effect of mental health on students essay

Understanding the Impact of Mental Health on Academic Performance

School Health and Wellness //

February 12, 2023

Mental health is an essential component of student success. Students struggling with poor mental health will face overall poor academic outcomes.

According to a 2022 YouthTruth student survey, over 50% of students at every high school grade level cited depression, stress, and anxiety as obstacles to learning —making these conditions ubiquitous in the culture of American teenagers. Additionally, the survey results indicated the percentage of students who feel happy about their lives declines 3–12 grades.

What is even more alarming is that fewer than half of secondary students—regardless of grade level, gender, race, or LGBTQ+ status—report they have an adult at school they can talk to when they feel upset or stressed, or have a problem.

It is abundantly clear mental health and academic performance are intertwined. Schools must take action if they intend to maintain their commitment to their students' overall well-being and academic excellence.

The Connection Between Mental Health and Academic Performance

Mental health challenges affect every facet of student life. Low self-esteem leads to decreased motivation and a lack of confidence when completing tasks or taking tests. Anxiety can make it difficult for students to study or attend classes. Depression can lead to decreased focus and concentration, making it hard for a student to remain engaged or complete work on time. But those are just a few of the complex challenges students face when managing their mental health and academic performance.

Left unaddressed, students with mental health challenges can experience adverse outcomes in their young lives. These include:

• trouble making friends,
• inability to learn, concentrate, or complete work,
• poor grades,
• suspension, and

Ultimately, left without support , students may even consider death by suicide.

When a student's unique needs are recognized, understood, and supported, they can showcase their strengths and reach their true potential. Student mental health needs are part of them, and it is your job as an educator to understand mental health implications in their learning.

What about students with learning differences?

Learning differences such as attention-deficit/hyperactivity disorder (ADHD) also play a harmful role in academic performance, particularly when they are not addressed in a learning plan. In fact, 70% of students with learning disabilities experience more symptoms of anxiety than students without learning disabilities, with anxiety and reading disorders co-occurring in approximately one in four students.

For example, students with ADHD may need help focusing, even when placed in supportive learning environments. Poorly managed ADHD and learning could lead them to fall behind in their studies or fail classes altogether. In the most extreme cases, students could experience bullying because of their ADHD, leaving them feeling stigmatized, which could impact an undiagnosed or co-occurring mental health challenge.

Schools must recognize that all mental health conditions are real and take steps to provide accommodations. Doing so better allows students the opportunity to learn effectively despite any mental health challenges they may be facing.

Mental Health and Its Impact on School Community

Mental health issues among students have far-reaching implications for school communities at large.

• Teachers may become overwhelmed trying to manage students with mental health needs within the classroom setting.
• Counseling centers and learning support specialists may become overburdened with requests for help.
• Parents may be concerned about their child's ability to succeed academically.
• Other members of the school community may struggle with how best to support those in need.

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Solutions to Consider

Schools should implement policies that empower teachers with more flexibility to accommodate students with special needs due to mental illness or disability—for example, allowing extra time on assignments or tests without penalty for late submissions.

Additionally, schools can train staff members in caring and thoughtful ways to manage and support students with mental health issues.

Finally, schools should offer additional resources—counseling sessions, therapy groups, or telehealth services —to support counselors and nursing staff who are already overwhelmed.

Telehealth allows students to connect with a professional on the student’s terms, by the way of technology they're familiar with—reducing the social stigma teens may feel in seeking mental health support. In addition, with telehealth, teens can receive care without worrying about being seen or traveling to a therapist’s office with their parents.

Taking Telehealth to Another Level

Schools nationwide are struggling to provide the support and qualified personnel needed to address mental health. Even if your school has an active counseling program, your staff can't be available 24/7/365 to your entire student population.

ISM's Wellness in Independent Secondary Education (WISE) program provides students in grades 9–12 access to mental health professionals 24 hours a day, seven days a week, through a custom phone app. Students can connect with professionals by calling or texting—the response is almost instantaneous.

Through on-demand access to an expansive network of licensed and experienced mental health and medical professionals, students receive support for:

• mental health—including anxiety and stress;
• primary and psychiatric care coordination;
• sexual and interpersonal violence support and advocacy;
• cognitive behavior therapy (CBT);
• suicide awareness, assessment, and prevention; and
• well-being and resiliency.

WISE is tailored to your school's unique needs—and complementary to your existing resources. Our goal is to empower your administrators, counseling services, and faculty members to provide the best support possible for your students.

For more information about WISE, please visit our webpage .

As a school leader, early identification and detection of mental health concerns support students to succeed academically. By considering flexible policies, providing appropriate training for staff members, and offering resources such as counseling sessions, therapy groups, or telehealth aimed explicitly at helping students cope, your school will be better equipped than ever to deal effectively with these complex issues—ensuring all young people reach their full potential both inside and outside the classroom walls.

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24/7/365 Digital Access to Live Mental Health Professionals 

Wellness in Independent Secondary Education (WISE) Program

Mental health crises have reached a high point in the news and in schools around the world. The impact on students who often don’t get the care they need is unimaginable. ISM’s Wellness in Independent Secondary Education (WISE) is the only program that provides resources for both students and school leaders to receive support from mental health professionals when they need it most. Students have 24/7 access to health experts through our custom phone app—enabling them to speak to a provider when their need is greatest. 

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• Mental Health Essay

Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

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The Mental Health Crisis In Our Schools

Mental health in schools: a hidden crisis affecting millions of students.

Meg Anderson

Kavitha Cardoza

Part One in an NPR Ed series on mental health in schools.

You might call it a silent epidemic.

Up to one in five kids living in the U.S. shows signs or symptoms of a mental health disorder in a given year.

So in a school classroom of 25 students, five of them may be struggling with the same issues many adults deal with: depression, anxiety, substance abuse.

And yet most children — nearly 80 percent — who need mental health services won't get them.

Whether treated or not, the children do go to school. And the problems they face can tie into major problems found in schools: chronic absence, low achievement, disruptive behavior and dropping out.

Experts say schools could play a role in identifying students with problems and helping them succeed. Yet it's a role many schools are not prepared for.

Educators face the simple fact that, often because of a lack of resources, there just aren't enough people to tackle the job. And the ones who are working on it are often drowning in huge caseloads. Kids in need can fall through the cracks.

Grief In The Classroom: 'Saying Nothing Says A Lot'

"No one ever asked me"

Katie is one of those kids.

She's 18 now. Back when she was 8, she had to transfer to a different school in Prince George's County, Md., in the middle of the year.

"At recess, I didn't have friends to play with," she recalls. "I would make an excuse to stay inside with the teachers and finish extra work or do extra credit."

We're not using Katie's last name to protect her privacy. She's been diagnosed with bulimia and depression.

She says that in the span of a few months, she went from honor roll to failing. She put on weight; other kids called her "fat." She began cutting herself with a razor every day. And she missed a ton of school.

"I felt like every single day was a bad day," she says. "I felt like nobody wanted to help me."

Katie says teachers acted like she didn't care about her schoolwork. "I was so invisible to them."

Every year of high school, she says, was "horrible." She told her therapist she wanted to die and was admitted into the hospital.

During all this time, she says, not a single principal or teacher or counselor ever asked her one simple question: "What's wrong?"

3 Things People Can Do In The Classroom That Robots Can't

If someone had asked, she says, she would have told them.

Who should have asked?

We talked to educators, advocates, teachers and parents across the country. Here's what they say a comprehensive approach to mental health and education would look like.

The role: The first place to spot trouble is in the home, whether that trouble is substance abuse, slipping grades or a child who sleeps too much. Adults at home — parents, siblings, other relatives — are often the first to notice something going on.

The reality: Many families do not know what to look for. Sometimes a serious problem can be overlooked as "just a phase." But it's those sudden changes — angry outbursts, declining grades, changes in sleeping or eating — that can signal problems. When something unusual crops up, families can keep in close touch with the school.

Why Emotional Learning May Be As Important As The ABCs

The teacher

The role: During the week, many students see their teachers even more than their own families. Teachers are in a prime spot to notice changes in behavior. They read essays, see how students relate with other kids and notice when they aren't paying attention.

The reality: Teachers already have a ton on their plates. They're pressured to get test scores up, on top of preparing lessons and grading assignments. Plus, many teachers receive minimal training in mental health issues. But when they do see something concerning, they can raise a flag.

The social worker

The role: Social workers act like a bridge. If teachers come to them with a concern — maybe a child is acting withdrawn — one of the first things they'll do is call home. They see each child through the lens of their family, school and community. They might learn that a family is going through a divorce or homelessness.

The reality: There aren't enough of them. According to one model, every school should have one social worker for every 250 students . The reality is that in some schools, social workers are responsible for many more .

The counselor

The role: In some schools, counselors focus solely on academics: helping students pick classes and apply to college. But in others, they also act a lot like social workers, serving as a link to families and working with students who need support.

The reality: Like school social workers, there just aren't enough counselors. On average nationwide, each counselor is responsible for nearly 500 students. The American School Counselor Association recommends a caseload nearly half that size.

The special education teacher

The Role: Special education teachers may start working with students when a mental health problem affects the ability to do school work. They are primarily responsible for working on academic skills.

The reality: Again, there aren't enough of them. Nearly every state has reported a shortage of special education teachers. Half of all school districts say they have trouble recruiting highly qualified candidates.

The school psychologist

The Role: Here's one job that, on paper, is truly dedicated to student mental health. School psychologists are key players when it comes to crisis intervention and can refer students to outside help, such as a psychiatrist.

The reality: If you sense a pattern here, you're right. In the U.S., there is just one school psychologist for every 1,400 students, according to the most recent data available from the National Association of School Psychologists.

The school nurse

The role: Most any school nurse will tell you, physical and mental health are tough to separate. That puts nurses in a prime spot to catch problems early. For example: A kid who comes into the nurse's office a lot, complaining of headaches or stomach problems? That could be a sign of anxiety, a strategy to avoid a bully, or a sign of troubles at home.

The reality: The U.S. Department of Health and Human Services recommends at least one nurse for every 750 students, but the actual ratio across the country can be much higher.

The principal

The role: As the top dogs in schools, principals make the big decisions about priorities. They can bring in social-emotional, anti-bullying and suicide-prevention programs.

The reality: Principals also have a lot on their plates: the day-to-day management of student behavior, school culture and teacher support.

Getting help, and "excited for life"

Katie says things started to turn around for her when she met a nurse at the Children's National Health System in Washington, D.C., who finally showed interest in what was wrong.

Now, she's begun college and wants to be a pediatric nurse.

"I'm doing a lot better now" she says. " Obviously, I mean, I'm a lot happier. I'm excited for school. I'm excited to graduate. I'm excited for life."

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How to Write a Mental Health in College Students Essay

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Writing is a skill that takes time to build. Essays force you to practice research, critical thinking and communication skills – college is the perfect time for you to practice these. However, there’s only so much you can learn about writing through preparation. If you’ve been assigned an essay on mental health, you may not be sure where to begin. You might also wonder if you should choose mental health as a topic for a college paper. Here’s how to write a “mental health in college students” essay. 

• What Not to Do

If you’re trying to choose a topic for a college application essay, mental health is usually not the way to go. Your personal statement should show colleges why you’re the best candidate to attend their school. Because many students write about mental health , your essay may get lost in the crowd. In addition, your mental health journey is only a part of who you are. 

It can be difficult for many students to write about personal mental struggles without seeming overdramatic. Unless mental health struggles have shaped your whole life, it’s best to discuss other topics. If you mention mental health, stay brief and matter-of-fact. Don’t let it become the whole point of your essay. 

• Review the Instructions

If you’re writing this essay for a college course, start by looking over the assignment instructions. Don’t just listen to what your teacher says – look up the assignment on the syllabus to see if you can find a rubric or other relevant information. 

Highlight the important points to make sure you know what matters to your professor. The instructions are parameters you can operate in to create an essay you enjoy. Make sure you check word count, essay structure and review corrections on past essays. If you’re confused about something, don’t hesitate to ask your professor for clarification. 

• Do the Research 

Regardless of what class you’re writing for, this is the kind of topic that requires hard numbers. You don’t want to make general claims about rates of student anxiety or mental illness – to be credible, you need specifics. Be careful with your wording to avoid all-or-nothing statements. Everyone experiences mental health differently. 

Your professor may or may not allow you to pick the specific mental health topic you write about. However, you can ensure that your paper is well-researched and organized clearly. Before you start writing, create at least a basic outline showing the flow of ideas. This will make the writing phase much faster because you’ll always know what to say next. 

• Write It Out 

Writer’s block often stems from perfectionism. This paper won’t be perfect the first time, so don’t worry about writing it perfectly! Start with an interesting line that gets your reader’s attention and make sure you have a clear thesis statement. Taken by itself, this sentence should describe the contents of your entire paper. 

Build your paragraphs to the right word length by using specific examples. You should start each paragraph with a topic sentence that takes your reader one step in your paper’s argument. Then, describe a specific example that further explains this idea. You can find specific examples in your research or simply explain more about what you mean. 

• Edit Your Work

Editing is an important final step before you turn an essay in. It gives you an opportunity to look at your writing as a whole and ensure everything makes sense. If possible, you should set your first draft aside for a while before you reread it. This will help you see your work with fresh eyes so you can edit it. 

Editing involves strengthening your paper’s organization, rewriting specific sentences and checking for errors. You should make major edits first and then do a final read-through to catch punctuation and spelling mistakes. It can be helpful to read your paper out loud or have a friend look it over as well. 

One Key Takeaway for Writing a Mental Health in College Students Essay

Many students struggle with mental health while in school. Whatever topic you choose and however you organize your essay, make sure to write it with a sensitive tone. This topic is nuanced and shouldn’t be treated as a black-and-white issue. Write from an informed and compassionate point of view and offer your readers hope. 

Use this guide to write an essay on mental health in college students that astounds and delights your professor. Putting in the work will build research and communication skills you’ll use for years – whether you’re a psychology major, a premed student or studying the arts at school. 

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Ginger Abbot is the writer, founder and Editor-in-Chief behind Classrooms. Through her work, she hopes to inspire students, grads, and educators on their own journey through learning. Find her professional portfolio here: https://classrooms.com/professional-portfolio-of-ginger-abbot/

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Students Get Real About Mental Health—and What They Need from Educators

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• Perspectives
• Student Support

M ental health issues among college students have skyrocketed . From 2013 to 2021, the number of students who reported feelings of depression increased 135 percent, and the number of those with one or more mental health problems doubled. Simply put, the well-being of our students is in jeopardy.

To deepen our understanding of this crisis, we asked 10 students to speak candidly about their mental health. We learned that the issues they face are uniquely theirs and yet collectively ours. We hope these responses will inform your teaching and encourage you to create safe classroom spaces where students feel seen and supported.

Students Share Their Mental Health Struggles—and What Support They Need

We asked these students and recent graduates, In what ways has your mental health affected your college experience, and how can professors better support you? Here’s what they had to say.

Elizabeth Ndungu, graduate student in the School of Professional Studies at Columbia University, United States: My mental health has affected me deeply, and I have sought therapy (which is a big thing for me, as I was born and raised in Africa and therapy is a “Western” concept). I’m a caregiver, so unexpected medical emergencies happen a lot, which mentally stresses me out. However, my professors have given me the time I need to perform my best. They’ve listened.

In general, I think professors can better support students by

Observing and reaching out to students if they notice a pattern of behavior.

Being kind. Giving a student a second chance may very well change their life for the better.

Being supportive. Remember students’ names, learn one unique thing about them that’s positive, or connect with them on LinkedIn or other social media platforms and show them that they have a mentor.

I think schools can better support students by

Admitting diverse students. Don’t just say it—do it. Seek out ways to make the school population more DEIA (diversity, equity, inclusion, accessibility) friendly, especially at historically white colleges. Inclusivity should be everywhere.

Making DEIA initiatives a priority. If you are educating organizations’ next leaders, make sure DEIA initiatives are in each program and cohort. Each of our classes should be tied to knowledge, strategy, and DEIA and its impact.

Raising awareness around mental health. Provide onsite and remote resources for mental assistance, automate low complexity tasks that will cause stress to students, invest in your staff and resources, and ensure that they are happy. Because dealing with unhappy staff will make unhappy students.

Pritish Dakhole, sophomore studying engineering at Birla Institute of Technology and Science, Pilani, India: Mental health is still stigmatized in India. We do not have easy access to therapy sessions, and it is a difficult topic to talk about with family. Thankfully, the scenario is changing.

I have been affected both positively and negatively by my mental health. Positively, because I have become more open-minded and perceptive. Negatively, because it has drained my will to continue, made me tired from all the overthinking, and made me turn to harmful addictions to distract myself from the pain.

