Date of Award

Spring 5-2021

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Amy-Jane Griffiths PhD

Second Advisor

Kelly Kennedy PhD

Third Advisor

Michael Salce EdD


Students with school refusal behavior (SRB) often present complex cases that include variations of internalizing (anxiety and depression) and externalizing (opposition and defiance) mental health struggles. Historically, incongruent classification methods and terminology have hindered the progress of effectively or consistently assessing SRB. Consequently, practitioners face several obstacles in the process of identifying and understanding these students. Despite guidance from past literature, several questions about how SRB interacts with students' mental health are left unanswered. The present study used data from over 100,000 student responses on the California Healthy Kids Survey-Secondary Core Module. A review of attendance questions from this survey resulted in similar prevalence outcomes as other large surveys. Through additional analysis, select demographic variables (grade, gender, race/ethnicity, socioeconomic status) presented a significant relationship with attendance. These findings were supported by previous research with similar results. Further, Cross-sectional data from the Social-Emotional Health Survey-Secondary and Social-Emotional Distress Scale-Secondary was used to assess students' mental health. Together, these measures reflect a dual-factor approach to mental health that considers both subjective well-being and psychopathology. Responses to these mental health screeners were compared in groups of students based on the amount of school they reported missing or skipping. Findings indicated that students' subjective well-being and psychological distress significantly changed as they missed or skipped school more frequently. Substantially lower reports of subjective well-being and greater reports of psychological distress were found as students reported more frequent attendance problems. However, as students began skipping or cutting school once a month or more often in the past 12 months (twice a month, once a week, and more than once a week), there was no longer a statistically significant difference in their mental health. Student responses appeared to plateau as their SRB became more chronic or frequent. These critical findings provided a better understanding of this unique behavior and advanced evidence-based assessment practices for earlier identification of SRB. Considering subjective well-being, in addition to measuring psychopathology, was a crucial component to understanding changes in mental health for students with SRB. These findings have extensive implications for practice and future research.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.




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