How is loneliness orientation implicated in the relationship between sleep problems, loneliness intensity, and school refusal in adolescents?

Prolonged loneliness adversely affects mental and physical health. Even if feelings of loneliness are high, the association between loneliness intensity, mental health, and school refusal may differ depending on how loneliness is framed (i.e., loneliness orientation). In this study, we aimed to develop a Loneliness Orientation Test to examine the relationship between loneliness intensity and loneliness orientation; examine the differential impact of sleep problems on loneliness intensity/orientation, feelings of school refusal, and the number of absences; and examine the relationship between the combined types of loneliness intensity with loneliness orientation, sleep problems, and school refusal. The study sample included 168 senior high school students. We used loneliness-related measures, including the Loneliness Oriented Test developed in this study, sleep-related measures (insomnia, sleep debt, and chronotype), and school refusal-related measures (feelings of school avoidance and absenteeism). These findings showed that feelings of school avoidance and absenteeism were associated with different sleep problems (insomnia, sleep debt, and chronotype). Additionally, one-fourth of lonely individuals viewed loneliness positively; those with a positive loneliness orientation did not have worse sleep conditions than those with a negative loneliness orientation. Even when loneliness intensity is strong, outcomes such as sleep problems vary depending on an individual's orientation toward loneliness. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-025-00586-9.