Professors and schools could provide better support through

Webinars and meetings that make students aware of the issues they face and how to tackle them.

Group sessions—preferably anonymous—to remove fear.

Feedback systems so that the college is made aware of the problems that lead to a bad mental state.

Flexible education systems that allow students to take breaks during periods of excessive burnout.

Ocean Ronquillo-Morgan, Class of ’21, studied computer science and business administration at the University of Southern California, United States: In February 2021, I called 911 twice in the span of two weeks. I thought I was dying. I felt confused, felt like my body was about to give way, then I called the paramedics. They hooked me up to an EKG and checked my pulse. It was the first time in my life that I experienced panic attacks.

I don’t think anything else could have been done at the classroom level besides extending deadlines in extenuating circumstances. That’s the unfortunate nature of post-education institutions—you still need to make it “fair” for all students.

Alberto Briones, Class of ’22, studied operations and information management at Northern Illinois University, United States: Mental health can be a touchy subject. I have experienced depression and anxiety, but just thinking about all the things I could miss in life if I gave up is what gave me the strength to keep going.

Something professors can do to support students’ mental health is give students time to study between tests. Sometimes professors schedule tests on the same day, and suddenly students must study for three or four exams, all in the same day. It becomes overwhelming and they have to prioritize what tests they need to study more for.

Anjali Bathra Ravikumar, sophomore studying management information systems at The University of Texas at Austin, United States: It is stressful to be an international student at a competitive university in a competitive major. I often find myself having breakdowns and calling my parents in a panic about my future. The relatively restricted job opportunities because of my visa status and uncertainty about whether I’ll be able to forge the career that I want are major reasons behind this.

I have noticed that a lot of my international-student friends are constantly hustling as well, since we feel that we always need to be 10 steps ahead and cannot afford to slow down.

The best thing that a professor can do for me is provide as much guidance as possible in their respective field. Most of my professors have done that. This helps weed out some of the doubts that I have about potential career paths and gives me better clarity about the future. I feel that I cannot ask for more since I don’t expect everyone to be informed of what life is like for an international student.

Schools, on the other hand, can do a lot for us, such as tailor career management resources, offer international student group counseling (I attended one session and it was very liberating), provide financial relief (this is the absolute best thing that can be done for us) during rough times such as COVID-19. For example, when millions of international students had to take online classes during the pandemic, schools could have offered reduced tuition rates.

Something else that can seem small but goes a long way is using inclusive language in university announcements and communication. Most of the emails that we receive from the university feel more tailored to or are directly addressing in-state students (especially when major changes were happening at the beginning of the pandemic), and it is natural for us to feel left out. It might be a simple thing, but a couple of lines at the end of each email announcement with links addressing our specific concerns would make a lot of difference to us since we wouldn’t have to do our own research to figure out what it means for us.

EDUCATE YOURSELF BEFORE DIVING INTO MENTAL HEALTH TALKS

Starting a mental health conversation with students before we are prepared can be harmful. Here’s some advice from “ It’s Time We Talk About Mental Health in Business Classrooms ” by Bahia El Oddi, founder of Human Sustainability Inside Out, and Carin-Isabel Knoop, executive director of the Case Research and Writing Group at Harvard Business School, on how to get ready for these critical conversations.

Learn to talk about mental health. Enhance your mental health literacy through free resources such as the Learn Mental Health Literacy course (specifically for educators), the World Health Organization , and the National Institute of Mental Health . Consult the CDC for language about mental and behavioral health and the American Psychiatry Association for ways to describe individuals presenting with potential mental health disorders .

Reflect on your own biases. Consider how your own story—being raised by a parent with a mental health disorder, for example—may influence how you react and relate to others. Determine your level of openness to discussing the struggles you or your loved ones face or have faced. While it is possible to discuss mental health in the classroom without these anecdotes or personal connections, the courage to be open about your own past can have a transformative effect on classroom discussion.

Understand students may need extra support. Make yourself accessible and approachable to your students from the start so you can establish trust early. Advise them to seek professional help when necessary.

Nick Neral, Class of ’18, studied marketing management at the University of Akron, United States: At the end of my first year of college, I decided to stop participating in Division I athletics and my mental health plummeted. After calling our campus counseling center and waiting six weeks for my first intake appointment, I was told I couldn’t start therapy for two more months, but I could get medication within a couple of days.

After getting prescriptions for an SSRI and Xanax, I never heard from another clinician at my school again. They had no clue if I got the meds, if I took them, how I was doing, and whether I was on campus every day.

When my mental health was at its poorest, I was very disconnected from my classes. I went to, I think, five or six out of 30 finance classes I had during the semester.

I think professors are in this mindset that 20 percent of the class will naturally excel, a majority will do well enough, and a small chunk probably can’t be saved. Sometimes we don’t need saving in the classroom, we just need professors looking out for our well-being. There’s more to the story when a kid doesn’t show up to 80 percent of their classes.

My experience—and seeing others go through similar events—led me to create a platform where therapists can create content and free resources at forhaley.com . Anyone can filter through the content based on how they’re feeling and what’s going on in their life without paying anything or creating an account.

Shreyas Gavit, Class of ’20 in the MBA program at Oakland University, United States: Mental health has affected me because I’ve been depressed and feel trapped; I can’t just go to my home country and come back to the United States whenever I need to. Instead, I have to wait on visa dates, which are a total mess.

Schools and professors could provide more guidance in understanding how immigration has been affected due to COVID-19.

Nigel Hammett, Class of ’19, studied industrial and systems engineering at North Carolina Agricultural & Technical State University, United States: Throughout college I faced mental stress—not only from school, like everyone, but also from many constant family issues going on back home that required my energy. At times, I learned how to push through my feelings and submerge myself in my schoolwork, although I should have unpacked my trauma and handled it in a more mature way.

Students need an environment that encourages inclusive, candid dialogue around how we are feeling. There’s a correlation between social and mental health to overall success in our respective careers.

Alek Nybro, Class of ’21, studied marketing at St. Edward’s University, United States: Anxiety shows up differently for every person. I consider myself to be high functioning. This means when the going gets tough, I dig down and keep pushing, but often to extents that aren’t physically, emotionally, or mentally healthy.

In school, I didn’t know when to step back and take a break. That’s probably my biggest regret about my college years.

Professors could help students by making everything iterative. There shouldn’t be a final grade for assignments or projects. If you want to go back and revise something for a better grade, you should be able to do so.

Patrick Mandiraatmadja, first-year graduate student studying technology management at Columbia University, United States: There are times when I have felt overwhelmed by the number of deadlines and exams crammed into a specific week or few days. I always want to put in my best effort to study, which can lead to less sleep and more anxiety. Then college becomes more about getting through assignments and exams just for the sake of it and less about the learning.

Because of the amount of work or busy work, I have less opportunity to go out and do the things that make me feel alive and excited about life—whether it’s being with friends, exploring my city, exercising, involving myself with professional and social networks outside of school, or simply taking a walk and enjoying my day.

Students want to know that our professors and schools care. Part of that is providing an environment where we can talk about our personal struggles. I also think professors and schools should update the policies on homework, assignments, and exams. Sometimes we may push through and neglect our mental health, not taking the time to care for ourselves, just to get through that homework or finish that exam. The added pressure causes us increased anxiety; it’s no wonder today’s young people are some of the most anxious and unmotivated compared to previous generations.

What We Learned from These Students

These students and young alumni offer an honest glimpse into how mental health struggles have affected their college experiences. Although every student faces their own unique—and sometimes complicated—challenges, we are learning that sometimes the best response is the simplest one.

We must show our students that we care. So lend an empathetic ear, offer that deadline extension, and turn your classroom into a safe haven for open discussion. Your students need it.

Special thanks to Justin Nguyen , founder of Declassified Media , for connecting HBP to these students and young alumni who volunteered to share their experiences.

Help shape our coverage: These students spoke candidly; now it’s your turn. What are the biggest challenges you face in addressing student mental health in and out of the classroom? What experiences have stood out to you? Let us know .

Elizabeth Ndungu is a graduate student in the School of Professional Studies at Columbia University.

Pritish Dakhole is a sophomore studying engineering at Birla Institute of Technology and Science in Pilani, India.

Ocean Ronquillo-Morgan is a member of the University of Southern California’s Class of ’21.

Alberto Briones is a member of Northern Illinois University’s Class of ’22.

Anjali Bathra Ravikumar is a sophomore at The University of Texas at Austin.

Nick Neral studied marketing management at the University of Akron and is a member of the Class of ’18.

Shreyas Gavit studied in the MBA program at Oakland University and graduated as a member of the Class of ’20.

Nigel Hammett studied industrial and systems engineering at North Carolina A&T State University and graduated as a member of Class of ’19.

Alek Nybro studied marketing at St. Edward’s University and graduated as a member of the Class of ’21.

Patrick Mandiraatmadja is a first-year graduate student studying technology management at Columbia University.

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• Open access
• Published: 20 September 2022

Factors that influence mental health of university and college students in the UK: a systematic review

• Fiona Campbell 1 ,
• Lindsay Blank 1 ,
• Anna Cantrell 1 ,
• Susan Baxter 1 ,
• Christopher Blackmore 1 ,
• Jan Dixon 1 &
• Elizabeth Goyder 1  

BMC Public Health volume  22 , Article number:  1778 ( 2022 ) Cite this article

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Worsening mental health of students in higher education is a public policy concern and the impact of measures to reduce transmission of COVID-19 has heightened awareness of this issue. Preventing poor mental health and supporting positive mental wellbeing needs to be based on an evidence informed understanding what factors influence the mental health of students.

To identify factors associated with mental health of students in higher education.

We undertook a systematic review of observational studies that measured factors associated with student mental wellbeing and poor mental health. Extensive searches were undertaken across five databases. We included studies undertaken in the UK and published within the last decade (2010–2020). Due to heterogeneity of factors, and diversity of outcomes used to measure wellbeing and poor mental health the findings were analysed and described narratively.

We included 31 studies, most of which were cross sectional in design. Those factors most strongly and consistently associated with increased risk of developing poor mental health included students with experiences of trauma in childhood, those that identify as LGBTQ and students with autism. Factors that promote wellbeing include developing strong and supportive social networks. Students who are prepared and able to adjust to the changes that moving into higher education presents also experience better mental health. Some behaviours that are associated with poor mental health include lack of engagement both with learning and leisure activities and poor mental health literacy.

Improved knowledge of factors associated with poor mental health and also those that increase mental wellbeing can provide a foundation for designing strategies and specific interventions that can prevent poor mental health and ensuring targeted support is available for students at increased risk.

Peer Review reports

Poor mental health of students in further and higher education is an increasing concern for public health and policy [ 1 , 2 , 3 , 4 ]. A 2020 Insight Network survey of students from 10 universities suggests that “1 in 5 students has a current mental health diagnosis” and that “almost half have experienced a serious psychological issue for which they felt they needed professional help”—an increase from 1 in 3 in the same survey conducted in 2018 [ 5 ]. A review of 105 Further Education (FE) colleges in England found that over a three-year period, 85% of colleges reported an increase in mental health difficulties [ 1 ]. Depression and anxiety were both prevalent and widespread in students; all colleges reported students experiencing depression and 99% reported students experiencing severe anxiety [ 5 , 6 ]. A UK cohort study found that levels of psychological distress increase on entering university [ 7 ], and recent evidence suggests that the prevalence of mental health problems among university students, including self-harm and suicide, is rising, [ 3 , 4 ] with increases in demand for services to support student mental health and reports of some universities finding a doubling of the number of students accessing support [ 8 ]. These common mental health difficulties clearly present considerable threat to the mental health and wellbeing of students but their impact also has educational, social and economic consequences such as academic underperformance and increased risk of dropping out of university [ 9 , 10 ].

Policy changes may have had an influence on the student experience, and on the levels of mental health problems seen in the student population; the biggest change has arguably been the move to widen higher education participation and to enable a more diverse demographic to access University education. The trend for widening participation has been continually rising since the late 1960s [ 11 ] but gained impetus in the 2000s through the work of the Higher Education Funding Council for England (HEFCE). Macaskill (2013) [ 12 ] suggests that the increased access to higher education will have resulted in more students attending university from minority groups and less affluent backgrounds, meaning that more students may be vulnerable to mental health problems, and these students may also experience greater challenges in making the transition to higher education.

Another significant change has been the introduction of tuition fees in 1998, which required students to self fund up to £1,000 per academic year. Since then, tuition fees have increased significantly for many students. With the abolition of maintenance grants, around 96% of government support for students now comes in the form of student loans [ 13 ]. It is estimated that in 2017, UK students were graduating with average debts of £50,000, and this figure was even higher for the poorest students [ 13 ]. There is a clear association between a student’s mental health and financial well-being [ 14 ], with “increased financial concern being consistently associated with worse health” [ 15 ].

The extent to which the increase in poor mental health is also being seen amongst non-students of a similar age is not well understood and warrants further study. However, the increase in poor mental health specifically within students in higher education highlights a need to understand what the risk factors are and what might be done within these settings to ensure young people are learning and developing and transitioning into adulthood in environments that promote mental wellbeing.

Commencing higher education represents a key transition point in a young person’s life. It is a stage often accompanied by significant change combined with high expectations of high expectations from students of what university life will be like, and also high expectations from themselves and others around their own academic performance. Relevant factors include moving away from home, learning to live independently, developing new social networks, adjusting to new ways of learning, and now also dealing with the additional greater financial burdens that students now face.

The recent global COVID-19 pandemic has had considerable impact on mental health across society, and there is concern that younger people (ages 18–25) have been particularly affected. Data from Canada [ 16 ] indicate that among survey respondents, “almost two-thirds (64%) of those aged 15 to 24 reported a negative impact on their mental health, while just over one-third (35%) of those aged 65 and older reported a negative impact on their mental health since physical distancing began” (ibid, p.4). This suggests that older adults are more prepared for the kind of social isolation which has been brought about through the response to COVID-19, whereas young adults have found this more difficult to cope with. UK data from the National Union of Students reports that for over half of UK students, their mental health is worse than before the pandemic [ 17 ]. Before COVID-19, students were already reporting increasing levels of mental health problems [ 2 ], but the COVID-19 pandemic has added a layer of “chronic and unpredictable” stress, creating the perfect conditions for a mental health crisis [ 18 ]. An example of this is the referrals (both urgent and routine) of young people with eating disorders for treatment in the NHS which almost doubled in number from 2019 to 2020 [ 19 ]. The travel restrictions enforced during the pandemic have also impacted on student mental health, particularly for international students who may have been unable to commence studies or go home to see friends and family during holidays [ 20 ].

With the increasing awareness and concern in the higher education sector and national bodies regarding student mental health has come increasing focus on how to respond. Various guidelines and best practice have been developed, e.g. ‘Degrees of Disturbance’ [ 21 ], ‘Good Practice Guide on Responding to Student Mental Health Issues: Duty of Care Responsibilities for Student Services in Higher Education’ [ 22 ] and the recent ‘The University Mental Health Charter’ [ 2 ]. Universities UK produced a Good Practice Guide in 2015 called “Student mental wellbeing in higher education” [ 23 ]. An increasing number of initiatives have emerged that are either student-led or jointly developed with students, and which reflect the increasing emphasis students and student bodies place on mental health and well-being and the increased demand for mental health support: Examples include: Nightline— www.nightline.ac.uk , Students Against Depression— www.studentsagainstdepression.org , Student Minds— www.studentminds.org.uk/student-minds-and-mental-wealth.html and The Alliance for Student-Led Wellbeing— www.alliancestudentwellbeing.weebly.com/ .

Although requests for professional support have increased substantially [ 24 ] only a third of students with mental health problems seek support from counselling services in the UK [ 12 ]. Many students encounter barriers to seeking help such as stigma or lack of awareness of services [ 25 ], and without formal support or intervention, there is a risk of deterioration. FE colleges and universities have identified the need to move beyond traditional forms of support and provide alternative, more accessible interventions aimed at improving mental health and well-being. Higher education institutions have a unique opportunity to identify, prevent, and treat mental health problems because they provide support in multiple aspects of students’ lives including academic studies, recreational activities, pastoral and counselling services, and residential accommodation.

In order to develop services that better meet the needs of students and design environments that are supportive of developing mental wellbeing it is necessary to explore and better understand the factors that lead to poor mental health in students.

