Work strain has been argued to be a significant cause of absenteeism in the popular and academic press. However, definitive evidence for associations between absenteeism and strain is currently lacking. A theory focused meta-analysis of 275 effects from 153 studies revealed positive but small associations between absenteeism and work strain, psychological illness, and physical illness. Structural equation modeling results suggested that the strain-absence connection may be mediated by psychological and physical symptoms. Little support was received for the purported volitional distinction between absence frequency and time lost absence measures on the basis of illness. Among the moderators examined, common measurement, midterm and stable sources of variance, and publication year received support.