Four-year trajectory of Korean youth mental health and impacts of school environment and school counselling: a observational study using national schools database

Objectives This study aimed to investigate changes in the mental health status of South Korean adolescents at a school level and identify school-related factors affecting these changes. Design A retrospective data analysis, population study. Setting South Korean high schools from 2013 to 2016. Participants Randomly sampled 827 schools (316？834 boys and 299？304 girls) Primary outcome measures Mean scores of the Adolescent Mental Health and Problem Behavior Questionnaire-II (AMPQ-II), a school-based mental health screening test, were used to explore changes in youth mental health. Data regarding the school environment and school counselling were gathered from the ‘School info’ website. A multilevel growth model was used to determine relationships between students’ mental health and school-related factors. Results Students’ mental health statuses in South Korea gradually improved over time (coefficient=？1.46？to ？1.70, p<0.001). School mobility rates (coefficient=0.93？to 1.00, p<0.05), school dropout rates (coefficient=0.38？to 0.40, p<0.001), school budgets per student (coefficient=？0.05？to ？0.06, p<0.01) and number of school counselling sessions (coefficient=0.14, p<0.01) were significantly associated with baseline AMPQ-II scores. The rate of change in AMPQ-II score increased when the number of school counselling sessions was higher (coefficient=？0.03, p<0.05) or the school budget was lower (coefficient=0.02, p<0.001). School environment explained 21.6% of the AMPQ-II baseline score variance and 9.3% of the rate of change variance. School counselling further explained 2.0% of the variance in baseline AMPQ-II scores and 2.3% of the rate of change variance. Conclusions This study suggests that school environment stability and active provision of school-based mental health services have a positive impact on youth mental health