Research objectives

The overall aim of this review was to identify, appraise and synthesise existing research evidence that explores the aetiology of poor mental health and mental wellbeing amongst students in tertiary level education. We aimed to gain a better understanding of the mechanisms that lead to poor mental health amongst tertiary level students and, in so doing, make evidence-based recommendations for policy, practice and future research priorities. Specific objectives in line with the project brief were to:

To co-produce with stakeholders a conceptual framework for exploring the factors associated with poorer mental health in students in tertiary settings. The factors may be both predictive, identifying students at risk, or causal, explaining why they are at risk. They may also be protective, promoting mental wellbeing.

To conduct a review drawing on qualitative studies, observational studies and surveys to explore the aetiology of poor mental health in students in university and college settings and identify factors which promote mental wellbeing amongst students.

To identify evidence-based recommendations for policy, service provision and future research that focus on prevention and early identification of poor mental health

Methodology

Identification of relevant evidence.

The following inclusion criteria were used to guide the development of the search strategy and the selection of studies.

We included students from a variety of further education settings (16 yrs + or 18 yrs + , including mature students, international students, distance learning students, students at specific transition points).

Universities and colleges in the UK. We were also interested in the context prior to the beginning of tertiary education, including factors during transition from home and secondary education or existing employment to tertiary education.

Any factor shown to be associated with mental health of students in tertiary level education. This included clinical indicators such as diagnosis and treatment and/or referral for depression and anxiety. Self-reported measures of wellbeing, happiness, stress, anxiety and depression were included. We did not include measures of academic achievement or engagement with learning as indicators of mental wellbeing.

Study design

We included cross-sectional and longitudinal studies that looked at factors associated with mental health outcomes in Table 5 .

Data extraction and quality appraisal

We extracted and tabulated key data from the included papers. Data extraction was undertaken by one reviewer, with a 10% sample checked for accuracy and consistency The quality of the included studies were evaluated using the Newcastle-Ottawa Scale [ 26 ] and the findings of the quality appraisal used in weighting the strength of associations and also identifying gaps for future high quality research.

Involvement of stakeholders

We recruited students, ex-students and parents of students to a public involvement group which met on-line three times during the process of the review and following the completion of the review. During a workshop meeting we asked for members of the group to draw on their personal experiences to suggest factors which were not mentioned in the literature.

Methods of synthesis

We undertook a narrative synthesis [ 27 ] due to the heterogeneity in the exposures and outcomes that were measured across the studies. Data showing the direction of effects and the strength of the association (correlation coefficients) were recorded and tabulated to aid comparison between studies.

Search strategy

Searches were conducted in the following electronic databases: Medline, Applied Social Sciences Index and Abstracts (ASSIA), International Bibliography of Social Sciences (IBSS), Science,PsycINFO and Science and Social Sciences Ciatation Indexes. Additional searches of grey literature, and reference lists of included studies were also undertaken.

The search strategy combined a number of terms relating to students and mental health and risk factors. The search terms included both subject (MeSH) and free-text searches. The searches were limited to papers about humans in English, published from 2010 to June 2020. The flow of studies through the review process is summarised in Fig.  1 .

Flow diagram

The full search strategy for Medline is provided in Appendix 1 .

Thirty-one quantitative, observational studies (39 papers) met the inclusion criteria. The total number of students that participated in the quantitative studies was 17,476, with studies ranging in size from 57 to 3706. Eighteen studies recruited student participants from only one university; five studies (10 publications) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] included seven or more universities. Six studies (7 publications) [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ] only recruited first year students, while the majority of studies recruited students from a range of year groups. Five studies [ 39 , 42 , 43 , 44 , 45 ] recruited only, or mainly, psychology students which may impact on the generalisability of findings. A number of studies focused on students studying particular subjects including: nursing [ 46 ] medicine [ 47 ], business [ 48 ], sports science [ 49 ]. One study [ 50 ] recruited LGBTQ (lesbian, gay, bisexual, transgender, intersex, queer/questioning) students, and one [ 51 ] recruited students who had attended hospital having self-harmed. In 27 of the studies, there were more female than male participants. The mean age of the participants ranged from 19 to 28 years. Ethnicity was not reported in 19 of the studies. Where ethnicity was reported, the proportion that were ‘white British’ ranged from 71 – 90%. See Table 1 for a summary of the characteristics of the included studies and the participants.

Design and quality appraisal of the included studies

The majority of included studies ( n  = 22) were cross-sectional surveys. Nine studies (10 publications) [ 35 , 36 , 39 , 41 , 43 , 50 , 51 , 52 , 53 , 62 ] were longitudinal in design, recording survey data at different time points to explore changes in the variables being measured. The duration of time that these studies covered ranged from 19 weeks to 12 years. Most of the studies ( n  = 22) only recruited participants from a single university. The use of one university setting and the large number of studies that recruited only psychology students weakens the wider applicability of the included studies.

Quantitative variables

Included studies ( n  = 31) measured a wide range of variables and explored their association with poor mental health and wellbeing. These included individual level factors: age, gender, sexual orientation, ethnicity and a range of psychological variables. They also included factors that related to mental health variables (family history, personal history and mental health literacy), pre-university factors (childhood trauma and parenting behaviour. University level factors including social isolation, adjustment and engagement with learning. Their association was measured against different measures of positive mental health and poor mental health.

Measurement of association and the strength of that association has some limitations in addressing our research question. It cannot prove causality, and nor can it capture fully the complexity of the inter-relationship and compounding aspect of the variables. For example, the stress of adjustment may be manageable, until it is combined with feeling isolated and out of place. Measurement itself may also be misleading, only capturing what is measureable, and may miss variables that are important but not known. We included both qualitative and PPI input to identify missed but important variables.

The wide range of variables and different outcomes, with few studies measuring the same variable and outcomes, prevented meta-analyses of findings which are therefore described narratively.

The variables described were categorised during the analyses into the following categories:

Vulnerabilities – factors that are associated with poor mental health

Individual level factors including; age, ethnicity, gender and a range of psychological variables were all measured against different mental health outcomes including depression, anxiety, paranoia, and suicidal behaviour, self-harm, coping and emotional intelligence.

Six studies [ 40 , 42 , 47 , 50 , 60 , 63 ] examined a student’s ages and association with mental health. There was inconsistency in the study findings, with studies finding that age (21 or older) was associated with fewer depressive symptoms, lower likelihood of suicide ideation and attempt, self-harm, and positively associated with better coping skills and mental wellbeing. This finding was not however consistent across studies and the association was weak. Theoretical models that seek to explain this mechanism have suggested that older age groups may cope better due to emotion-regulation strategies improving with age [ 67 ]. However, those over 30 experienced greater financial stress than those aged 17-19 in another study [ 63 ].

Sexual orientation

Four studies [ 33 , 40 , 64 , 68 ] examined the association between poor mental health and sexual orientation status. In all of the studies LGBTQ students were at significantly greater risk of mental health problems including depression [ 40 ], anxiety [ 40 ], suicidal behaviour [ 33 , 40 , 64 ], self harm [ 33 , 40 , 64 ], use of mental health services [ 33 ] and low levels of wellbeing [ 68 ]. The risk of mental health problems in these students compared with heterosexual students, ranged from OR 1.4 to 4.5. This elevated risk may reflect the greater levels of isolation and discrimination commonly experienced by minority groups.

Nine studies [ 33 , 38 , 39 , 40 , 42 , 47 , 50 , 60 , 63 ] examined whether gender was associated mental health variables. Two studies [ 33 , 47 ] found that being female was statistically significantly associated with use of mental health services, having a current mental health problem, suicide risk, self harm [ 33 ] and depression [ 47 ]. The results were not consistent, with another study [ 60 ] finding the association was not significant. Three studies [ 39 , 40 , 42 ] that considered mediating variables such as adaptability and coping found no difference or very weak associations.

Two studies [ 47 , 60 ] examined the extent to which ethnicity was associated with mental health One study [ 47 ] reported that the risks of depression were significantly greater for those who categorised themselves as non-white (OR 8.36 p = 0.004). Non-white ethnicity was also associated with poorer mental health in another cross-sectional study [ 63 ]. There was no significant difference in the McIntyre et al. (2018) study [ 60 ]. The small number of participants from ethnic minority groups represented across the studies means that this data is very limited.

Family factors

Six studies [ 33 , 40 , 42 , 50 , 60 ] explored the association of a concept that related to a student’s experiences in childhood and before going to university. Three studies [ 40 , 50 , 60 ] explored the impact of ACEs (Adverse Childhood Experiences) assessed using the same scale by Feletti (2009) [ 69 ] and another explored the impact of abuse in childhood [ 46 ]. Two studies examined the impact of attachment anxiety and avoidance [ 42 ], and parental acceptance [ 46 , 59 ]. The studies measured different mental health outcomes including; positive and negative affect, coping, suicide risk, suicide attempt, current mental health problem, use of mental health services, psychological adjustment, depression and anxiety.

The three studies that explored the impact of ACE’s all found a significant and positive relationship with poor mental health amongst university students. O’Neill et al. (2018) [ 50 ] in a longitudinal study ( n  = 739) showed that there was in increased likelihood in self-harm and suicidal behaviours in those with either moderate or high levels of childhood adversities (OR:5.5 to 8.6) [ 50 ]. McIntyre et al. (2018) [ 60 ] ( n  = 1135) also explored other dimensions of adversity including childhood trauma through multiple regression analysis with other predictive variables. They found that childhood trauma was significantly positively correlated with anxiety, depression and paranoia (ß = 0.18, 0.09, 0.18) though the association was not as strong as the correlation seen for loneliness (ß = 0.40) [ 60 ]. McLafferty et al. (2019) [ 40 ] explored the compounding impact of childhood adversity and negative parenting practices (over-control, overprotection and overindulgence) on poor mental health (depression OR 1.8, anxiety OR 2.1 suicidal behaviour OR 2.3, self-harm OR 2.0).

Gaan et al.’s (2019) survey of LGBTQ students ( n  = 1567) found in a multivariate analyses that sexual abuse, other abuse from violence from someone close, and being female had the highest odds ratios for poor mental health and were significantly associated with all poor mental health outcomes [ 33 ].

While childhood trauma and past abuse poses a risk to mental health for all young people it may place additional stresses for students at university. Entry to university represents life stage where there is potential exposure to new and additional stressors, and the possibility that these students may become more isolated and find it more difficult to develop a sense of belonging. Students may be separated for the first time from protective friendships. However, the mechanisms that link childhood adversities and negative psychopathology, self-harm and suicidal behaviour are not clear [ 40 ]. McLafferty et al. (2019) also measured the ability to cope and these are not always impacted by childhood adversities [ 40 ]. They suggest that some children learn to cope and build resilience that may be beneficial.

McLafferty et al. (2019) [ 40 ] also studied parenting practices. Parental over-control and over-indulgence was also related to significantly poorer coping (OR -0.075 p  < 0.05) and this was related to developing poorer coping scores (OR -0.21 p  < 0.001) [ 40 ]. These parenting factors only became risk factors when stress levels were high for students at university. It should be noted that these studies used self-report, and responses regarding views of parenting may be subjective and open to interpretation. Lloyd et al.’s (2014) survey found significant positive correlations between perceived parental acceptance and students’ psychological adjustment, with paternal acceptance being the stronger predictor of adjustment.

Autistic students may display social communication and interaction deficits that can have negative emotional impacts. This may be particularly true during young adulthood, a period of increased social demands and expectations. Two studies [ 56 ] found that those with autism had a low but statistically significant association with poor social problem-solving skills and depression.

Mental health history

Three studies [ 47 , 51 , 68 ] investigated mental health variables and their impact on mental health of students in higher education. These included; a family history of mental illness and a personal history of mental illness.

Students with a family history or a personal history of mental illness appear to have a significantly greater risk of developing problems with mental health at university [ 47 ]. Mahadevan et al. (2010) [ 51 ] found that university students who self-harm have a significantly greater risk (OR 5.33) of having an eating disorder than a comparison group of young adults who self-harm but are not students.

Buffers – factors that are protective of mental wellbeing

Psychological factors.

Twelve studies [ 29 , 39 , 40 , 41 , 42 , 43 , 46 , 49 , 54 , 58 , 64 ] assessed the association of a range of psychological variables and different aspects of mental wellbeing and poor mental health. We categorised these into the following two categories: firstly, psychological variables measuring an individual’s response to change and stressors including adaptability, resilience, grit and emotional regulation [ 39 , 40 , 41 , 42 , 43 , 46 , 49 , 54 , 58 ] and secondly, those that measure self-esteem and body image [ 29 , 64 ].

The evidence from the eight included quantitative studies suggests that students with psychological strengths including; optimism, self-efficacy [ 70 ], resilience, grit [ 58 ], use of positive reappraisal [ 49 ], helpful coping strategies [ 42 ] and emotional intelligence [ 41 , 46 ] are more likely to experience greater mental wellbeing (see Table 2 for a description of the psychological variables measured). The positive association between these psychological strengths and mental well-being had a positive affect with associations ranging from r  = 0.2–0.5 and OR1.27 [ 41 , 43 , 46 , 49 , 54 ] (low to moderate strength of association). The negative associations with depressive symptoms are also statistically significant but with a weaker association ( r  = -0.2—0.3) [ 43 , 49 , 54 ].

Denovan (2017a) [ 43 ] in a longitudinal study found that the association between psychological strengths and positive mental wellbeing was not static and that not all the strengths remained statistically significant over time. The only factors that remained significant during the transition period were self-efficacy and optimism, remaining statistically significant as they started university and 6 months later.

Parental factors

Only one study [ 59 ] explored family factors associated with the development of psychological strengths that would equip young people as they managed the challenges and stressors encountered during the transition to higher education. Lloyd et al. (2014) [ 59 ] found that perceived maternal and paternal acceptance made significant and unique contributions to students’ psychological adjustment. Their research methods are limited by their reliance on retrospective measures and self-report measures of variables, and these results could be influenced by recall bias.

Two studies [ 29 , 64 ] considered the impact of how individuals view themselves on poor mental health. One study considered the impact of self-esteem and the association with non-accidental self-injury (NSSI) and suicide attempt amongst 734 university students. As rates of suicide and NSSI are higher amongst LGBT (lesbian, gay, bisexual, transgender) students, the prevalence of low self-esteem was compared. There was a low but statistically significant association between low self-esteem and NSSI, though not for suicide attempt. A large survey, including participants from seven universities [ 42 ] compared depressive symptoms in students with marked body image concerns, reporting that the risk of depressive symptoms was greater (OR 2.93) than for those with lower levels of body image concerns.

Mental health literacy and help seeking behaviour

Two studies [ 48 , 68 ] investigated attitudes to mental illness, mental health literacy and help seeking for mental health problems.

University students who lack sufficient mental health literacy skills to be able to recognise problems or where there are attitudes that foster shame at admitting to having mental health problems can result in students not recognising problems and/or failing to seek professional help [ 48 , 68 ]. Gorcyznski et al. (2017) [ 68 ] found that women and those who had a history of previous mental health problems exhibited significantly higher levels of mental health literacy. Greater mental health literacy was associated with an increased likelihood that individuals would seek help for mental health problems. They found that many students find it hard to identify symptoms of mental health problems and that 42% of students are unaware of where to access available resources. Of those who expressed an intention to seek help for mental health problems, most expressed a preference for online resources, and seeking help from family and friends, rather than medical professionals such as GPs.

Kotera et al. (2019) [ 48 ] identified self-compassion as an explanatory variable, reducing social comparison, promoting self-acceptance and recognition that discomfort is an inevitable human experience. The study found a strong, significant correlation between self-compassion and mental health symptoms ( r  = -0.6. p  < 0.01).

There again appears to be a cycle of reinforcement, where poor mental health symptoms are felt to be a source of shame and become hidden, help is not sought, and further isolation ensues, leading to further deterioration in mental health. Factors that can interrupt the cycle are self-compassion, leading to more readiness to seek help (see Fig.  2 ).

Poor mental health – cycles of reinforcement

Social networks

Nine studies [ 33 , 38 , 41 , 46 , 51 , 54 , 60 , 64 , 65 ] examined the concepts of loneliness and social support and its association with mental health in university students. One study also included students at other Higher Education Institutions [ 46 ]. Eight of the studies were surveys, and one was a retrospective case control study to examine the differences between university students and age-matched young people (non-university students) who attended hospital following deliberate self-harm [ 51 ].

Included studies demonstrated considerable variation in how they measured the concepts of social isolation, loneliness, social support and a sense of belonging. There were also differences in the types of outcomes measured to assess mental wellbeing and poor mental health. Grouping the studies within a broad category of ‘social factors’ therefore represents a limitation of this review given that different aspects of the phenomena may have been being measured. The tools used to measure these variables also differed. Only one scale (The UCLA loneliness scale) was used across multiple studies [ 41 , 60 , 65 ]. Diverse mental health outcomes were measured across the studies including positive affect, flourishing, self-harm, suicide risk, depression, anxiety and paranoia.

