School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
Pediatrics. 2012 May;129(5):925-49. doi: 10.1542/peds.2011-2248. Epub 2012 Apr 2.
The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the school environment in cohort studies.
Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers.
Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological shortcomings were common.
There is limited evidence that the school environment has a major influence on adolescent mental health, although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring school-level factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs.
学校环境对青少年情绪健康的重要性的证据基础从未被系统地审查过。我们旨在综合针对学校环境的干预措施（1）和队列研究中学校环境（2）对青少年情绪健康影响的证据。
对 Medline、Embase、PsychINFO、CINAHL、ERIC、社会引文索引和灰色文献进行了搜索。纳入标准为（1）队列或对照试验设计，（2）参与者年龄为 11 至 18 岁，（3）情绪健康结果，以及（4）学校环境暴露或干预。由 2 名独立审查员检索和提取相关研究的数据。
共审查了 9 篇报告 5 项对照试验的论文，以及 30 篇报告 23 项研究的队列论文。两项非随机试验发现，支持性的学校环境改善了学生的情绪健康，但三项随机对照试验没有发现。六项（20%）队列论文研究了学校层面的因素，但没有发现效果。有一些证据表明，学生对学校联系和教师支持的个人感知预测未来的情绪健康。多层次研究表明，学校效应小于个体水平效应。方法学上的缺陷很常见。
虽然学生对教师支持和学校联系的个人感知与更好的情绪健康相关，但学校环境对青少年心理健康的影响有限。需要更多测量学校层面因素的研究。与复杂的全校计划相比，评估 1 或 2 个环境因素的随机对照试验可能更成功地建立有效的和可行的干预措施。
