Improving Mental Health in Adolescence: Risk Factors and Interventions within the School Context

Research shows that 5% of 11-15 year olds suffer from an emotional disorder, and 7% of 15/16 year olds engage in deliberate self harm (DSH). Schools are regarded as key in influencing adolescents‘ mental health, but there is not enough scientific evidence to show what factors are important in this context, or what can be done to improve students‘ experiences. This study will review the evidence from previous research regarding the link between emotional distress and school-related problems, and will analyse questionnaire data collected from adolescents to identify links between DSH and previous experiences of school achievement, school enjoyment, bullying, peer relationships and truancy. The findings will provide important information for health and education professionals regarding strategies for reducing school-age adolescents‘ experiences of emotional distress and DSH. This study will also include case study research of four schools to explore the barriers and facilitators to delivering mental health activities, and the design and testing out of new materials and activities in schools. The findings will directly contribute to a future large-scale school-based intervention, which will aim to reduce students‘ experiences of emotional distress, increase their coping skills and improve their mental health.

Emotional distress is a serious problem among adolescents in Britain: 5% 11-15 year olds suffer from an emotional disorder, and 7% 15/16 year olds engage in deliberate self harm (DSH). If unaddressed, such experiences can lead to serious long-term morbidity. Schools have been identified as an important influence on resilience/vulnerability. Through four inter-connected studies, this research will explore the importance of the school context (a) in contributing to emotional distress and DSH, and (b) as a potential setting for interventions to prevent such experiences and improve the mental health of this age group. The first study will identify school-related risk factors for DSH at age 14/15 years: epidemiological data from the Avon Longitudinal Study of Parents and Children (ALSPAC) - n=14,138 - measuring school enjoyment, school achievement, bullying, peer friendships and truancy between the ages of 7 and 13, and DSH at ages 11 and 14/15 will be analysed using logistic regression and multi-level models. The second will be a systematic literature review of evidence for (a) the influence of school-related risk factors on the incidence of emotional disorder and DSH in adolescence and (b) an association between emotional disorder and other difficulties associated with adolescence. The third will be a qualitative investigation of the facilitators and barriers to secondary schools adopting a whole-school approach to addressing students‘ mental health needs. Four schools that provide a contrast in terms of mental health activities will be included as case studies, and in-depth interviews, observations and document analysis will be undertaken. The final study will examine of the feasibility of conducting a cluster randomised controlled trial of a school-based intervention to improve adolescents‘ strategies for coping with emotional distress. This will involve designing and piloting materials, identifying and testing outcome measures, assessing schools‘ willingness to participate, and designing the trial methodology. The proposed programme of research will extend current knowledge regarding the nature of the association between emotional distress and DSH and the school environment, and will highlight areas in which interventions could be developed, that have the potential to reduce such experiences among adolescents. It will also generate findings that will inform the development of a school-based intervention and evaluation, which would greatly improve the evidence base regarding strategies for improving mental health in adolescence.