When School Walls Meet Emotional Hurdles: A Cross-Sectional Study on Alexithymia and School Refusal in High Schools.

Alexithymia, the difficulty in recognizing and expressing emotions, can create significant challenges for students, contributing to anxiety and stress that predict school-refusal behaviors. This study explored how alexithymia and school refusal behaviors impact high school students' academic performance (grade point average; GPA), considering how gender, school type, and academic major play a role. Utilizing snowball sampling, 265 students with a mean age of 16.41( = 1.7) participated in the study online, completing the Perth Alexithymia Questionnaire (PAQ) and the School Refusal Assessment Scale-Revised (SRAS-R). Through statistical analyses, including path analysis, quasi-Bayesian mediation, and Hayes moderation, we found that alexithymia and GPA were associated. Also, school refusal behaviors, like avoiding social interactions or seeking tangible rewards, did not mediate this relationship but school refusal due to avoiding negative emotions positively predicted GPA. Students in STEM (science, technology, engineering, math) fields, known for their rigorous and less emotive curricula, showed higher levels of alexithymia. In contrast, public school students were more likely to skip school for external rewards. Female students had lower alexithymia scores and higher GPAs than males. Path analysis, in turn, revealed that studying in gifted school and F2 (escaping evaluative situations) showed the largest effect sizes. School refusal findings highlight the importance of tailored interventions: public schools' high F4 needs mentorship, peer support, and extracurriculars to counter socioeconomic refusal drivers. Also, embedding emotional literacy workshops into the curriculum, offering flexible attendance options, and fostering supportive environments with peer mentoring or teacher check-ins can counteract emotional isolation and distress, proactively addressing alexithymia's roots and refusal triggers before they escalate.