for maintaining attendance. It's worth noting that this situation may differ in clinical samples, where higher symptom levels might be more common.\\u003c/p\\u003e \\u003cp\\u003eFuture studies should consider the experiences of groups at risk to experience social outsiderhood or internalizing symptoms, such as ethnic, sexual, and gender identity minorities, students with learning difficulties or physical disability, to provide a more comprehensive understanding of school-related issues across different groups at risk.\\u003c/p\\u003e \\u003cp\\u003eStrengths and limitations\\u003c/p\\u003e \\u003cp\\u003eA key strength of this study is its large sample size from Finnish schools, which enhances the generalizability of the findings. However, a limitation is the operationalization of loneliness and ostracism. The measures used are indirect, which may impact the results and their comparability with other studies. The items focused on feelings of unhappiness due to a lack of friends and social exclusion within the school context, which aligns with the study's main aim. However, the impact of loneliness or exclusion outside of school on overall well-being and school attendance remains unclear. Additionally, the measure of loneliness did not explicitly use the term \\\"lonely,\\\" which could both mitigate stigma but also affect validity and comparability. It is important to acknowledge the potential for self-report bias in this study, particularly given the adolescent population. Adolescents may have varying levels of self-awareness and may be influenced by social desirability or fear of stigma when reporting sensitive issues such as loneliness, ostracism, and internalizing symptoms. Self-report measures rely on individuals\\u0026rsquo; perceptions and willingness to disclose their experiences, which can introduce biases affecting the accuracy of the data. Furthermore, memory bias may have affected responding to the question about number of days absent from school. In addition, our questionnaire was lengthy, which might have affected the motivation to respond.\\u003c/p\\u003e \\u003cp\\u003eData collection occurred during the COVID-19 pandemic, which likely exacerbated feelings of social exclusion and internalizing symptoms, as indicated by previous research (Racine et al., 2021), and may have contributed to increased school absenteeism.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThis study established significant associations between loneliness, ostracism, internalizing symptoms, and school absenteeism, applicable to all types of school attendance problems: emotion-based absence, truancy, school withdrawal, and school exclusion. The highest levels of ostracism and loneliness were reported by those experiencing school exclusion. The relationship between loneliness, ostracism, and school absenteeism was mediated by internalizing symptoms, highlighting the interplay of these factors. Future research should further investigate these dynamics and explore effective interventions to support students in overcoming social and emotional challenges, ultimately promoting better attendance and overall well-being.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval\\u003c/strong\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the research ethics committee of \\u0026Aring;bo Akademi University (2020/06/26).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors whose names appear on the submission\\u003c/p\\u003e\\n\\u003cp\\u003e1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e2) drafted the work or revised it critically for important intellectual content;\\u003c/p\\u003e\\n\\u003cp\\u003e3) approved the version to be published; and\\u003c/p\\u003e\\n\\u003cp\\u003e4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe first author was funded by C.G. Sundell foundation. XX was funded by Strategic Research Council 352648.\\u003c/p\\u003e\\n\\u003cp\\u003eThe present study is also part of the EDUCA Flagship project funded by the Research Council of Finland (#358924,\\u0026nbsp;#358947), for authors XX.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eData may be made available upon requests from the first author.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eAlanko K, Melander K, Ranta K, Engblom J, Kosola S (2023) \\u003cem\\u003eTime trends in adolescent school absences and associated bullying involvement between 2000 and 2019: A nationwide study\\u003c/em\\u003e [Preprint]. In Review. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.21203/rs.3.rs-2651595/v1\\u003c/span\\u003e\\u003cspan address=\\\"10.21203/rs.3.rs-2651595/v1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAllen K, Kern ML, Vella-Brodrick D, Hattie J, Waters L (2018) What Schools Need to Know About Fostering School Belonging: A Meta-analysis. Educational Psychol Rev 30(1):1\\u0026ndash;34. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s10648-016-9389-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10648-016-9389-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArslan G, Yıldırım M (2022) Psychological Maltreatment and Loneliness in Adolescents: Social Ostracism and Affective Experiences. Psychol Rep 125(6):3028\\u0026ndash;3048. