Abstract
ObjectiveRecent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom. MethodBaseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health. ResultsThe study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p < .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p < .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p < .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health. ConclusionSchool-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people. Clinical trial registration informationMYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.
Highlights
This study is a cross-sectional secondary analysis of baseline data collected as part of the MYRIAD Project, a cluster randomized controlled trial evaluating whether school-based mindfulness training improves mental health of young people (ISRCTN Registry reference 86619085).[17]
We reported the intracluster correlation coefficient (ICC), which is the proportion of the total variance in the outcome attributed at the school level
Survey; SDQ 1⁄4 Strengths and Difficulties Questionnaire; SEL 1⁄4 social and emotional learning; SEND 1⁄4 special educational needs and disability; WEMWBS 1⁄4 Warwick-Edinburgh Mental Well-Being Scale. aOFSTED operates in England only. bSDQ cutoff points: normal (0–14); borderline (15–17); high (18–19); very high (20–40).[25] cCES-D cutoff points: low (0–15); at risk of depression (16–27); caseness (28–60).[23]
Summary
Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. Different aspects of school experience may influence mental health and well-being in young people through various mechanisms (see Figure S1, available online) Some factors, such as the experience of pervasive bullying in the school environment, may directly impact a young person’s mental health, while others may act indirectly—for instance, the quality and character of the school as an institution, often referred to as school climate.[7] some potential influences will be outside the school’s control, for example, the socioeconomic profile of the school catchment area, yet may still be important influences on pupils’ mental health and could be an indicator of need for additional resources.[8] Given the long-term and Journal of the American Academy of Child & Adolescent Psychiatry Volume - / Number - / - 2021 www.jaacap.org near-universal access that education provides, schools are a potentially powerful setting for delivering effective interventions to support well-being, to prevent mental health problems, and to triage identified difficulties.[9] Mental health provision in schools is highly variable within as well as between countries and is a current policy focus in the United Kingdom, which traditionally has not had a strong school-based mental health service.[10]. 85 secondary schools from the United Kingdom, collecting www.jaacap.org data on psychopathology, depression, and well-being using well-established continuous measures
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