J Am Acad Child Adolesc Psychiatry. 2023 Oct 18:S0890-8567(23)02136-6. doi: 10.1016/j.jaac.2023.10.004. Online ahead of print.
ABSTRACT
OBJECTIVE: Adolescence is a key developmental window that may determine long-term mental health. As schools may influence students’ mental health, we examined the association of school-level characteristics with students’ mental health over time.
METHOD: We analysed longitudinal data from a cluster randomised controlled trial on 8,376 students (55% female; aged 11-14 years at baseline) across 84 schools in the United Kingdom. Data collection started in the academic years 2016/2017 (Cohort 1) and 2017/2018 (Cohort 2), with follow-up at 1, 1.5, and 2 years. We explored students’ mental health (risk for depression (Center for Epidemiologic Studies-Depression Scale), social-emotional-behavioural difficulties (Strength and Difficulties Questionnaire)) and well-being (Warwick-Edinburgh Mental Well-Being Scale), and their relationship with student- and school-level characteristics, using multilevel regression models.
RESULTS: Mental health difficulties and poorer well-being increased over time, particularly in girls. Differences among schools represented a small but statistically significant proportion of variation (95% CI) in students’ mental health at each timepoint: depression: 1.7% (0.9%-2.5%) to 2.5% (1.6%-3.4%), social-emotional-behavioural difficulties: 1.9% (1.1%-2.7%) to 2.8% (2.1%-3.5%), and well-being: 1.8% (0.9%-2.7%) to 2.2% (1.4%-3.0%). Better student-rated school climate analysed as time-varying at the student- and school-level was associated with lower risk of depression (regression coefficient (95%CI) student-level: -4.25 (-4.48,-4.01), school-level: -4.28 (-5.81,-2.75)), fewer social-emotional-behavioural difficulties (student-level: -2.46 (-2.57,-2.35), school-level: -2.36 (-3.08,-1.63)), and higher well-being (student-level: 3.88 (3.70,4.05); school-level: 4.28 (3.17,5.38)), which was a stable relationship.
CONCLUSION: Student-rated school climate predicted mental health in early adolescence. Policy and system interventions that focus on school climate may promote students’ mental health.
PMID:37866473 | DOI:10.1016/j.jaac.2023.10.004