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1177/00332941211040430\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/00332941211040430\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAvenevoli S, Knight E, Kessler RC, Merikangas KR (2008) Epidemiology of depression in children and adolescents. In \\u003cem\\u003eHandbook of depression in children and adolescents\\u003c/em\\u003e (pp. 6\\u0026ndash;32). The Guilford Press. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/978-1-4899-1510-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/978-1-4899-1510-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBaumeister RF, DeWall CN, Ciarocco NJ, Twenge JM (2005) Social exclusion impairs self-regulation. J Personal Soc Psychol 88(4):589\\u0026ndash;604. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1037/0022-3514.88.4.589\\u003c/span\\u003e\\u003cspan address=\\\"10.1037/0022-3514.88.4.589\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBeeson CML, Brittain H, Vaillancourt T (2020) The Temporal Precedence of Peer Rejection, Rejection Sensitivity, Depression, and Aggression Across Adolescence. Child Psychiatry Hum Dev 51(5). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003eArticle 5. https://doi.org/10.1007/s10578-020-01008-2\\u003c/span\\u003e\\u003cspan address=\\\"Article 5. 10.1007/s10578-020-01008-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBronfenbrenner U (1979) The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA (2006) Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychol Aging 21(1):140\\u0026ndash;151. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1037/0882-7974.21.1.140\\u003c/span\\u003e\\u003cspan address=\\\"10.1037/0882-7974.21.1.140\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT (2015) Loneliness: Clinical Import and Interventions. Perspect Psychol Science: J Association Psychol Sci 10(2):238\\u0026ndash;249. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1177/1745691615570616\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/1745691615570616\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCaldwell DM, Davies SR, Hetrick SE, Palmer JC, Caro P, L\\u0026oacute;pez-L\\u0026oacute;pez JA, Gunnell D, Kidger J, Thomas J, French C, Stockings E, Campbell R, Welton NJ (2019) School-based interventions to prevent anxiety and depression in children and young people: A systematic review and network meta-analysis. Lancet Psychiatry 6(12). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003eArticle 12. https://doi.org/10.1016/S2215-0366(19)30403-1\\u003c/span\\u003e\\u003cspan address=\\\"Article 12. 10.1016/S2215-0366(19)30403-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCarpentieri R, Iannoni ME, Curto M, Biagiarelli M, Listanti G, Andraos MP, Mantovani B, Farulla C, Pelaccia S, Grosso G, Speranza AM, Sarlatto C (n.d.). School Refusal Behavior: Role of Personality Styles, Social Functioning, and Psychiatric Symptoms in a Sample of Adolescent Help-Seekers. Clin Neuropsychiatry, \\u003cem\\u003e19\\u003c/em\\u003e(1), 20\\u0026ndash;28. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.36131/cnfioritieditore20220104\\u003c/span\\u003e\\u003cspan address=\\\"10.36131/cnfioritieditore20220104\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCarroll E, Ye K, McCoy S (2022) Educationally maintained inequality? The role of risk factors and resilience at 9, 13 and 17 in disabled young people\\u0026rsquo;s post-school pathways at 20. Ir Educational Stud 41(3):573\\u0026ndash;594 a9h\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCasu G, Hlebec V, Boccaletti L, Bolko I, Manattini A, Hanson E (2021) Promoting Mental Health and Well-Being among Adolescent Young Carers in Europe: A Randomized Controlled Trial Protocol. \\u003cem\\u003eInternational Journal of Environmental Research and Public Health\\u003c/em\\u003e, \\u003cem\\u003e18\\u003c/em\\u003e(4), 2045. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.3390/ijerph18042045\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph18042045\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEgger HL, Costello JE, Angold A (2003) School Refusal and Psychiatric Disorders: A Community Study. J Am Acad Child Adolesc Psychiatry 42(7):797\\u0026ndash;807. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1097/01.CHI.0000046865.56865.79\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/01.CHI.0000046865.56865.79\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFavotto L, Michaelson V, Pickett W, Davison C (2019) The role of family and computer-mediated communication in adolescent loneliness. PLoS ONE 14(6):e0214617. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1371/journal.pone.0214617\\u003c/span\\u003e\\u003cspan address=\\\"10.1371/journal.pone.0214617\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFinning K, Ukoumunne OC, Ford T, Danielson-Waters E, Shaw L, Jager IRD, Stentiford L, Moore DA (2019) \\u003cem\\u003eReview: The association between anxiety and poor attendance at school \\u0026ndash; a systematic review\\u003c/em\\u003e. 12\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFinning K, Ukoumunne OC, Ford T, Danielsson-Waters E, Shaw L, De Jager R, Stentiford I, L., Moore DA (2019) The association between child and adolescent depression and poor attendance at school: A systematic review and meta-analysis. J Affect Disord 245:928\\u0026ndash;938. