Adolescent Internalizing Symptoms, School Experiences, and Attendance: Sex-Specific Within-Person Pathways

ABSTRACTObjective The directionality of longitudinal pathways between adolescent mental health, subjective school experiences and attendance is unclear, and the nature of sex differences is uncertain. This study aimed to disentangle reciprocal, within-person dynamics between internalizing symptoms and key school-related factors (attendance, relationships with staff, school belonging), and test for moderation by sex. Method Data were from three annual waves (2021-2023) of the #BeeWell study and linked administrative attendance records: N=25,506 English adolescents (aged 12-15) attending 154 schools. Multigroup Random-Intercept Cross-Lagged Panel Models examined within-person longitudinal pathways by sex. Results A robust 'child-driven' pathway was found for both sexes: increases in internalizing symptoms predicted later reductions in school belonging (βs=−.07 to −.13). This pattern extended to relationships with staff for boys (T2→T3, β=−.08) and school attendance for girls (T1→T2, β=−.09; specific to authorized absences). Sex-specific protective pathways also emerged: improved relationships with staff predicted reduced internalizing symptoms for boys (T2→T3, β=−.07), while increased school belonging predicted reduced internalizing symptoms for girls (T2→T3, β=−.07). Most pathways (19 of 24) operated equivalently across sexes. Notably, changes in attendance did not predict changes in internalizing symptoms for either sex. Conclusion Most within-person dynamics between internalizing symptoms and school-related factors do not vary by sex, but significant moderation was found for key protective and risk pathways. Results support tiered intervention: universal strategies strengthening subjective school experiences for all students, alongside targeted approaches leveraging enhancements in relationships with staff for boys, and school belonging for girls. Study registration information Longitudinal associations across school attendance, school belonging, relationships with staff, and internalising symptoms in early-to-middle adolescence: A developmental cascades investigation; https://doi.org/10.17605/OSF.IO/DKFW9