Network analysis of school absence: central symptoms and their functions.

Objective: School attendance problems (SAPs) often develop and persist through complex interactions among numerous influences. This study used network analysis to identify: (i) the most central symptoms reported by youths with SAPs; (ii) the most central functions underlying those symptoms; and (iii) the relationships among symptoms and among functions. Method: Self-reported symptoms and their functions were assessed via an online survey comprising the Inventory of School Attendance Problems. We analysed data from Finnish middle school students (M age = 14.9 years, range 12-17, gender: 40% male, 57% female, 3% other) reporting school absence of ≥10%. There were 349 responses for symptoms and 333 responses for functions. Network analysis was used to identify the most central symptoms and functions (nodes) along with the associations between different symptoms, and the associations between different functions (edges). Results: Results indicated complex networks among the symptoms and among the functions. Depression emerged as the descriptively most central node in both networks. In the symptoms network, it showed moderate links to Performance Anxiety, Aggression, and Social Anxiety. In the functions network, its strongest links were to School Aversion/Attractive Alternatives and Social Anxiety. Social Anxiety was also highly central in the functions network, with links to Agoraphobia/Panic and Problems with Peers. All 13 nodes were interlinked in both the symptoms and functions networks, reflecting widespread co-occurrence among symptoms and among functions. Conclusions: Depression's central position across both the symptom and function networks may make it a valuable intervention target, even when other symptoms are also salient.