A cross-cultural, mixed methods study of school climate and adolescent mental health

Mental health problems in adolescence can have devastating and long-lasting effects on health and development, but access to treatment is limited, especially in low- and middle-income countries (LMICs) where 90% of the world's adolescents live. One approach supported by the World Health Organization (WHO) and UNICEF is to locate mental health care in schools where it is easily accessible to adolescents and can be delivered by trained school staff. However, individual schools differ dramatically in terms of their norms, policies, and values(collectively termed school climate), meaning that some schools are likely to be more suitable places for mental health intervention than others. Moreover, research has shown that a positive school climate in which students feel listened to, valued, and able to express themselves, is associated with improved academic performance, an dreduced violence, substance use, and problem behaviour.

Understanding which elements of the school climate promote and which elements undermine mental health is crucial for the design and implementation of effective and feasible school-based interventions. However, most research on school climate and mental health has been done in high-income countries. There has been limited cross-cultural work in LMICs despite the diversity of adolescents' experiences of mental health and school in these settings. The PhD aims to address this gap by exploring how school climate is conceptualised and related to adolescent mental health in Nepal. Working in partnership with Transcultural Psychosocial Organization(TPO) Nepal, an experienced mental health research organisation, the PhD student will:

(i) Build a conceptual model of the effects of school climate on adolescent mental health by reviewing qualitative and quantitative research from LMICs

(ii) Review the characteristics and mechanisms of existing interventions that seek to improve adolescent mental health by targeting the school climate

(iii) Explore how school climate influences adolescent mental health and how it can be optimised by consulting with adolescents, teachers, parents, and health workers in Nepal.

(iv) Explore associations between school climate and adolescent mental health by analysing survey data from atrial of a school-based mental health intervention in Nepal.

(v) Integrate findings related to objectives 1-4 to make recommendations about how to optimise the school climate for mental health intervention in Nepal, with learning for other LMIC settings.

TPO will support the PhD student to design and implement culturally appropriate and feasible research in Nepal through mentorship and access to field sites. TPO will also engage the student in research training and activities with mental health stakeholders in Nepal.

Through the PhD, the student will develop as a sensitive and skilled mixed methods global mental health researcher with solid experience in an international partnership and abroad academic network. The PhD will have impact generating learning on school climate to inform local and global policy and research on school-based mental healthcare in LMICs. It will also help to strengthen the partnership between KCL and TPO through mutual capacity building and by strengthening a growing community of UK and Nepali early career researchers.