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.jad.2018.11.055\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jad.2018.11.055\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGijzen MWM, Rasing SPA, Creemers DHM, Smit F, Engels RC, M. E, De Beurs D (2021) Suicide ideation as a symptom of adolescent depression. A network analysis. J Affect Disord 278:68\\u0026ndash;77. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.jad.2020.09.029\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jad.2020.09.029\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoodman R (1997) The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry Allied Discip 38(5):581\\u0026ndash;586. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1111/j.1469-7610.1997.tb01545.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1469-7610.1997.tb01545.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGranell de Aldaz E, Feldman L, Vivas E, Gelfand DM (1987) Characteristics of Venezuelan school refusers. Toward the development of a high-risk profile. J Nerv Ment Dis 175(7):402\\u0026ndash;407. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1097/00005053-198707000-00003\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/00005053-198707000-00003\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGreene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV (2002) Psychiatric Comorbidity, Family Dysfunction, and Social Impairment in Referred Youth With Oppositional Defiant Disorder. Am J Psychiatry 159(7):1214\\u0026ndash;1224. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1176/appi.ajp.159.7.1214\\u003c/span\\u003e\\u003cspan address=\\\"10.1176/appi.ajp.159.7.1214\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHavik T, Bru E, Ertesv\\u0026aring;g SK (2015) Assessing Reasons for School Non-attendance. Scandinavian J Educational Res 59(3):316\\u0026ndash;336. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/00313831.2014.904424\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/00313831.2014.904424\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHeinrich LM, Gullone E (2006) The clinical significance of loneliness: A literature review. Clin Psychol Rev 26(6):695\\u0026ndash;718. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.cpr.2006.04.002\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.cpr.2006.04.002\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHeyne D, Gren-Landell M, Melvin G, Gentle-Genitty C (2019) Differentiation Between School Attendance Problems: Why and How? Cogn Behav Pract 26(1):8\\u0026ndash;34. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.cbpra.2018.03.006\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.cbpra.2018.03.006\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIngul JM, Nordahl HM (2013) Anxiety as a risk factor for school absenteeism: What differentiates anxious school attenders from non-attenders? Ann Gen Psychiatry 12(1):25\\u0026ndash;33 a9h\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKearney CA (2007) Forms and functions of school refusal behavior in youth: An empirical analysis of absenteeism severity. J Child Psychol Psychiatry Allied Discip 48(1):53\\u0026ndash;61. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1111/j.1469-7610.2006.01634.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1469-7610.2006.01634.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKearney CA (2016) Managing School Absenteeism at Multiple Tiers: An Evidence-Based and Practical Guide for Professionals. Oxford University Press\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKearney CA, Graczyk PA (2020) A multidimensional, multi-tiered system of supports model to promote school attendance and address school absenteeism. Clin Child Fam Psychol Rev 23(3):316\\u0026ndash;337. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s10567-020-00317-1\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10567-020-00317-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, He J, Koretz D, McLaughlin KA, Petukhova M, Sampson NA, Zaslavsky AM, Merikangas KR (2012) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 69(4):372\\u0026ndash;380. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1001/archgenpsychiatry.2011.160\\u003c/span\\u003e\\u003cspan address=\\\"10.1001/archgenpsychiatry.2011.160\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKiuru N, Salmela-Aro K, Laursen B, Vasalampi K, Beattie M, Tunkkari M, Junttila N (2024) Profiles of Loneliness and Ostracism During Adolescence: Consequences, Antecedents, and Protective Factors. Child Psychiatry Hum Dev. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s10578-024-01664-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10578-024-01664-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKnollmann M, Reissner V, Hebebrand J (2019) Towards a comprehensive assessment of school absenteeism: Development and initial validation of the inventory of school attendance problems. Eur Child Adolesc Psychiatry 28(3):399\\u0026ndash;414. