Internalizing and externalizing difficulties were assessed by the Dutch self-report version of the Strengths and Difficulties Questionnaire (SDQ) [27]. The SDQ consists of 25 items regarding emotional problems, conduct problems, hyperactivity-inattention, peer problems, and prosocial behavior, all scored on a 3-point scale: 0 = ‘not true’, 1 = ‘somewhat true’, and 2 = ‘certainly true’. The SDQ can be divided into two subscales, i.e. an internalizing scale (items on emotional and peer problems) and an externalizing scale (items on conduct problems and hyperactivity-inattention), both ranging from 0–20. A higher score indicates more problems [28].

Mental well-being was assessed by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) [29]. This scale consists of 14 items assessing elements of mental well-being, such as happiness and sense of purpose in life. Each of the 14 items was answered on a 5-point Likert scale (1 ‘none of the time’ to 5 ‘all of the time’), based on the adolescents’ experiences in the past two weeks. A total score is generated based on the 14 answers, with a minimum total score of 14 and a maximum total score of 70. A higher score indicated a higher level of mental well-being.

Sickness absence was assessed by the question: “How many days in the past four weeks have you been absent from school because you were sick?” (Answer categories ranged from ‘0 days’ to ‘≥ 7 days’) [30]. For analysis purposes, sickness absence in the past four weeks was recoded into ‘0 days’, ‘1 day’, and ‘≥ 2 days’.

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