Research suggests one way to prevent depression and anxiety is a strong sense of connection in high school
In Australia, decades of investment in early intervention and treatment services have not decreased rates of depression and anxiety. This has sparked more interest in what we can do to prevent mental health problems. Schools are ideal settings for prevention because you can reach large numbers of students, help build healthy skills and habits, and capitalize on schools being both learning and social environments.
What is 'school connectedness'?
It can include things such as, knowing teachers support them, having a friend to talk to about their problems, feeling like they can be themselves at school and like school is an enjoyable place to be, and actively participating in school activities.
School connectedness has been linked to better academic achievement and well-being. But it is now attracting attention as a possible way to protect against depression and anxiety.
However, existing research reviews have tended to look at cross-sectional studies (data collected at one point in time) rather than longitudinal studies (data collected over time). And they haven't considered anxiety and depression specifically, making it difficult to determine if there is a preventative effect.
In a new study, we investigated whether school connectedness prevents the onset of later depression and anxiety in 14 to 24 year-olds. We did this with funding from the UK charity, the Wellcome Trust as part of its push to identify innovative interventions for anxiety and depression.
We systematically reviewed ten years of evidence examining relationships between school connectedness and depression and anxiety. After screening 3,552 potential articles, we found 34 longitudinal and two intervention studies which met our inclusion criteria. The intervention studies measured the change in participants' depressive symptoms before and after a program, compared to participants who did not receive the program.
We then summarized the findings from the included articles.
To ensure young people's perspectives informed our review, we also partnered with five youth advisers aged 16 to 21 with lived experience of mental health problems and/or the schooling system in Australia, Indonesia, and the Philippines.
Most studies found higher levels of school connectedness predicted lower levels of depression and anxiety later. Most studies examined depression.
For example, United States one study of nearly 10,000 students found higher levels of self-reported school connectedness (questions included, "you feel like you are part of your school", "the teachers at school treat you fairly") led to reductions in self-reported depressive symptoms in the past week. This effect occurred both later in secondary school and persisted into early adulthood, even when accounting for previous depressive symptoms.
The program encouraged supportive relationships between members of the school community, promoted school belonging, increased participation in school activities, and promoted social skills among students. The study found this led to a reduction in depressive symptoms 17 months later.
Reflections from youth advisers
Our findings resonated with the experience of our youth advisers. For example, one 18-year-old adviser from Australia reflected,
"I've had mental health issues my whole life […] I noticed the second that I moved schools to a more healthy environment, the rapid improvement of my mental health."
Another 18-year-old adviser from Indonesia explained,
"Knowing your school is there for you really calms you down, takes one more thought out of your head, and more weight off your shoulders."
Most of the studies were from high-income countries, primarily the US, yet our advisers stressed the importance of cultural context. One 16-year-old youth adviser explained the importance of religion.
"In Indonesia you can't really dismiss religion. You can't ignore it because it's so deeply rooted in our society and that in turn reflects (on) other things like our mental health and even school connectedness."
Interestingly, we found one study reported higher levels of school connectedness led to higher levels of internal distress. Our youth advisers noted that sometimes feeling more connected to school can come with increased expectations from teachers and pressure to perform, which might increase anxiety in some students.
What does this mean for schools?
Our findings show how schools matter for mental health and that fostering school connectedness might be a way to prevent depression and anxiety.
This includes, actively listening to students, being available and accessible, advocating for students, encouraging students in their school work even if they are struggling, having empathy for students' difficulties, and treating students like "humans".
Students are also more likely to ask for help with their learning when teachers say hello, talk to them and take an interest in what they are doing, and show they are proud of them.
Our youth advisers reinforced the importance of feeling acknowledged by teachers and peers and that students need to be able to safely express their identity. One 16-year-old youth adviser from Australia explained that feeling connected to school has many parts.
"You've got that social aspect, but you've also got extra-curricular activities, how you're going through your studies, your classes […] it's the positive emotions, it's the relationships, it's the meaning, it's engagement, the accomplishment, it's all of that. Once you feel supported in all these areas is when you feel connected."
Across the pandemic, school closures and remote learning have shaped a different appreciation of the significance of schools for mental health and well-being. The question now is how governments, schools and communities act on this information.
More information: Monika Raniti et al, The role of school connectedness in the prevention of youth depression and anxiety: a systematic review with youth consultation, BMC Public Health (2022). DOI: 10.1186/s12889-022-14364-6