Three studies [ 41 , 60 , 62 ] measuring loneliness, two longitudinally [ 41 , 62 ], found a consistently positive association between loneliness and poor mental health in university students. Greater loneliness was linked to greater anxiety, stress, depression, poor general mental health, paranoia, alcohol abuse and eating disorder problems. The strength of the correlations ranged from 0–3-0.4 and were all statistically significant (see Tables 3 and 4 ). Loneliness was the strongest overall predictor of mental distress, of those measured. A strong identification with university friendship groups was most protective against distress relative to other social identities [ 60 ]. Whether poor mental health is the cause, or the result of loneliness was explored further in the studies. The results suggest that for general mental health, stress, depression and anxiety, loneliness induces or exacerbates symptoms of poor mental health over time [ 60 , 62 ]. The feedback cycle is evident, with loneliness leading to poor mental health which leads to withdrawal from social contacts and further exacerbation of loneliness.

Factors associated with protecting against loneliness by fostering supportive friendships and promoting mental wellbeing were also identified. Beliefs about the value of ‘leisure coping’, and attributes of resilience and emotional intelligence had a moderate, positive and significant association with developing mental wellbeing and were explored in three studies [ 46 , 54 , 66 ].

The transition to and first year at university represent critical times when friendships are developed. Thomas et al. (2020) [ 65 ] explored the factors that predict loneliness in the first year of university. A sense of community and higher levels of ‘social capital’ were significantly associated with lower levels of loneliness. ‘Social capital’ scales measure the development of emotionally supportive friendships and the ability to adjust to the disruption of old friendships as students transition to university. Students able to form close relationships within their first year at university are less likely to experience loneliness (r-0.09, r- 0.36, r- 0.34). One study [ 38 ] investigating the relationship between student experience and being the first in the family to attend university found that these students had lower ratings for peer group interactions.

Young adults at university and in higher education are facing multiple adjustments. Their ability to cope with these is influenced by many factors. Supportive friendships and a sense of belonging are factors that strengthen coping. Nightingale et al. (2012) undertook a longitudinal study to explore what factors were associated with university adjustment in a sample of first year students ( n  = 331) [ 41 ]. They found that higher skills of emotion management and emotional self-efficacy were predictive of stable adjustment. These students also reported the lowest levels of loneliness and depression. This group had the skills to recognise their emotions and cope with stressors and were confident to access support. Students with poor emotion management and low levels of emotional self-efficacy may benefit from intervention to support the development of adaptive coping strategies and seeking support.

The positive and negative feedback loops

The relationship between the variables described appeared to work in positive and negative feedback loops with high levels of social capital easing the formation of a social network which acts as a critical buffer to stressors (see Fig.  3 ). Social networks and support give further strengthening and reinforcement, stimulating positive affect, engagement and flourishing. These, in turn, widen and deepen social networks for support and enhance a sense of wellbeing. Conversely young people who enter the transition to university/higher education with less social capital are less likely to identify with and locate a social network; isolation may follow, along with loneliness, anxiety, further withdrawal from contact with social networks and learning, and depression.

Triggers – factors that may act in combination with other factors to lead to poor mental health

Stress is seen as playing a key role in the development of poor mental health for students in higher education. Theoretical models and empirical studies have suggested that increases in stress are associated with decreases in student mental health [ 12 , 43 ]. Students at university experience the well-recognised stressors associated with academic study such as exams and course work. However, perhaps less well recognised are the processes of transition, requiring adapting to a new social and academic environment (Fisher 1994 cited by Denovan 2017a) [ 43 ]. Por et al. (2011) [ 46 ] in a small ( n  = 130 prospective survey found a statistically significant correlation between higher levels of emotional intelligence and lower levels of perceived stress ( r  = 0.40). Higher perceived stress was also associated with negative affect in two studies [ 43 , 46 ], and strongly negatively associated with positive affect (correlation -0.62) [ 54 ].

University variables

Eleven studies [ 35 , 39 , 47 , 51 , 52 , 54 , 60 , 63 , 65 , 83 , 84 ] explored university variables, and their association with mental health outcomes. The range of factors and their impact on mental health variables is limited, and there is little overlap. Knowledge gaps are shown by factors highlighted by our PPI group as potentially important but not identified in the literature (see Table 5 ). It should be noted that these may reflect the focus of our review, and our exclusion of intervention studies which may evaluate university factors.

High levels of perceived stress caused by exam and course work pressure was positively associated with poor mental health and lack of wellbeing [ 51 , 52 , 54 ]. Other potential stressors including financial anxieties and accommodation factors appeared to be less consistently associated with mental health outcomes [ 35 , 38 , 47 , 51 , 60 , 62 ]. Important mediators and buffers to these stressors are coping strategies and supportive networks (see conceptual model Appendix 2 ). One impact of financial pressures was that students who worked longer hours had less interaction with their peers, limiting the opportunities for these students to benefit from the protective effects of social support.

Red flags – behaviours associated with poor mental health and/or wellbeing

Engagement with learning and leisure activities.

Engagement with learning activities was strongly and positively associated with characteristics of adaptability [ 39 ] and also happiness and wellbeing [ 52 ] (see Fig.  4 ). Boulton et al. (2019) [ 52 ] undertook a longitudinal survey of undergraduate students at a campus-based university. They found that engagement and wellbeing varied during the term but were strongly correlated.

Engagement and wellbeing

Engagement occurred in a wide range of activities and behaviours. The authors suggest that the strong correlation between all forms of engagement with learning has possible instrumental value for the design of systems to monitor student engagement. Monitoring engagement might be used to identify changes in the behaviour of individuals to assist tutors in providing support and pastoral care. Students also were found to benefit from good induction activities provided by the university. Greater induction satisfaction was positively and strongly associated with a sense of community at university and with lower levels of loneliness [ 65 ].

The inte r- related nature of these variables is depicted in Fig.  4 . Greater adaptability is strongly associated with more positive engagement in learning and university life. More engagement is associated with higher mental wellbeing.

Denovan et al. (2017b) [ 54 ] explored leisure coping, its psychosocial functions and its relationship with mental wellbeing. An individual’s beliefs about the benefits of leisure activities to manage stress, facilitate the development of companionship and enhance mood were positively associated with flourishing and were negatively associated with perceived stress. Resilience was also measured. Resilience was strongly and positively associated with leisure coping beliefs and with indicators of mental wellbeing. The authors conclude that resilient individuals are more likely to use constructive means of coping (such as leisure coping) to proactively cultivate positive emotions which counteract the experience of stress and promote wellbeing. Leisure coping is predictive of positive affect which provides a strategy to reduce stress and sustain coping. The belief that friendships acquired through leisure provide social support is an example of leisure coping belief. Strong emotionally attached friendships that develop through participation in shared leisure pursuits are predictive of higher levels of well-being. Friendship bonds formed with fellow students at university are particularly important for maintaining mental health, and opportunities need to be developed and supported to ensure that meaningful social connections are made.

The ‘broaden-and-build theory’ (Fredickson 2004 [ 85 ] cited by [ 54 ]) may offer an explanation for the association seen between resilience, leisure coping and psychological wellbeing. The theory is based upon the role that positive and negative emotions have in shaping human adaptation. Positive emotions broaden thinking, enabling the individual to consider a range of ways of dealing with and adapting to their environment. Conversely, negative emotions narrow thinking and limit options for adapting. The former facilitates flourishing, facilitating future wellbeing. Resilient individuals are more likely to use constructive means of coping which generate positive emotion (Tugade & Fredrickson 2004 [ 86 ], cited by [ 54 ]). Positive emotions therefore lead to growth in coping resources, leading to greater well-being.

Health behaviours at university

Seven studies [ 29 , 31 , 38 , 45 , 51 , 54 , 66 ] examined how lifestyle behaviours might be linked with mental health outcomes. The studies looked at leisure activities [ 63 , 80 ], diet [ 29 ], alcohol use [ 29 , 31 , 38 , 51 ] and sleep [ 45 ].

Depressive symptoms were independently associated with problem drinking and possible alcohol dependence for both genders but were not associated with frequency of drinking and heavy episodic drinking. Students with higher levels of depressive symptoms reported significantly more problem drinking and possible alcohol dependence [ 31 ]. Mahadevan et al. (2010) [ 51 ] compared students and non-students seen in hospital for self-harm and found no difference in harmful use of alcohol and illicit drugs.

Poor sleep quality and increased consumption of unhealthy foods were also positively associated with depressive symptoms and perceived stress [ 29 ]. The correlation with dietary behaviours and poor mental health outcomes was low, but also confirmed by the negative correlation between less perceived stress and depressive symptoms and consumption of a healthier diet.

Physical activity and participation in leisure pursuits were both strongly correlated with mental wellbeing ( r  = 0.4) [ 54 ], and negatively correlated with depressive symptoms and anxiety ( r  = -0.6, -0.7) [ 66 ].

Thirty studies measuring the association between a wide range of factors and poor mental health and mental wellbeing in university and college students were identified and included in this review. Our purpose was to identify the factors that contribute to the growing prevalence of poor mental health amongst students in tertiary level education within the UK. We also aimed to identify factors that promote mental wellbeing and protect against deteriorating poor mental health.

Loneliness and social isolation were strongly associated with poor mental health and a sense of belonging and a strong support network were strongly associated with mental wellbeing and happiness. These associations were strongly positive in the eight studies that explored them and are consistent with other meta-analyses exploring the link between social support and mental health [ 87 ].

Another factor that appeared to be protective was older age when starting university. A wide range of personal traits and characteristics were also explored. Those associated with resilience, ability to adjust and better coping led to improved mental wellbeing. Better engagement appeared as an important mediator to potentially explain the relationship between these two variables. Engagement led to students being able to then tap into those features that are protective and promoting of mental wellbeing.

Other important risk factors for poor mental wellbeing that emerged were those students with existing or previous mental illness. Students on the autism spectrum and those with poor social problem-solving also were more likely to suffer from poor mental health. Negative self-image was also associated with poor mental health at university. Eating disorders were strongly associated with poor mental wellbeing and were found to be far more of a risk in students at university than in a comparative group of young people not in higher education. Other studies of university students also found that pre-existing poor mental health was a strong predictor of poor mental health in university students [ 88 ].

At a family level, the experience of childhood trauma and adverse experiences including, for example, neglect, household dysfunction or abuse, were strongly associated with poor mental health in young people at university. Students with a greater number of ‘adverse childhood experiences’ were at significantly greater risk of poor mental health than those students without experience of childhood trauma. This was also identified in a review of factors associated with depression and suicide related outcomes amongst university undergraduate students [ 88 ].

Our findings, in contrast to findings from other studies of university students, did not find that female gender associated with poor mental health and wellbeing, and it also found that being a mature student was protective of mental wellbeing.

Exam and course work pressure was associated with perceived stress and poor mental health. A lack of engagement with learning activities was also associated with poor mental health. A number of variables were not consistently shown to be associated with poor mental health including financial concerns and accommodation factors. Very little evidence related to university organisation or support structures was assessed in the evidence. One study found that a good induction programme had benefits for student mental wellbeing and may be a factor that enables students to become a part of a social network positive reinforcement cycle. Involvement in leisure activities was also found to be associated with improved coping strategies and better mental wellbeing. Students with poorer mental health tended to also eat in a less healthy manner, consume more harmful levels of alcohol, and experience poorer sleep.

This evidence review of the factors that influence mental health and wellbeing indicate areas where universities and higher education settings could develop and evaluate innovations in practice. These include:

Interventions before university to improve preparation of young people and their families for the transition to university.

Exploratory work to identify the acceptability and feasibility of identifying students at risk or who many be exhibiting indications of deteriorating mental health

Interventions that set out to foster a sense of belonging and identify

Creating environments that are helpful for building social networks

Improving mental health literacy and access to high quality support services

This review has a number of limitations. Most of the included studies were cross-sectional in design, with a small number being longitudinal ( n  = 7), following students over a period of time to observe changes in the outcomes being measured. Two limitations of these sources of data is that they help to understand associations but do not reveal causality; secondly, we can only report the findings for those variables that were measured, and we therefore have to support causation in assuming these are the only factors that are related to mental health.

Furthermore, our approach has segregated and categorised variables in order to better understand the extent to which they impact mental health. This approach does not sufficiently explore or reveal the extent to which variables may compound one another, for example, feeling the stress of new ways of learning may not be a factor that influences mental health until it is combined with a sense of loneliness, anxiety about financial debt and a lack of parental support. We have used our PPI group and the development of vignettes of their experiences to seek to illustrate the compounding nature of the variables identified.

We limited our inclusion criteria to studies undertaken in the UK and published within the last decade (2009–2020), again meaning we may have limited our inclusion of relevant data. We also undertook single data extraction of data which may increase the risk of error in our data.

Understanding factors that influence students’ mental health and wellbeing offers the potential to find ways to identify strategies that enhance the students’ abilities to cope with the challenges of higher education. This review revealed a wide range of variables and the mechanisms that may explain how they impact upon mental wellbeing and increase the risk of poor mental health amongst students. It also identified a need for interventions that are implemented before young people make the transition to higher education. We both identified young people who are particularly vulnerable and the factors that arise that exacerbate poor mental health. We highlight that a sense of belonging and supportive networks are important buffers and that there are indicators including lack of engagement that may enable early intervention to provide targeted and appropriate support.

Availability of data and materials

Further details of the study and the findings can be provided on request to the lead author ([email protected]).

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Acknowledgements

We acknowledge the input from our public advisory group which included current and former students, and family members of students who have struggled with their mental health. The group gave us their extremely valuable insights to assist our understanding of the evidence.

This project was supported by funding from the National Institute for Health Research as part of the NIHR Public Health Research  Programme (fuding reference 127659 Public Health Review Team). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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All of the included authors designed the project methods and prepared a protocol. A.C. designed the search strategy. F.C, L.B and C.B screened the identified citations and undertook data extraction. S.B. led the PPI involvement. JD participated as a member of the PPI group. F.C and L.B undertook the analysis. F.C. and L.B wrote the main manuscript text. All authors reviewed the manuscript. F.C designed Figs. 2 , 3 and 4 . The author(s) read and approved the final manuscript.

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Campbell, F., Blank, L., Cantrell, A. et al. Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 22 , 1778 (2022). https://doi.org/10.1186/s12889-022-13943-x

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Covid-19’s Impact on Students’ Academic and Mental Well-Being

The pandemic has revealed—and exacerbated—inequities that hold many students back. Here’s how teachers can help.

The pandemic has shone a spotlight on inequality in America: School closures and social isolation have affected all students, but particularly those living in poverty. Adding to the damage to their learning, a mental health crisis is emerging as many students have lost access to services that were offered by schools.

No matter what form school takes when the new year begins—whether students and teachers are back in the school building together or still at home—teachers will face a pressing issue: How can they help students recover and stay on track throughout the year even as their lives are likely to continue to be disrupted by the pandemic?

New research provides insights about the scope of the problem—as well as potential solutions.

The Achievement Gap Is Likely to Widen

A new study suggests that the coronavirus will undo months of academic gains, leaving many students behind. The study authors project that students will start the new school year with an average of 66 percent of the learning gains in reading and 44 percent of the learning gains in math, relative to the gains for a typical school year. But the situation is worse on the reading front, as the researchers also predict that the top third of students will make gains, possibly because they’re likely to continue reading with their families while schools are closed, thus widening the achievement gap.

To make matters worse, “few school systems provide plans to support students who need accommodations or other special populations,” the researchers point out in the study, potentially impacting students with special needs and English language learners.

Of course, the idea that over the summer students forget some of what they learned in school isn’t new. But there’s a big difference between summer learning loss and pandemic-related learning loss: During the summer, formal schooling stops, and learning loss happens at roughly the same rate for all students, the researchers point out. But instruction has been uneven during the pandemic, as some students have been able to participate fully in online learning while others have faced obstacles—such as lack of internet access—that have hindered their progress.

In the study, researchers analyzed a national sample of 5 million students in grades 3–8 who took the MAP Growth test, a tool schools use to assess students’ reading and math growth throughout the school year. The researchers compared typical growth in a standard-length school year to projections based on students being out of school from mid-March on. To make those projections, they looked at research on the summer slide, weather- and disaster-related closures (such as New Orleans after Hurricane Katrina), and absenteeism.