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s00787-018-1204-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00787-018-1204-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLaine C (2023) The psychometric properties of the Inventory of school attendance problems in a Finnish sample. Unpublished Master's thesis. \\u0026Aring;bo Akademi University\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLeduc K, Tougas A-M, Robert V, Boulanger C (2022) School Refusal in Youth: A Systematic Review of Ecological Factors. Child Psychiatry Hum Dev. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s10578-022-01469-7\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10578-022-01469-7\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLeu A, Becker S (2017) A cross-national and comparative classification of in-country awareness and policy responses to \\u0026lsquo;young carers\\u0026rsquo;. J Youth Stud 20(6):750\\u0026ndash;762. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/13676261.2016.1260698\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/13676261.2016.1260698\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLyyra N, Junttila N, Tynj\\u0026auml;l\\u0026auml; J, Villberg J, V\\u0026auml;limaa R (2022) Loneliness, subjective health complaints, and medicine use among Finnish adolescents 2006\\u0026ndash;2018. Scand J Public Health 50(8) Article 8. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1177/14034948221117970\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/14034948221117970\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStrand M, A.-S (2014) School \\u0026ndash; no thanks \\u0026ndash; it ain\\u0026rsquo;t my thing\\u0026rsquo;: Accounts for truancy. Students\\u0026rsquo; perspectives on their truancy and school lives. Int J Adolescence Youth 19(2):262\\u0026ndash;277. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/02673843.2012.743920\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/02673843.2012.743920\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMacdonald G, Leary MR (2005) Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull 131(2). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003eArticle 2. https://doi.org/10.1037/0033-2909.131.2.202\\u003c/span\\u003e\\u003cspan address=\\\"Article 2. 10.1037/0033-2909.131.2.202\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMelvin GA, Heyne D, Gray KM, Hastings RP, Totsika V, Tonge BJ, Freeman MM (2019) The Kids and Teens at School (KiTeS) Framework: An Inclusive Bioecological Systems Approach to Understanding School Absenteeism and School Attendance Problems. \\u003cem\\u003eFrontiers in Education\\u003c/em\\u003e, \\u003cem\\u003e4\\u003c/em\\u003e. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.frontiersin.org/articles/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.frontiersin.org/articles/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3389/feduc.2019.00061\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/feduc.2019.00061\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMullarkey MC, Marchetti I, Beevers CG (2019) Using Network Analysis to Identify Central Symptoms of Adolescent Depression. J Clin Child Adolesc Psychology: Official J Soc Clin Child Adolesc Psychol Am Psychol Association Div 53(4):656\\u0026ndash;668. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/15374416.2018.1437735\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/15374416.2018.1437735\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. \\u003cem\\u003e48\\u003c/em\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePlace M, Hulsmeier J, Davis S, Taylor E (2002) The coping mechanisms of children with school refusal. J Res Special Educational Needs 2(2). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1111/j.1471-3802.2002.00167.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1471-3802.2002.00167.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. psyh\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eQualter P, Vanhalst J, Harris R, Van Roekel E, Lodder G, Bangee M, Maes M, Verhagen M (2015) Loneliness across the life span. Perspect Psychol Science: J Association Psychol Sci 10(2):250\\u0026ndash;264. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1177/1745691615568999\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/1745691615568999\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRevelle W (2015) Package \\u0026lsquo;Psych.\\u0026rsquo; \\u003cem\\u003eThe Comprehensive R Archive Network\\u003c/em\\u003e, December 12, 2023. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://cran.r-project.org/web/packages/psych/psych.pdf\\u003c/span\\u003e\\u003cspan address=\\\"https://cran.r-project.org/web/packages/psych/psych.pdf\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRosseel Y (2012) lavaan: An \\u003cem\\u003eR\\u003c/em\\u003e Package for Structural Equation Modeling. J Stat Softw 48(2). