University of Oxford, Oxford, United Kingdom.
University of Oxford, Oxford, United Kingdom; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
J Am Acad Child Adolesc Psychiatry. 2024 Feb;63(2):266-282. doi: 10.1016/j.jaac.2023.10.004. Epub 2023 Oct 20.
Adolescence is a key developmental window that may determine long-term mental health. As schools may influence mental health of students, this study aimed to examine the association of school-level characteristics with students' mental health over time.
Longitudinal data from a cluster randomized controlled trial comprising 8,376 students (55% female; aged 11-14 years at baseline) across 84 schools in the United Kingdom were analyzed. 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. Students' mental health (risk for depression [Center for Epidemiologic Studies Depression Scale], social-emotional-behavioral difficulties [Strength and Difficulties Questionnaire]) and well-being (Warwick-Edinburgh Mental Well-Being Scale) and relationships with student- and school-level characteristics were explored using multilevel regression models.
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 time point: depression, 1.7% (0.9%-2.5%) to 2.5% (1.6%-3.4%); social-emotional-behavioral 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 analyzed as a time-varying factor 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-behavioral 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.
Student-rated school climate predicted mental health in early adolescence. Policy and system interventions that focus on school climate may promote students' mental health.
青春期是一个关键的发展窗口，可能决定长期的心理健康。由于学校可能会影响学生的心理健康，本研究旨在探讨学校层面的特征与学生心理健康随时间的变化关系。
本研究使用来自英国 84 所学校的 8376 名学生（55%为女性，基线年龄为 11-14 岁）的一项集群随机对照试验的纵向数据进行分析。数据收集始于 2016/2017 学年（队列 1）和 2017/2018 学年（队列 2），并在 1、1.5 和 2 年时进行了随访。使用多层次回归模型探讨了学生心理健康（抑郁风险[流行病学研究中心抑郁量表]、社会情感行为困难[强项与困难问卷]）和幸福感（华威-爱丁堡心理健康量表）与学生和学校层面特征的关系。
心理健康问题和较差的幸福感随着时间的推移而增加，尤其是在女孩中。学校之间的差异代表了学生在每个时间点心理健康的一小部分但具有统计学意义的变异比例（95%置信区间）：抑郁，1.7%（0.9%-2.5%）至 2.5%（1.6%-3.4%）；社会情感行为困难，1.9%（1.1%-2.7%）至 2.8%（2.1%-3.5%）；和幸福感，1.8%（0.9%-2.7%）至 2.2%（1.4%-3.0%）。作为学生和学校层面的时变因素分析，更好的学生自评学校氛围与抑郁风险降低相关（学生水平回归系数[95%置信区间]：-4.25[-4.48，-4.01]；学校水平：-4.28[-5.81，-2.75]），社会情感行为困难减少（学生水平：-2.46[-2.57，-2.35]；学校水平：-2.36[-3.08，-1.63]），幸福感提高（学生水平：3.88[3.70，4.05]；学校水平：4.28[3.17，5.38]），这是一种稳定的关系。
学生自评的学校氛围预测了青少年早期的心理健康。关注学校氛围的政策和制度干预可能会促进学生的心理健康。
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