The researchers predict that, on average, students will experience substantial drops in reading and math, losing roughly three months’ worth of gains in reading and five months’ worth of gains in math. For Megan Kuhfeld, the lead author of the study, the biggest takeaway isn’t that learning loss will happen—that’s a given by this point—but that students will come back to school having declined at vastly different rates.

“We might be facing unprecedented levels of variability come fall,” Kuhfeld told me. “Especially in school districts that serve families with lots of different needs and resources. Instead of having students reading at a grade level above or below in their classroom, teachers might have kids who slipped back a lot versus kids who have moved forward.” 

Disproportionate Impact on Students Living in Poverty and Students of Color

Horace Mann once referred to schools as the “great equalizers,” yet the pandemic threatens to expose the underlying inequities of remote learning. According to a 2015 Pew Research Center analysis , 17 percent of teenagers have difficulty completing homework assignments because they do not have reliable access to a computer or internet connection. For Black students, the number spikes to 25 percent.

“There are many reasons to believe the Covid-19 impacts might be larger for children in poverty and children of color,” Kuhfeld wrote in the study. Their families suffer higher rates of infection, and the economic burden disproportionately falls on Black and Hispanic parents, who are less likely to be able to work from home during the pandemic.

Although children are less likely to become infected with Covid-19, the adult mortality rates, coupled with the devastating economic consequences of the pandemic, will likely have an indelible impact on their well-being.

Impacts on Students’ Mental Health

That impact on well-being may be magnified by another effect of school closures: Schools are “the de facto mental health system for many children and adolescents,” providing mental health services to 57 percent of adolescents who need care, according to the authors of a recent study published in JAMA Pediatrics . School closures may be especially disruptive for children from lower-income families, who are disproportionately likely to receive mental health services exclusively from schools.

“The Covid-19 pandemic may worsen existing mental health problems and lead to more cases among children and adolescents because of the unique combination of the public health crisis, social isolation, and economic recession,” write the authors of that study.

A major concern the researchers point to: Since most mental health disorders begin in childhood, it is essential that any mental health issues be identified early and treated. Left untreated, they can lead to serious health and emotional problems. In the short term, video conferencing may be an effective way to deliver mental health services to children.

Mental health and academic achievement are linked, research shows. Chronic stress changes the chemical and physical structure of the brain, impairing cognitive skills like attention, concentration, memory, and creativity. “You see deficits in your ability to regulate emotions in adaptive ways as a result of stress,” said Cara Wellman, a professor of neuroscience and psychology at Indiana University in a 2014 interview . In her research, Wellman discovered that chronic stress causes the connections between brain cells to shrink in mice, leading to cognitive deficiencies in the prefrontal cortex. 

While trauma-informed practices were widely used before the pandemic, they’re likely to be even more integral as students experience economic hardships and grieve the loss of family and friends. Teachers can look to schools like Fall-Hamilton Elementary in Nashville, Tennessee, as a model for trauma-informed practices . 

3 Ways Teachers Can Prepare

When schools reopen, many students may be behind, compared to a typical school year, so teachers will need to be very methodical about checking in on their students—not just academically but also emotionally. Some may feel prepared to tackle the new school year head-on, but others will still be recovering from the pandemic and may still be reeling from trauma, grief, and anxiety. 

Here are a few strategies teachers can prioritize when the new school year begins:

• Focus on relationships first. Fear and anxiety about the pandemic—coupled with uncertainty about the future—can be disruptive to a student’s ability to come to school ready to learn. Teachers can act as a powerful buffer against the adverse effects of trauma by helping to establish a safe and supportive environment for learning. From morning meetings to regular check-ins with students, strategies that center around relationship-building will be needed in the fall.
• Strengthen diagnostic testing. Educators should prepare for a greater range of variability in student learning than they would expect in a typical school year. Low-stakes assessments such as exit tickets and quizzes can help teachers gauge how much extra support students will need, how much time should be spent reviewing last year’s material, and what new topics can be covered.
• Differentiate instruction—particularly for vulnerable students. For the vast majority of schools, the abrupt transition to online learning left little time to plan a strategy that could adequately meet every student’s needs—in a recent survey by the Education Trust, only 24 percent of parents said that their child’s school was providing materials and other resources to support students with disabilities, and a quarter of non-English-speaking students were unable to obtain materials in their own language. Teachers can work to ensure that the students on the margins get the support they need by taking stock of students’ knowledge and skills, and differentiating instruction by giving them choices, connecting the curriculum to their interests, and providing them multiple opportunities to demonstrate their learning.

Mental Health Essay for Students and Children

500+ words essay on mental health.

Every year world mental health day is observed on October 10. It was started as an annual activity by the world federation for mental health by deputy secretary-general of UNO at that time. Mental health resources differ significantly from one country to another. While the developed countries in the western world provide mental health programs for all age groups. Also, there are third world countries they struggle to find the basic needs of the families. Thus, it becomes prudent that we are asked to focus on mental health importance for one day. The mental health essay is an insight into the importance of mental health in everyone’s life. 

Mental Health

In the formidable years, this had no specific theme planned. The main aim was to promote and advocate the public on important issues. Also, in the first three years, one of the central activities done to help the day become special was the 2-hour telecast by the US information agency satellite system. 

Mental health is not just a concept that refers to an individual’s psychological and emotional well being. Rather it’s a state of psychological and emotional well being where an individual is able to use their cognitive and emotional capabilities, meet the ordinary demand and functions in the society. According to WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors like cultural differences, competing professional theories, and subjective assessments that affect how mental health is defined. Also, there are many experts that agree that mental illness and mental health are not antonyms. So, in other words, when the recognized mental disorder is absent, it is not necessarily a sign of mental health. 

Get the huge list of more than 500 Essay Topics and Ideas

One way to think about mental health is to look at how effectively and successfully does a person acts. So, there are factors such as feeling competent, capable, able to handle the normal stress levels, maintaining satisfying relationships and also leading an independent life. Also, this includes recovering from difficult situations and being able to bounce back.  

Important Benefits of Good Mental Health

Mental health is related to the personality as a whole of that person. Thus, the most important function of school and education is to safeguard the mental health of boys and girls. Physical fitness is not the only measure of good health alone. Rather it’s just a means of promoting mental as well as moral health of the child. The two main factors that affect the most are feeling of inferiority and insecurity. Thus, it affects the child the most. So, they lose self-initiative and confidence. This should be avoided and children should be constantly encouraged to believe in themselves.

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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

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• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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• Published: 27 April 2022

School educational models and child mental health among K-12 students: a scoping review

• Ting Yu 1 ,
• Jian Xu 1 ,
• Yining Jiang 1 ,
• Hui Hua 1 ,
• Yulai Zhou 1 &
• Xiangrong Guo 1 , 2  

Child and Adolescent Psychiatry and Mental Health volume  16 , Article number:  32 ( 2022 ) Cite this article

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The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies.

This scoping review followed the framework of Arksey and O’Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases.

Results/findings

After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development.

Conclusions

The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.

Introduction

In recent years, mental health conditions among children and adolescents have received considerable attention as a public health concern. Globally about 10–20% of children and adolescents experience mental health problems [ 1 , 2 ], and mental health problems in early life may have the potential for long-term adverse consequences [ 3 , 4 ]. In 2019, the World Health Organization has pointed out that childhood and adolescence are critical periods for the acquisition of socio-emotional capabilities and for prevention of mental health problems [ 5 ]. A comprehensive multi-level solution to child mental health problems needs to be put forward for the sake of a healthier lifestyle and environment for future generations.

The school is a unique resource to help children improve their mental health. A few generations ago, schools’ priority was to teach the traditional subjects, such as reading, writing, and arithmetic. However, children are now spending a large amount of time at school where they learn, play and socialize. For some students, schools have a positive influence on their mental health. While for others, schools can present as a considerable source of stress, worry, and unhappiness, and hinder academic achievement [ 2 ]. According to Greenberg et al., today’s schools need to teach beyond basic skills (such as reading, writing, and counting skills) and enhance students’ social-emotional competence, characters, health, and civic engagement [ 6 ]. Therefore, universal mental health promotion in school settings is recognized to be particularly effective in improving students’ emotional well-being [ 2 , 7 ].

Research evidence over the last two decades has shown that schools can make a difference to students’ mental health [ 8 ]. Previous related systematic reviews or meta-analyses focused on the effects of a particular school-based intervention on child mental health [ 9 , 10 ] and answered a specific question with available research, however, reviews covering different school-related factors or school-based interventions are still lacking. An appropriate model of school education requires the combination of different school-related factors (such as curriculum, homework, and physical activities) and therefore needs to focus on multiple primary outcomes. Thus, we consider that a scoping review may be more appropriate to help us synthesize the recent evidence than a systematic review or meta-analysis, as the wide coverage and the heterogeneous nature of related literature focusing on multiple primary outcomes are not amenable to a more precise systematic review or meta-analysis [ 11 ]. To the best of our knowledge, this review is among the first to provide a comprehensive overview of available evidence on the potential impacts of multiple school-related factors or school-based interventions on student mental health, and identify school-related risk/protective factors involved in the development of mental health problems among K-12 students, and therefore, to help develop a holistic model of K-12 education.

A scoping review was systematically conducted following the methodological framework of Arksey and O'Malley [ 12 ]: defining the research question; identifying relevant studies; study selection; data extraction; and summarizing and reporting results. The protocol for this review was specified in advance and submitted for registration in the PROSPERO database (Reference number, CRD42019123126).

Defining the research question (stage 1)

For this review, we sought to answer the following questions:

What is known from the existing literature on the potential impacts of school-related factors or school-based interventions on student mental health?

What are the interrelationships among these factors involved in the school educational process?

What are the cross-cultural differences in K-12 education process across nations and societies?

Identifying relevant studies (stage 2)

The search was conducted in PubMed, Web of Science and Embase electronic databases, and the dates of the published articles included in the search were limited to the last 5 years until 23 March 2021. The PsycExtra database was also searched to identify relevant evidence in the grey literature [ 13 ]. In recent 5 years, mental disorders among children and adolescents have increased at an alarming rate [ 14 , 15 ] and relevant policies calling for a greater role of schools in promoting student mental health have been issued in different countries [ 16 , 17 , 18 ], making educational settings at the forefront of the prevention initiative globally. Therefore, limiting research source published in the past 5 years was pre-defined since these publications reflected the newest discoveries, theories, processes, or practices. Search terms were selected based on the eligibility criteria and outcomes of interest were described as follows (Additional file 1 : Table S1). The search strategy was peer-reviewed by the librarian of Shanghai Jiao Tong University School of Medicine.

Study selection (stage 3)

T.Y. and Y.J. independently identified relevant articles by screening the titles, reviewing the abstracts and full-text articles. If any disagreement arises, the disagreement shall be resolved by discussion between the two reviewers and a third reviewer (J. X.).

Inclusion criteria were (1) according to the study designs: only randomized controlled trials (RCT)/quasi-RCT, longitudinal and cross-sectional studies; (2) according to the languages: articles only published in English or Chinese; (3) according to the ages of the subjects: preschoolers (3.5–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age); and (4) according to the study topics: only articles examining the associations between factors involved in the school education and student mental health outcomes (psychological distress, such as depression, anxiety, stress, self-injury, suicide; and/or psychological well-being, such as self-esteem, self-concept, self-efficacy, optimism and happiness) in educational settings. Exclusion criteria: (1) Conference abstracts, case report/series, and descriptive articles were excluded due to overall quality and reliability. (2) Studies investigating problems potentially on a causal pathway to mental health disorders but without close associations with school education models (such as problems probably caused by family backgrounds) were excluded. (3) Studies using schools as the recruitment places but without school-related topics were also excluded.

Data extraction (stage 4)

T.Y. and Y.J., and X.G., Y. Z., H.H. extracted data from the included studies using a pre-defined extraction sheet. Researchers extracted the following information from each eligible study: study background (name of the first author, publication year, and study location), sample characteristics (number of participants, ages of participants, and sex proportion), design [intervention (RCT or quasi-RCT), or observational (cross-sectional or longitudinal) study], and instruments used to assess exposures in school settings and mental health outcomes. For intervention studies (RCTs and quasi-RCTs), we also extracted weeks of intervention, descriptions of the program, duration and frequency. T.Y. reviewed all the data extraction sheets under the supervision of J. X.

Summarizing and reporting the results (stage 5)

Results were summarized and reported using a narrative synthesis approach. Studies were sorted according to (a) factors/exposures associated with child and adolescent mental health in educational settings, and (b) components of school-based interventions to facilitate student mental health development. Key findings from the studies were then compared, contrasted and synthesized to illuminate themes which appeared across multiple investigations.

Search results and characteristics of the included articles

The search yielded 25,338 citations, from which 558 were screened in full-text. Finally, a total of 197 original articles were included in this scoping review: 72 RCTs (including individually randomized and cluster-randomized trials), 27 quasi-RCTs, 29 longitudinal studies and 69 cross-sectional studies (Fig.  1 for details). Based on thematic analyses, the included studies were analyzed and thematically grouped into five overarching categories based on the common themes in the types of intervention programs or exposures in the school context: curriculum, homework and tests, interpersonal relationships, physical activity and after-school activities. Table 1 provided a numerical summary of the characteristics of the included articles. The 197 articles included data from 46 countries in total, covering 24 European countries, 13 Asian countries, 4 American countries, 3 African countries, and 2 Oceanian countries. Most intervention studies were conducted in the United States of America (n = 16), followed by Australia (n = 11) and the United Kingdom (n = 11). Most observational studies were conducted in the United States of America (n = 19), followed by China (n = 15) and Canada (n = 8). Figure  2 illustrated the geographical distribution of the included studies. Further detailed descriptions of the intervention studies or observational studies were provided in Additional file 1 : Tables S2 and S3, respectively.

Study selection process

Geographical distribution of included studies: A intervention studies; B observational studies

The association between school curriculum and student mental health was investigated in four cross-sectional studies. Mathematics performance was found to be adversely associated with levels of anxiety or negative emotional responses among primary school students [ 19 ]. However, in middle schools, difficulties and stressors students may encounter in learning academic lessons (such as difficulties/stressors in taking notes and understanding teachers’ instructions) could contribute to lowered self-esteem [ 20 ] and increased suicidal ideation or attempts [ 21 ]. Innovative integration of different courses instead of the traditional approach of teaching biology, chemistry, and physics separately, could improve students’ self-concept [ 22 ].

To promote student mental health, 64 intervention studies were involved in innovative curricula integrating different types of competencies, including social emotional learning (SEL), mindfulness-intervention, cognitive behavioral therapy (CBT)-based curriculum, life skills training, stress management curriculum, and so on (Fig.  3 ). Curricula focusing on SEL put an emphasis on the development of child social-emotional skills such as managing emotions, coping skills and empathy [ 23 ], and showed positive effects on depression, anxiety, stress, negative affect and emotional problems [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], especially in children with psychological symptoms [ 24 ] and girls [ 23 , 27 ], as well as increased prosocial behaviors [ 38 ], self-esteem [ 39 , 40 , 41 , 42 ] and positive affect [ 43 ]. However, four programs reported non-significant effects of SEL on student mental health outcomes [ 44 , 45 , 46 , 47 ], while two programs demonstrated increased levels of anxiety [ 48 ] and a reduction of subjective well-being [ 49 ] at post-intervention. Mindfulness-based curriculum showed its potential to endorse positive outcomes for youth including reduced emotional problems and negative affect [ 50 , 51 , 52 , 53 , 54 , 55 , 56 ] as well as increased well-being and positive emotions [ 51 , 52 , 57 , 58 , 59 , 60 ], especially among high-risk children with emotional problems or perceived stress before interventions [ 50 , 53 ]. However, non-significant effects were also reported in an Australian study in secondary schools [ 61 ]. Curricula based on CBT targeted children at risk or with early symptoms of mental illness [ 62 , 63 , 64 , 65 , 66 , 67 ], or all students regardless of symptom levels as a universal program [ 68 , 69 , 70 ], and could impose a positive effect on self-esteem, well-being, distress, stress and suicidality. However, a universal CBT trial in Swedish primary schools found no evidence of long-term effects of such program on anxiety prevention [ 71 ]. Five intervention studies based on life-skill-training were found to be effective in promoting self-efficacy [ 72 , 73 ], self-esteem [ 73 , 74 ], and reducing depression/anxiety-like symptoms [ 72 , 75 , 76 ]. Courses covering stress management skills have also been reported to improve life satisfaction, increase happiness and decrease anxiety levels among students in developing countries [ 77 , 78 , 79 ]. In practice, innovative teaching forms such as the game play [ 67 , 80 , 81 ] and outdoor learning [ 82 , 83 ] embedded in the traditional classes could help address the mental health and social participation concerns for children and youth. Limited evidence supported the mental health benefits of resilience-based curricula [ 84 , 85 , 86 ], which deserve further studies.