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.18637/jss.v048.i02\\u003c/span\\u003e\\u003cspan address=\\\"10.18637/jss.v048.i02\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRubin K, Coplan R, Bowker J (2009) Social Withdrawal in Childhood. Ann Rev Psychol 60:141\\u0026ndash;171. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1146/annurev.psych.60.110707.163642\\u003c/span\\u003e\\u003cspan address=\\\"10.1146/annurev.psych.60.110707.163642\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSchwartz-Mette RA, Shankman J, Dueweke AR, Borowski S, Rose AJ (2020) Relations of friendship experiences with depressive symptoms and loneliness in childhood and adolescence: A meta-analytic review. Psychol Bull 146(8):664\\u0026ndash;700. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1037/bul0000239\\u003c/span\\u003e\\u003cspan address=\\\"10.1037/bul0000239\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStillman TF, Baumeister RF, Lambert NM, Crescioni AW, DeWall CN, Fincham FD (2009) Alone and without purpose: Life loses meaning following social exclusion. J Exp Soc Psychol 45(4):686\\u0026ndash;694. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.jesp.2009.03.007\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jesp.2009.03.007\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStoeckli G (2009) The Role of Individual and Social Factors in Classroom Loneliness. J Educational Res 103(1):28\\u0026ndash;39. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1080/00220670903231169\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/00220670903231169\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTwenge JM, Haidt J, Blake AB, McAllister C, Lemon H, Le Roy A (2021) Worldwide increases in adolescent loneliness. J Adolesc 93:257\\u0026ndash;269. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.adolescence.2021.06.006\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.adolescence.2021.06.006\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWeiss RS (1973) \\u003cem\\u003eLoneliness: The experience of emotional and social isolation\\u003c/em\\u003e (pp. xxii, 236). The MIT Press\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWickham H, Averick M, Bryan J, Chang W, McGowan LD, Fran\\u0026ccedil;ois R, Grolemund G, Hayes A, Henry L, Hester J, Kuhn M, Pedersen TL, Miller E, Bache SM, M\\u0026uuml;ller K, Ooms J, Robinson D, Seidel DP, Spinu V, Yutani H (2019) Welcome to the Tidyverse. J Open Source Softw 4(43):1686. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.21105/joss.01686\\u003c/span\\u003e\\u003cspan address=\\\"10.21105/joss.01686\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWilliams KD (2007) Ostracism. Ann Rev Psychol 58(1):425\\u0026ndash;452. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1146/annurev.psych.58.110405.085641\\u003c/span\\u003e\\u003cspan address=\\\"10.1146/annurev.psych.58.110405.085641\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWilson SJ, Lipsey MW, Derzon JH (2003) The effects of school-based intervention programs on aggressive behavior: A meta-analysis. J Consult Clin Psychol 71(1):136\\u0026ndash;149. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1037/0022-006X.71.1.136\\u003c/span\\u003e\\u003cspan address=\\\"10.1037/0022-006X.71.1.136\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5402404/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5402404/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eInternalizing psychiatric symptoms and school absenteeism often co-occur. This study explores their detailed associations and examines whether internalizing symptoms (depression and anxiety) mediate the relationship between social outsiderhood (loneliness and ostracism) and school absence. It also investigates the links between various types of school absence (truancy, emotion-basedabsence, school withdrawal, and school exclusion) and experiences of loneliness and/or ostracism. Data were collected from 1,866 Finnish middle school adolescents (M age\\u0026thinsp;=\\u0026thinsp;14.95, SD\\u0026thinsp;=\\u0026thinsp;0.86). Findings indicate that both loneliness and ostracism are associated with school absenteeism, with internalizing symptoms serving as a mediator, however, with a low effect size. Students experiencing school exclusion reported the highest levels of social outsiderhood. These results underscore the importance of addressing students' social situations when assessing school absence and developing preventive interventions within the school context.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Association Between Social Outsiderhood and School Absence is Mediated by Internalizing Symptoms\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-11-25 08:14:57\",\"doi\":\"10.21203/rs.3.rs-5402404/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"505f8ea7-c306-4b15-b99b-0f0a5b008aca\",\"owner\":[],\"postedDate\":\"November 25th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-11-27T09:39:00+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-11-25 08:14:57\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5402404\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5402404\",\"identity\":\"rs-5402404\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}