Harvest plots for overview of curriculum-based intervention studies, grouped by different types of curriculum-based interventions. The height of the bars corresponded to the sample sizes on a logarithmic scale of each study. Red bars represented positive effects of interventions on student mental health outcomes, grey bars represented non-significant effects on student mental health outcomes, and black bars represented negative effects on student mental health outcomes

Large cluster-randomized trials utilizing multi-component whole-school interventions which involves various aspects of school life (curriculum, interpersonal relationships, activities), such as the Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) program in India and the Together at School program in Finland, have been proved to be beneficial for prevention from depression [ 87 , 88 , 89 ] and psychological problems [ 90 ].

Homework and tests

The association between homework and psychological ill-being outcomes was investigated in four cross-sectional studies and one longitudinal study. Incomplete homework and longer homework durations were associated with a higher risk of anxiety symptoms [ 91 , 92 ], negative emotions [ 93 , 94 , 95 ] and even psychological distress in adulthood [ 96 ].

Innumerable exams during the educational process starting from primary schools may lead to increased anxiety and depression levels [ 97 , 98 ], particularly among senior students preparing for college entrance examinations [ 99 ]. Students with higher test scores had a lower probability to have emotional and behavioral problems [ 100 ], in comparison with students who failed examinations [ 93 , 101 ]. Depression and test anxiety were found to be highly correlated [ 102 ]. In terms of psychological well-being outcomes, findings were consistent in the negative associations between student test anxiety and self-esteem/life-satisfaction levels [ 103 , 104 ]. Regarding intervention studies, adolescent students at a high risk of test anxiety benefited from CBT or attention training by strengthening sense of control and meta-cognitive beliefs [ 105 , 106 ]. However, more knowledge about the criteria for an upcoming test was not related to anxiety levels during lessons [ 107 ].

Interpersonal relationships

School-based interpersonal (student–student or student–teacher) relationships are also important to student mental health. Low support from schoolmates/teachers and negative interpersonal events were reported to be associated with psychosomatic health complaints [ 108 , 109 , 110 , 111 , 112 , 113 ]. In contrast, positive interpersonal relationships in schools could promote emotional well-being [ 114 , 115 , 116 , 117 ] and reduce depressive symptoms in students [ 118 , 119 , 120 ].

Student–teacher relationships

Negative teaching behaviors were associated with negative affect [ 121 , 122 ] and low self-efficacy [ 123 ] among primary and high school students. Student–teacher conflicts at the beginning of the school year were associated with higher anxiety levels in students at the end of the year, and high-achieving girls were most susceptible to such negative associations [ 124 ]. Higher levels of perceived teachers’ support were correlated with decreased risks of depression [ 125 ], mental health problems [ 126 ] as well as increased positive affect [ 127 , 128 ] and improved mental well-being [ 129 , 130 ]. Better student–teacher relationships were positively associated with self-esteem/efficacy [ 131 ], while negatively associated with the risks of adolescents’ externalizing behaviors [ 132 ] among secondary school students. Longitudinal studies demonstrated that high intimacy levels between students and teachers were correlated with reduced emotional symptoms [ 133 ] and increased life-satisfaction among students [ 134 ]. In addition, more respect to teachers in 10th grade students was associated with higher self-efficacy and lower stress levels 1 year later [ 135 ].

A growing body of research focused on the issue of how to increase positive interactions between teachers and students in teaching practices. Actually, interventions on improving teaching skills to promote a positive classroom atmosphere could potentially benefit children, especially those experiencing a moderate to high level of risks of mental health problems [ 136 , 137 ].

Student–student relationships

Findings were consistent in considering the positive peer relationship as a protective factor against internalizing and externalizing behaviors [ 138 , 139 , 140 , 141 , 142 ], depression [ 143 , 144 , 145 ], anxiety [ 146 ], self-harm [ 147 ] and suicide [ 148 ], and as a favorable factor for positive affect [ 149 , 150 ], increased happiness [ 151 ], self-efficacy [ 152 ], optimism [ 153 , 154 ] and mental well-being [ 155 ]. In contrast, peer-hassles, friendlessness, negative peer-beliefs, peer-conflicts/isolation and peer-rejection, have been identified in the development of psychological distress among students [ 141 , 143 , 149 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 ].

As schools and classrooms are common settings to build peer relationships, student social skills to enhance the student–student relationship can be incorporated into school education. Training of interpersonal skills among secondary school students with depressive symptoms appeared to be effective in decreasing adolescent internalizing and externalizing symptoms [ 166 ]. In addition, recent studies also identified the effectiveness of small-group learning activities in the cognitive development and mental health promotion among students [ 87 , 88 , 89 , 90 , 167 ].

Physical activity in school

Moderate-to-high-intensity physical activity during school days has been confirmed to benefit children and adolescents in relation to various psychosocial outcomes, such as reduced symptoms of depression [ 168 ], emotional problems [ 169 ] and mental distress [ 170 ] as well as improved self-efficacy [ 171 ] and mental well-being [ 172 , 173 ]. In addition, participation in physical education (PE) at least twice a week was significantly associated with a lower likelihood of suicidal ideation and stress [ 174 ].

A variety of school‐based physical activity interventions or lessons have been proposed in previous studies to promote physical activity levels and psychosocial fitness in students, including integrating physical activities into classroom settings [ 175 , 176 , 177 , 178 ], assigning physical activity homework [ 178 ], physically-active academic lessons [ 179 , 180 ] as well as an obligation of ensuring the participation of various kinds of sports (such as aerobic exercises, resistance exercises, yoga) in PE lessons [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 ]. Although the effectiveness of these proposed physical activity interventions was not consistent, physical education is suggested to implement sustainably as other academic courses with special attention.

After-school activities

Several cross-sectional studies have synthesized evidence on the positive effects of leisure-time physical activity against student depression, anxiety, stress, and psychological distress [ 193 , 194 , 195 , 196 , 197 , 198 , 199 ]. Extracurricular sport participation (such as sports, dance, and martial arts) could foster perceived self-efficacy, self-esteem, improve mental health status [ 200 , 201 , 202 , 203 ], and reduce emotional problems [ 204 ] and depressive symptoms [ 205 ]. Participation in team sports was more strongly related to beneficial mental health outcomes than individual sports, especially in high school girls [ 199 ]. Other forms of organized activities, such as youth organizations and arts, have also been demonstrated to benefit self-esteem [ 201 ], self-worth [ 206 ], satisfaction with life and optimism [ 207 , 208 ].

However, different types of after-school activities may result in different impacts on student mental health. Previous studies demonstrated that students participating in after-school programs of yoga or sports had better well-being and self-efficacy [ 209 ], and decreased levels of anxiety [ 210 ] and negative mood [ 211 ], while another study showed that the after-school yoga program induced no significant changes in levels of depression, anxiety and stress among students [ 212 ]. Inconsistent findings on the effects of participation in art activities on student mental health were also reported [ 213 , 214 ]. Another study also highlighted the benefits of after-school clubs, demonstrating an improvement in socio-emotional competencies and emotional status, and sustained effects at 12-month follow-up [ 215 ].

Based on the potential importance of the five school-based factors identified in student mental development, a multi-component school educational model is therefore proposed to conceptualize the five school-based dimensions (including curriculum, homework and tests, interpersonal relationships, physical activity, and after-school activities) for K-12 students to promote their mental health (Fig.  4 ). The interrelationships among the five dimensions and cross-cultural comparisons are further discussed as follows in a holistic way.

The multi-component school educational model is proposed to conceptualize the five school-based dimensions (including curriculum set, homework and tests, physical activity, interpersonal relationships and after-school activities) for K-12 students to promote student mental health

Comprehensive understanding of K-12 school educational models: the reciprocal relationships among factors

Students’ experiences in the school educational context are dynamic processes which englobe a variety of educational elements (such as curriculum, homework, tests) and social elements (such as interpersonal relationships and social activities in schools). Based on the educational model proposed in this review, these educational/social elements are closely related and interact with each other, which play an important role in students’ psychosocial development.

Being aware of this, initiatives aimed to improve student social and emotional competencies may certainly impact student psychological well-being, at least in part, in a way of developing supportive relationships between teachers-students or between peers [ 35 , 89 ]. On the other hand, the enhancement of interpersonal relationships at school could serve as a potent source of motivation for student academic progress so as to further promote psychological well-being [ 131 , 132 ]. In addition, school education reforms intended to provide pupils with more varied teaching and learning practices to promote supportive interpersonal relationships between students and teachers or between peers, such as education programs outside the classroom [ 82 ], cooperative learning [ 167 ] and adaptive classroom management [ 136 , 137 ], have also been advocated among nations recently.

Our findings also suggested that participation in non-academic activities was an important component of positive youth development. Actually, these school-based activities in different contexts also require teacher–student interactions or peer interactions. Social aspects of physical activities have been proposed to strengthen relationship-building and other interpersonal skills that may additionally protect students against the development of mental health problems [ 130 , 203 ]. Among various types of sports, team sports seemed to be associated with more beneficial outcomes compared with individual sports due to the social aspect of being part of a team [ 194 , 199 ]. Participation in music, student council, and other clubs/organizations may also provide students with frequent connections with peers, and opportunities to build relationships with others that share similar interests [ 201 ]. Further, frequent and supportive interactions with teachers and peers in sports and clubs may promote student positive views of the self and encourage their health-promoting behaviors (such as physical activities).

However, due to increasing academic pressure, children have to spend a large amount of time on academic studies, and inevitably displace time on sleep, leisure, exercises/sports, and extracurricular activities [ 92 ]. Although the right amount of homework may improve school achievements [ 216 ] and higher test scores may help prevent students from mental distress [ 100 , 101 , 102 ], over-emphasis on academic achivements may lead to elevated stress levels and poor health outcomes ultimately. The anxiety specifically related to academic achievement and test-taking at school was frequently reported among students who felt pressured and overwhelmed by the continuous evaluation of their academic performance [ 98 , 103 , 104 ]. In such high-pressure academic environments, strategies to alleviate the levels of stress among students should be incorporated into intervention efforts, such as stress management skill training [ 77 , 78 , 79 ], CBT-based curriculum [ 62 , 64 , 66 , 105 ], and attention training [ 106 ]. Therefore, school supportive policies that allow students continued access to various non-academic activities as well as improve their social aspect of participation may be one fruitful avenue to promote student well-being.

Cross-cultural differences in K-12 educational models among different nations and societies

As we reviewed above, heavy academic burden exists as an important school-related stressor for students [ 91 , 92 , 94 , 95 , 96 ], probably due to excessive examinations [ 97 , 98 , 99 ] and unsatisfactory academic performance [ 100 , 101 , 102 ]. Actually, extrinsic cultural factors significantly impact upon student academic burden. In most countries, college admission policies affect the entire ecological system of K-12 education, because success in life or careers is determined by examination performance to a large extent [ 217 ]. The impacts of heavy academic burden may be greatest in Asian cultures where more after-school time of students is spent on homework, exam preparations, and extracurricular classes for academic improvement (such as in Korea, Japan, China and Singapore) [ 92 , 95 , 218 ]. As a consequence, the high proportion of adolescents fall in the “academic burnout group” in Asian countries [ 219 ], which highlights the need to take further measures to combat the issue. As an issue of concern, the “double reduction” policy has been implemented nationwide in China since 2021, being aimed to relieve students of excessive study burden, and the effects of the policy are anticipated but remain unknown up to now.

Other factors such as school curriculum and extra-curricular commitments, vary among societies and nations and may explain the cross-cultural differences in educational models [ 220 ]. For example, in Finland, the primary science subject is as important as mathematics or reading, while Chinese schools often lack time to arrange a sufficient number of science courses [ 221 ], which could be explained by different educational traditions of the two countries. In addition, approximately 75% of high schools in Korea failed to implement national curriculum guidelines for physical education (150 min/week), instead replacing that time with self-guided study to prepare for university admission exams [ 174 ]. In terms of the arrangement of the after-school time, Asian students spend most of their after-school time on private tutoring or doing homework [ 222 ], 2–3 times longer than the time spent by adolescents in most western countries/cities [ 92 ]. However, according to our analyses and summaries, most intervention studies targeting the improvement of mental health of students by school education were conducted in western countries (Fig.  2 ), suggesting that special attention needs to be paid to the students’ mental health issue on campus, especially in countries where students have heavy study-loads. Merits of the different educational traditions also need to be considered in the designs of educational models among different countries.

Strengths and limitations

This study focuses on an interdisciplinary topic covering the fields of developmental behavioral pediatrics and education, and the establishment of appropriate school educational models is teamwork involving multiple disciplines including pediatrics, prevention, education, services and policy. Although there are lots of studies focusing on a particular factor in school educational processes to promote student mental health, comprehensive analysis/understanding on multi-component educational model is lacking, which is important and urgently needed for the development of multi-dimensional educational models/strategies. Therefore, we included a wide range of related studies, summarized a comprehensive understanding of the evidence base, and discussed the interrelationships among the components/factors of school educational models and the cross-cultural gaps in K-12 education across different societies, which may have significant implications for future policy-making.

Some limitations also exist and are worth noting. First, this review used the method of the scoping review which adopted a descriptive approach, rather than the meta-analysis or systematic review which provided a rigorous method of synthesizing the literature. Under the subject (appropriate school education model among K-12 students) of this scoping review, multiple related topics (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) were included rather than one specific topic. Therefore, we consider that the method of the scoping-review is appropriate, given that the aim of this review is to chart or map the available literature on a given subject rather than answering a specific question by providing effect sizes across multiple studies. Second, we limited the study search within recent 5 years. Although we consider that the fields involved in this scoping review change quickly with the acquisition of new knowledge/information in recent 5 years, limiting the literature search within recent 5 years may make us miss some related but relatively old literature. Third, we only included studies disseminated in English or Chinese, which may limit the generalizability of our results to other non-English/Chinese speaking countries.

This scoping review has revealed that the K-12 schools are unique settings where almost all the children and adolescents can be reached, and through which existing educational components (such as curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) can be leveraged and integrated to form a holistic model of school education, and therefore to promote student mental health. In future, the school may be considered as an ideal setting to implement school-based mental health interventions. Our review suggests the need of comprehensive multi-component educational model, which involves academic, social and physical factors, to be established to improve student academic achievement and simultaneously maintain their mental health.

However, questions still remain as to what is optimal integration of various educational components to form the best model of school education, and how to promote the wide application of the appropriate school educational model. Individual differences among students/schools and cross-cultural differences may need to be considered in the model design process.

Availability of data and materials

The data analysed in this review are available from the corresponding author upon request.

Abbreviations

Cognitive behavioral therapy

Physical education

Randomized controlled trials

Social emotional learning

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Acknowledgements

We thank the librarian of Shanghai Jiao Tong University School of Medicine for their help.

This study was supported by the National Natural Science Foundation of China (NSFC, 81974486, 81673189) (to Jian Xu), Shanghai Jiao Tong University School of Medicine Gaofeng Clinical Medicine Grant Support (20172016) (to Jian Xu), Shanghai Sailing Program (21YF1451500) (to Hui Hua).

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Ting Yu, Jian Xu, Yining Jiang, Hui Hua, Yulai Zhou & Xiangrong Guo

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JX conceived the scoping review, supervised the review process and reviewed the manuscript. TY conducted study selection and data extraction, charted, synthesized the data, and drafted the manuscript. YJ conducted study selection and data extraction. XG, YZ and HH conducted data extraction. All authors read and approved the final manuscript.

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Additional file 1: table s1..

Search strategies used for each database. Table S2 . Summaries of intervention studies (randomized/quasi-randomized controlled trials) investigating the effects of school-based interventions on child mental health (n = 99). Table S3. Summaries of observational research on relationships between school-related factors and student mental health outcomes (n = 98).

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Yu, T., Xu, J., Jiang, Y. et al. School educational models and child mental health among K-12 students: a scoping review. Child Adolesc Psychiatry Ment Health 16 , 32 (2022). https://doi.org/10.1186/s13034-022-00469-8

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Study tracks shifts in student mental health during college

by Dartmouth College

A four-year study by Dartmouth researchers captures the most in-depth data yet on how college students' self-esteem and mental health fluctuates during their four years in academia, identifying key populations and stressors that the researchers say administrators could target to improve student well-being.

The study also provides among the first real-time accounts of how the coronavirus pandemic affected students' behavior and mental health. The stress and uncertainty of COVID-19 resulted in long-lasting behavioral changes that persisted as a "new normal" even as the pandemic diminished, including feeling more stressed, less socially engaged, and sleeping more.

The researchers tracked more than 200 Dartmouth undergraduates in the classes of 2021 and 2022 for all four years of college. Students volunteered to let a specially developed app called StudentLife tap into the sensors that are built into smartphones. The app cataloged their daily physical and social activity , how long they slept, their location and travel, the time they spent on their phone, and how often they listened to music or videos. Students also filled out weekly behavioral surveys, and selected students gave post-study interviews.

The study—which is the longest mobile-sensing study ever conducted—is published in Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies .

The researchers will present it at the Association of Computing Machinery's UbiComp/ISWC 2024 conference in Melbourne, Australia, in October. The team made their anonymized data set publicly available —including self-reports, surveys, and phone-sensing and brain-imaging data—to help advance research into the mental health of students during their college years.

Andrew Campbell, the paper's senior author and Dartmouth's Albert Bradley 1915 Third Century Professor of Computer Science said that the study's extensive data reinforces the importance of college and university administrators across the country being more attuned to how and when students' mental well-being changes during the school year.

"For the first time, we've produced granular data about the ebb and flow of student mental health. It's incredibly dynamic—there's nothing that's a steady state through the term, let alone through the year," he said. "These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most."

First-year and female students are especially at risk for high anxiety and low self-esteem , the study finds. Among first-year students, self-esteem dropped to its lowest point in the first weeks of their transition from high school to college but rose steadily every semester until it was about 10% higher by graduation.

"We can see that students came out of high school with a certain level of self-esteem that dropped off to the lowest point of the four years. Some said they started to experience 'imposter syndrome' from being around other high-performing students," Campbell said. "As the years progress, though, we can draw a straight line from low to high as their self-esteem improves. I think we would see a similar trend class over class. To me, that's a very positive thing."

Female students—who made up 60% of study participants—experienced, on average, 5% greater stress levels and 10% lower self-esteem than male students. More significantly, the data show that female students tended to be less active, with male students walking 37% more often.

Sophomores were 40% more socially active compared to their first year, the researchers report. However, these students also reported feeling 13% more stressed than during their first year as their workload increased, they felt pressure to socialize, or as first-year social groups dispersed.

One student in a sorority recalled that having pre-arranged activities "kind of adds stress as I feel like I should be having fun because everyone tells me that it is fun." Another student noted that after the first year," students have more access to the whole campus, and that is when you start feeling excluded from things."

In a novel finding, the researchers identify an "anticipatory stress spike" of 17% experienced in the last two weeks of summer break. While still lower than mid-academic year stress, the spike was consistent across different summers.

In post-study interviews, some students pointed to returning to campus early for team sports. Others specified reconnecting with family and high school friends during their first summer home, saying they felt "a sense of leaving behind the comfort and familiarity of these long-standing friendships" as the break ended, the researchers report.

"This is a foundational study," said Subigya Nepal, first author of the study and a Ph.D. candidate in Campbell's research group. "It has more real-time granular data than anything we or anyone else has provided before. We don't know yet how it will translate to campuses nationwide, but it can be a template for getting the conversation going."

The depth and accuracy of the study data suggest that mobile-sensing software could eventually give universities the ability to create proactive mental-health policies specific to certain student populations and times of year, Campbell said.

For example, a paper Campbell's research group published in 2022 based on StudentLife data showed that first-generation students experienced lower self-esteem and higher levels of depression than other students throughout their four years of college.

"We will be able to look at campus in much more nuanced ways than waiting for the results of an annual mental health study and then developing policy," Campbell said. "We know that Dartmouth is a small and very tight-knit campus community. But if we applied these same methods to a college with similar attributes, I believe we would find very similar trends."

Weathering the pandemic

When students returned home at the start of the coronavirus pandemic, the researchers found that self-esteem actually increased during the pandemic by 5% overall and by another 6% afterward when life returned closer to what it was before. One student suggested in their interview that getting older came with more confidence. Others indicated that being home led to them spending more time with friends, talking on the phone, on social media, or streaming movies together.

The data show that phone usage—measured by the duration a phone was unlocked—indeed increased by nearly 33 minutes, or 19%, during the pandemic, while time spent in physical activity dropped by 52 minutes, or 27%. By 2022, phone usage fell from its pandemic peak to just above pre-pandemic levels, while engagement in physical activity had recovered to exceed the pre-pandemic period by three minutes.

Despite reporting higher self-esteem, students' feelings of stress increased by more than 10% during the pandemic. Since the pandemic, stress fell by less than 2% of its pandemic peak, indicating that the experience had a lasting impact on student well-being, the researchers report.

In early 2021, as students returned to campus, the reunion with friends and community was tempered by an overwhelming concern of the still-rampant coronavirus. "There was the first outbreak in winter 2021 and that was terrifying," one student recalls. Another student adds, "You could be put into isolation for a long time even if you did not have COVID. Everyone was afraid to contact-trace anyone else in case they got mad at each other."

Female students were especially concerned about the coronavirus, on average 13% more than male students. "Even though the girls might have been hanging out with each other more, they are more aware of the impact," one female student reported. "I actually had COVID and exposed some friends of mine. All the girls that I told tested as they were worried. They were continually checking up to make sure that they did not have it and take it home to their family."

Students still learning remotely had social levels 16% higher than students on campus, who engaged in activity an average of 10% less often than when they were learning from home. However, on-campus students used their phones 47% more often. When interviewed after the study, these students reported spending extended periods of time video-calling or streaming movies with friends and family.

Social activity and engagement had not yet returned to pre-pandemic levels by the end of the study in June 2022, recovering by a little less than 3% after a nearly 10% drop during the pandemic. Similarly, the pandemic seems to have made students stick closer to home, with their distance traveled cut by nearly half during the pandemic and holding at that level in the time since.

Campbell and several of his fellow researchers are now developing a smartphone app known as MoodCapture that uses artificial intelligence paired with facial-image processing software to reliably detect the onset of depression before the user even knows something is wrong.

Provided by Dartmouth College

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Student mental health is still suffering–how should we address it?

The key to supporting school systems, and students, is to harness the power of culturally-competent and age-appropriate solutions.

Key points:

• Varied mental health supports can help students to become stakeholders in their well-being
• Empowering staff and students with a sense of belonging
• Schools are key to solving mental health equity gaps
• For more news on student mental health, visit eSN’s SEL & Well-Being hub

Between March 2020 and March 2021, K-12 schools in the U.S. saw an unprecedented influx in federal government aid, totaling nearly $190 billion. This funding aimed to help students recover both academically and emotionally from the pandemic. School districts across the country utilized these grants to hire counselors, social workers, psychologists, and other care providers. In theory, this should have been transformative; however, the available workforce wasn’t large enough to meet the demand, and traditionally underserved and rural districts faced the brunt of this shortage.

Subsequent follow-up funding has been deployed by the federal government in a necessary step to increase the workforce of care providers. As these funding opportunities come to a close, many districts are still left struggling to adequately address their students’ mental health needs.

According to the CDC, more than one in three high school students experienced poor mental health during the pandemic, but in reality, the rate of U.S. students struggling with these challenges was rising even before COVID. The pandemic’s disruption to students’ schooling and development only exacerbated mental health issues, resulting in worsening anxiety, depression, and behavioral issues. As funds such as ESSER come to a close, schools that were able to increase care teams or introduce new mental well-being initiatives are now facing a funding cliff. The impact of this is predictable: Students will suffer as staff and programs are cut. To address this problem, the U.S. education system must look to alternative solutions.

Expanding beyond traditional approaches

Counselors, social workers, and school psychologists are the most impactful front-line resources available for supporting student mental well-being; however, these professionals are saddled with huge caseloads and demands beyond their normal purview. For example, according to a 2020 survey of 7,000 school counselors , many were required to serve as substitute teachers, perform temperature checks, and take on other tasks as a result of the COVID-19 crisis. To improve mental health support to students, we have to expand our narrow perception of what care can look like.

Looking beyond a traditional western medicine approach, school districts should consider adopting solutions such as peer-to-peer counseling, where students who have been trained can meet to support one another and address personal, social, or emotional challenges. Peer-to-peer counseling empowers students to become stakeholders in their mental health while also providing benefits such as cultural relevance, early intervention, crisis prevention, and social-emotional skill development. This effective strategy is strongly advocated for by California’s Children Trust , which has worked tirelessly over the past few years to make peer-to-peer support reimbursable for California schools through Medi-Cal, the state’s Medicaid program.

Additionally, utilizing a community-based collaborative care model can further bolster a school system’s mental health resources. This type of approach is not meant to replace the role of trained mental health professionals, but it can provide Multi-Tiered System of Supports (MTSS) Tier 1 and 2 for large student populations. An effective initiative of this kind may look like inviting vetted community leaders to come in and offer culturally-tailored support, a resource that’s frequently lacking in schools. When coupled with other solutions, community-based care approaches can play a central role in improving student mental well-being.

Embracing technology

While in-person methods such as professional counseling, peer-to-peer programs, and community-based collaborative care models present a range of benefits, an immediate and ready solution exists for K-12 to effectively close the gaps in its mental health resources: digital mental health products.

Technology is accessible and readily complements care providers, and dozens of culturally competent and evidence-based products are successfully being utilized in school districts. These digital products can complement in-school care providers with treatment plans and access to telehealth, assessment tools, screening, tracking, and preventative technologies, which provide education, awareness, peer support, and other non-clinical approaches.

While effective technology solutions exist, the majority of schools face barriers to adopting and utilizing them. Figuring out how to fund product implementation, choosing which products to trust, and understanding exactly what types of student mental health concerns need to be addressed are common obstacles voiced by school systems.

Proper resource allocation can help ensure a brighter future

While there are currently several mental health-focused technology products available, investment for these types of innovations is still lacking. With federal funding drying up, large VC-backed companies that haven’t previously worked in the education sector are beginning to enter the scene, and oftentimes, these companies are driven by interests that don’t meet the needs of the students they are meant to be serving.

The key to supporting school systems, and ultimately students, is to harness the power of culturally-competent and age-appropriate solutions that entrepreneurs with lived experiences are developing while also supporting school systems by helping them identify, adopt, and utilize these transformative products.

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The Impact of Mental Health on Society Essay

There is no doubt that poor mental health takes an immense toll on the lives of affected individuals. Many conditions are barely manageable if not to say debilitating, which prevents mental health patients from taking care of themselves and living their lives to the fullest. What is often left out from the discussion on mental health is how it manifests itself on a larger scale. This paper discusses the impact of mental health on society in terms of education, workforce, and safety.

Mental illnesses have a profound economic impact on society. Suffering from a mental health condition often means reduced productivity and resourcefulness in individuals. It is not to say that mental health patients lack the skills or expertise to fulfill the assigned tasks. However, they struggle to find the energy and motivation to do so. Recent studies have shown that depression reduces activity in the frontal lobe – the part of the human brain that is responsible for higher-order mental faculties such as long-term planning and decision-making. It is readily imaginable how a depressed employee could fall short in these important aspects and underperform. Apart from that, mentally ill employees not only underperform, they may also be endangering the lives of other people. To put things into perspective, a WHO-led study evaluates the losses that the global economy experiences due to depression and anxiety disorders at US$1 trillion.

An individual’s mental health affects his or her educational outcomes. Firstly, the same factors that prevent people from performing well at work – limited decision-making and the inability to plan long-term stifle academic performance. On top of that, it has been found that two other components that often accompany mental illness – anhedonia and social dysfunction’ is the most influential component – play a significant role in shaping educational outcomes. Not being able to take pleasure in learning and function in society often lead to drop-outs.

Lastly, there is a link between psychiatric disorders and criminality and violent behavior, though its nature is still debated. Admittedly, that is not to say that all people with mental conditions are dangerous – that would be a harmful generalization. However, the inability to receive timely and adequate treatment, experiencing illusions and hallucinations as well as suffering from paranoia are all risk factors for delinquent behaviors. Mentally ill individuals are arrested and sent to prisons at a disproportionate rate, primarily because the justice system has not yet figured out the best way to handle them. Conversely, this category of people is also at risk of falling victim to violent crimes. To recapitulate, unmanaged public mental health concerns reduce safety, be the problems caused by mentally ill individuals or not.

Indeed, it is not only the individuals but also society on the whole that suffers from the adverse consequences of deteriorating mental health. Poor mental health is linked to underwhelming work performance, as affected individuals are not able to be as efficient at work as they could be if they were not suffering from their conditions. Academic performance also suffers, mainly from anhedonia and social dysfunction, while the high dropout rate means fewer qualified cadres in the workforce. Mental disorders translate into not tremendous economic losses worldwide. Lastly, unmanaged mental health issues may lead to crime outbreaks as some people can no longer control themselves or put themselves in risky situations.

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Digest No. 12 - March 2024

Effects of meditation, yoga, and mindfulness on student mental health.

Breedvelt, J., Y. Amanvermez, M. Harrer, E. Karyotaki, S. Gilbody, C. Bockting, P. Cuijpers, and D. Ebert.“The Effects of Meditation, Yoga, and Mindfulness on Depression, Anxiety, and Stress in Tertiary Education Students: A Meta-Analysis.” Frontiers in Psychiatry 10 , no. 193 (2019): 1–15.

CENTRAL TAKEAWAY

Meditation, yoga, and mindfulness may be an inexpensive way to reduce the incidence of moderate to severe mental health concerns like depression, stress, and anxiety in student populations. They may also offer a more welcoming and less stigmatized environment for students who wish to avoid scrutiny over their mental health decisions.

Due to the rising frequency of mental health issues among postsecondary students and a growing recognition of the negative effects these issues have on important outcomes like physical health, cognitive development, academic performance, productivity, and overall wellbeing, many institutions of higher education have sought to supplement traditional psychological treatments with alternative medicine practices like meditation, yoga, and mindfulness. Indeed, many institutions now offer wellness programs and courses focused on these alternative practices.

However, the degree to which these activities are preventative of or are effective at treating these mental health conditions has been occluded by the generally poor quality of research in this area. The present study seeks to provide clarity on these issues, asking, “What are the effects of mindfulness, meditation, and yoga on depression, anxiety, stress, and academic achievement in tertiary education students vs. control?” (p. 2). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol, the authors identified 24 qualitative studies and 23 quantitative studies examining postsecondary student populations. The qualitative studies were synthesized via a systematic review, while the quantitative articles were analyzed using highly sophisticated meta-analysis methods that included subgroup analyses as well as corrective measures for design bias, researcher allegiance to a particular outcome, and the use of convenience samples. In total, the quantitative studies included 1,373 participants across all conditions (no treatment; standard treatment; meditation, yoga, or mindfulness treatment).

DISCUSSION OF THE FINDINGS

Meditation, yoga, and mindfulness appear to moderately improve the symptoms of depression (g=0.42), anxiety (g=0.46), and stress (g=0.42) when compared to receiving no treatment at all. These effects appear to be somewhat durable, with similar effect sizes evident during long-term follow up examinations that occurred between one and 24 months after formal treatment concluded. Notably, the effect size on depression is similar to that produced by recent meta-analyses of cognitive behavioral therapy on mixed clinical and non-clinical populations and was nearly twice as effective as internet-based interventions.

But is meditation, yoga, or mindfulness better than standard treatments? The meta-analysis concluded that there is “no evidence” that these alternative treatments are “more effective than active control” treatments which here consisted variously of pharmaceuticals, exercise, or cognitive behavioral therapy (p. 12). Therefore, the benefits of meditation, yoga, and mindfulness may in fact be due to third factors, like doing any activity that includes social interaction and peer support, or that requires scheduling activities. Interestingly, the length of treatment with meditation, yoga, or mindfulness did not seem to influence their effectiveness.

IMPLICATIONS FOR ACTION BY CAMPUS LEADERS

Given the state of the evidence, and their rough parity in efficacy compared to standard treatments, there seems to be little downside to instantiating meditation, yoga, and mindfulness experiences on campus. While these practices are not a replacement for standard therapies, their scalability and reduced cost compared to psychotherapy suggest they may have a role to play in preventing mental health issues from arising or from becoming as severe as they otherwise would be.

Furthermore, as for-credit classes or on-campus activities, these practices may present a lower barrier for entry for students who may struggle to navigate complex mental health treatment systems. This, combined with the relative lack of stigma around the alternative practices, may be especially beneficial for students whose families, home cultures, religions, and/or political views continue to stigmatize mental health concerns.

ABOUT THE AUTHORS

Josefien J. F. Breedvelt is a Prudence Trust Research Fellow at King’s College London.

Yagmur Amanvermez is a researcher in the Department of Social and Behavioral Sciences at Tilburg University.

Mathias Harrer is a researcher at the Technische Universität München.

Eirini Karyotaki is an associate professor in the Department of Clinical, Neuro- and Developmental Psychology at Vrije Universiteit Amsterdam.

Simon Gilbody is a professor of psychological medicine and psychiatric epidemiology at the University of York.

Claudi L. H. Bockting is a professor of clinical psychology at the Amsterdam University Medical Center.

Pim Cuijpers is a professor in the Department of Clinical, Neuro-, and Developmental Psychology at Vrije Universiteit Amsterdam.

David D. Ebert is a professor of psychology and digital mental health care at the Technische Universität München.

RECOMMENDED FOLLOW-UP LITERATURE

Huang, J., Y. Nigatu, R. Smail-Crevier, X. Zhang, J. Wang. “Interventions for Common Mental Health Problems among University and College Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” Journal of Psychiatric Research 107 (2018): 1–10. https://doi.org/10.1016/j.jpsychires.2018.09.018

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End the Phone-Based Childhood Now

The environment in which kids grow up today is hostile to human development.

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S omething went suddenly and horribly wrong for adolescents in the early 2010s. By now you’ve likely seen the statistics : Rates of depression and anxiety in the United States—fairly stable in the 2000s—rose by more than 50 percent in many studies from 2010 to 2019. The suicide rate rose 48 percent for adolescents ages 10 to 19. For girls ages 10 to 14, it rose 131 percent.

The problem was not limited to the U.S.: Similar patterns emerged around the same time in Canada, the U.K., Australia, New Zealand , the Nordic countries , and beyond . By a variety of measures and in a variety of countries, the members of Generation Z (born in and after 1996) are suffering from anxiety, depression, self-harm, and related disorders at levels higher than any other generation for which we have data.

The decline in mental health is just one of many signs that something went awry. Loneliness and friendlessness among American teens began to surge around 2012. Academic achievement went down, too. According to “The Nation’s Report Card,” scores in reading and math began to decline for U.S. students after 2012, reversing decades of slow but generally steady increase. PISA, the major international measure of educational trends, shows that declines in math, reading, and science happened globally, also beginning in the early 2010s.

Read: It sure looks like phones are making students dumber

As the oldest members of Gen Z reach their late 20s, their troubles are carrying over into adulthood. Young adults are dating less , having less sex, and showing less interest in ever having children than prior generations. They are more likely to live with their parents. They were less likely to get jobs as teens , and managers say they are harder to work with. Many of these trends began with earlier generations, but most of them accelerated with Gen Z.

Surveys show that members of Gen Z are shyer and more risk averse than previous generations, too, and risk aversion may make them less ambitious. In an interview last May , OpenAI co-founder Sam Altman and Stripe co-founder Patrick Collison noted that, for the first time since the 1970s, none of Silicon Valley’s preeminent entrepreneurs are under 30. “Something has really gone wrong,” Altman said. In a famously young industry, he was baffled by the sudden absence of great founders in their 20s.

Generations are not monolithic, of course. Many young people are flourishing. Taken as a whole, however, Gen Z is in poor mental health and is lagging behind previous generations on many important metrics. And if a generation is doing poorly––if it is more anxious and depressed and is starting families, careers, and important companies at a substantially lower rate than previous generations––then the sociological and economic consequences will be profound for the entire society.

What happened in the early 2010s that altered adolescent development and worsened mental health? Theories abound , but the fact that similar trends are found in many countries worldwide means that events and trends that are specific to the United States cannot be the main story.

I think the answer can be stated simply, although the underlying psychology is complex: Those were the years when adolescents in rich countries traded in their flip phones for smartphones and moved much more of their social lives online—particularly onto social-media platforms designed for virality and addiction . Once young people began carrying the entire internet in their pockets, available to them day and night, it altered their daily experiences and developmental pathways across the board. Friendship, dating, sexuality, exercise, sleep, academics, politics, family dynamics, identity—all were affected. Life changed rapidly for younger children, too, as they began to get access to their parents’ smartphones and, later, got their own iPads, laptops, and even smartphones during elementary school.

Jonathan Haidt: Get phones out of schools now

As a social psychologist who has long studied social and moral development, I have been involved in debates about the effects of digital technology for years. Typically, the scientific questions have been framed somewhat narrowly, to make them easier to address with data. For example, do adolescents who consume more social media have higher levels of depression? Does using a smartphone just before bedtime interfere with sleep? The answer to these questions is usually found to be yes, although the size of the relationship is often statistically small, which has led some researchers to conclude that these new technologies are not responsible for the gigantic increases in mental illness that began in the early 2010s.

But before we can evaluate the evidence on any one potential avenue of harm, we need to step back and ask a broader question: What is childhood––including adolescence––and how did it change when smartphones moved to the center of it? If we take a more holistic view of what childhood is and what young children, tweens, and teens need to do to mature into competent adults, the picture becomes much clearer. Smartphone-based life, it turns out, alters or interferes with a great number of developmental processes.

The intrusion of smartphones and social media are not the only changes that have deformed childhood. There’s an important backstory, beginning as long ago as the 1980s, when we started systematically depriving children and adolescents of freedom, unsupervised play, responsibility, and opportunities for risk taking, all of which promote competence, maturity, and mental health. But the change in childhood accelerated in the early 2010s, when an already independence-deprived generation was lured into a new virtual universe that seemed safe to parents but in fact is more dangerous, in many respects, than the physical world.

My claim is that the new phone-based childhood that took shape roughly 12 years ago is making young people sick and blocking their progress to flourishing in adulthood. We need a dramatic cultural correction, and we need it now.

Brain development is sometimes said to be “experience-expectant,” because specific parts of the brain show increased plasticity during periods of life when an animal’s brain can “expect” to have certain kinds of experiences. You can see this with baby geese, who will imprint on whatever mother-sized object moves in their vicinity just after they hatch. You can see it with human children, who are able to learn languages quickly and take on the local accent, but only through early puberty; after that, it’s hard to learn a language and sound like a native speaker. There is also some evidence of a sensitive period for cultural learning more generally. Japanese children who spent a few years in California in the 1970s came to feel “American” in their identity and ways of interacting only if they attended American schools for a few years between ages 9 and 15. If they left before age 9, there was no lasting impact. If they didn’t arrive until they were 15, it was too late; they didn’t come to feel American.

Human childhood is an extended cultural apprenticeship with different tasks at different ages all the way through puberty. Once we see it this way, we can identify factors that promote or impede the right kinds of learning at each age. For children of all ages, one of the most powerful drivers of learning is the strong motivation to play. Play is the work of childhood, and all young mammals have the same job: to wire up their brains by playing vigorously and often, practicing the moves and skills they’ll need as adults. Kittens will play-pounce on anything that looks like a mouse tail. Human children will play games such as Tag and Sharks and Minnows, which let them practice both their predator skills and their escaping-from-predator skills. Adolescents will play sports with greater intensity, and will incorporate playfulness into their social interactions—flirting, teasing, and developing inside jokes that bond friends together. Hundreds of studies on young rats, monkeys, and humans show that young mammals want to play, need to play, and end up socially, cognitively, and emotionally impaired when they are deprived of play .

One crucial aspect of play is physical risk taking. Children and adolescents must take risks and fail—often—in environments in which failure is not very costly. This is how they extend their abilities, overcome their fears, learn to estimate risk, and learn to cooperate in order to take on larger challenges later. The ever-present possibility of getting hurt while running around, exploring, play-fighting, or getting into a real conflict with another group adds an element of thrill, and thrilling play appears to be the most effective kind for overcoming childhood anxieties and building social, emotional, and physical competence. The desire for risk and thrill increases in the teen years, when failure might carry more serious consequences. Children of all ages need to choose the risk they are ready for at a given moment. Young people who are deprived of opportunities for risk taking and independent exploration will, on average, develop into more anxious and risk-averse adults .

From the April 2014 issue: The overprotected kid

Human childhood and adolescence evolved outdoors, in a physical world full of dangers and opportunities. Its central activities––play, exploration, and intense socializing––were largely unsupervised by adults, allowing children to make their own choices, resolve their own conflicts, and take care of one another. Shared adventures and shared adversity bound young people together into strong friendship clusters within which they mastered the social dynamics of small groups, which prepared them to master bigger challenges and larger groups later on.

And then we changed childhood.

The changes started slowly in the late 1970s and ’80s, before the arrival of the internet, as many parents in the U.S. grew fearful that their children would be harmed or abducted if left unsupervised. Such crimes have always been extremely rare, but they loomed larger in parents’ minds thanks in part to rising levels of street crime combined with the arrival of cable TV, which enabled round-the-clock coverage of missing-children cases. A general decline in social capital ––the degree to which people knew and trusted their neighbors and institutions–– exacerbated parental fears . Meanwhile, rising competition for college admissions encouraged more intensive forms of parenting . In the 1990s, American parents began pulling their children indoors or insisting that afternoons be spent in adult-run enrichment activities. Free play, independent exploration, and teen-hangout time declined.

In recent decades, seeing unchaperoned children outdoors has become so novel that when one is spotted in the wild, some adults feel it is their duty to call the police. In 2015, the Pew Research Center found that parents, on average, believed that children should be at least 10 years old to play unsupervised in front of their house, and that kids should be 14 before being allowed to go unsupervised to a public park. Most of these same parents had enjoyed joyous and unsupervised outdoor play by the age of 7 or 8.

But overprotection is only part of the story. The transition away from a more independent childhood was facilitated by steady improvements in digital technology, which made it easier and more inviting for young people to spend a lot more time at home, indoors, and alone in their rooms. Eventually, tech companies got access to children 24/7. They developed exciting virtual activities, engineered for “engagement,” that are nothing like the real-world experiences young brains evolved to expect.

The first wave came ashore in the 1990s with the arrival of dial-up internet access, which made personal computers good for something beyond word processing and basic games. By 2003, 55 percent of American households had a computer with (slow) internet access. Rates of adolescent depression, loneliness, and other measures of poor mental health did not rise in this first wave. If anything, they went down a bit. Millennial teens (born 1981 through 1995), who were the first to go through puberty with access to the internet, were psychologically healthier and happier, on average, than their older siblings or parents in Generation X (born 1965 through 1980).

The second wave began to rise in the 2000s, though its full force didn’t hit until the early 2010s. It began rather innocently with the introduction of social-media platforms that helped people connect with their friends. Posting and sharing content became much easier with sites such as Friendster (launched in 2003), Myspace (2003), and Facebook (2004).

Teens embraced social media soon after it came out, but the time they could spend on these sites was limited in those early years because the sites could only be accessed from a computer, often the family computer in the living room. Young people couldn’t access social media (and the rest of the internet) from the school bus, during class time, or while hanging out with friends outdoors. Many teens in the early-to-mid-2000s had cellphones, but these were basic phones (many of them flip phones) that had no internet access. Typing on them was difficult––they had only number keys. Basic phones were tools that helped Millennials meet up with one another in person or talk with each other one-on-one. I have seen no evidence to suggest that basic cellphones harmed the mental health of Millennials.

It was not until the introduction of the iPhone (2007), the App Store (2008), and high-speed internet (which reached 50 percent of American homes in 2007 )—and the corresponding pivot to mobile made by many providers of social media, video games, and porn—that it became possible for adolescents to spend nearly every waking moment online. The extraordinary synergy among these innovations was what powered the second technological wave. In 2011, only 23 percent of teens had a smartphone. By 2015, that number had risen to 73 percent , and a quarter of teens said they were online “almost constantly.” Their younger siblings in elementary school didn’t usually have their own smartphones, but after its release in 2010, the iPad quickly became a staple of young children’s daily lives. It was in this brief period, from 2010 to 2015, that childhood in America (and many other countries) was rewired into a form that was more sedentary, solitary, virtual, and incompatible with healthy human development.

In the 2000s, Silicon Valley and its world-changing inventions were a source of pride and excitement in America. Smart and ambitious young people around the world wanted to move to the West Coast to be part of the digital revolution. Tech-company founders such as Steve Jobs and Sergey Brin were lauded as gods, or at least as modern Prometheans, bringing humans godlike powers. The Arab Spring bloomed in 2011 with the help of decentralized social platforms, including Twitter and Facebook. When pundits and entrepreneurs talked about the power of social media to transform society, it didn’t sound like a dark prophecy.

You have to put yourself back in this heady time to understand why adults acquiesced so readily to the rapid transformation of childhood. Many parents had concerns , even then, about what their children were doing online, especially because of the internet’s ability to put children in contact with strangers. But there was also a lot of excitement about the upsides of this new digital world. If computers and the internet were the vanguards of progress, and if young people––widely referred to as “digital natives”––were going to live their lives entwined with these technologies, then why not give them a head start? I remember how exciting it was to see my 2-year-old son master the touch-and-swipe interface of my first iPhone in 2008. I thought I could see his neurons being woven together faster as a result of the stimulation it brought to his brain, compared to the passivity of watching television or the slowness of building a block tower. I thought I could see his future job prospects improving.

Touchscreen devices were also a godsend for harried parents. Many of us discovered that we could have peace at a restaurant, on a long car trip, or at home while making dinner or replying to emails if we just gave our children what they most wanted: our smartphones and tablets. We saw that everyone else was doing it and figured it must be okay.

It was the same for older children, desperate to join their friends on social-media platforms, where the minimum age to open an account was set by law to 13, even though no research had been done to establish the safety of these products for minors. Because the platforms did nothing (and still do nothing) to verify the stated age of new-account applicants, any 10-year-old could open multiple accounts without parental permission or knowledge, and many did. Facebook and later Instagram became places where many sixth and seventh graders were hanging out and socializing. If parents did find out about these accounts, it was too late. Nobody wanted their child to be isolated and alone, so parents rarely forced their children to shut down their accounts.

We had no idea what we were doing.

The numbers are hard to believe. The most recent Gallup data show that American teens spend about five hours a day just on social-media platforms (including watching videos on TikTok and YouTube). Add in all the other phone- and screen-based activities, and the number rises to somewhere between seven and nine hours a day, on average . The numbers are even higher in single-parent and low-income families, and among Black, Hispanic, and Native American families.

These very high numbers do not include time spent in front of screens for school or homework, nor do they include all the time adolescents spend paying only partial attention to events in the real world while thinking about what they’re missing on social media or waiting for their phones to ping. Pew reports that in 2022, one-third of teens said they were on one of the major social-media sites “almost constantly,” and nearly half said the same of the internet in general. For these heavy users, nearly every waking hour is an hour absorbed, in full or in part, by their devices.

In Thoreau’s terms, how much of life is exchanged for all this screen time? Arguably, most of it. Everything else in an adolescent’s day must get squeezed down or eliminated entirely to make room for the vast amount of content that is consumed, and for the hundreds of “friends,” “followers,” and other network connections that must be serviced with texts, posts, comments, likes, snaps, and direct messages. I recently surveyed my students at NYU, and most of them reported that the very first thing they do when they open their eyes in the morning is check their texts, direct messages, and social-media feeds. It’s also the last thing they do before they close their eyes at night. And it’s a lot of what they do in between.

The amount of time that adolescents spend sleeping declined in the early 2010s , and many studies tie sleep loss directly to the use of devices around bedtime, particularly when they’re used to scroll through social media . Exercise declined , too, which is unfortunate because exercise, like sleep, improves both mental and physical health. Book reading has been declining for decades, pushed aside by digital alternatives, but the decline, like so much else, sped up in the early 2010 s. With passive entertainment always available, adolescent minds likely wander less than they used to; contemplation and imagination might be placed on the list of things winnowed down or crowded out.

But perhaps the most devastating cost of the new phone-based childhood was the collapse of time spent interacting with other people face-to-face. A study of how Americans spend their time found that, before 2010, young people (ages 15 to 24) reported spending far more time with their friends (about two hours a day, on average, not counting time together at school) than did older people (who spent just 30 to 60 minutes with friends). Time with friends began decreasing for young people in the 2000s, but the drop accelerated in the 2010s, while it barely changed for older people. By 2019, young people’s time with friends had dropped to just 67 minutes a day. It turns out that Gen Z had been socially distancing for many years and had mostly completed the project by the time COVID-19 struck.

Read: What happens when kids don’t see their peers for months

You might question the importance of this decline. After all, isn’t much of this online time spent interacting with friends through texting, social media, and multiplayer video games? Isn’t that just as good?

Some of it surely is, and virtual interactions offer unique benefits too, especially for young people who are geographically or socially isolated. But in general, the virtual world lacks many of the features that make human interactions in the real world nutritious, as we might say, for physical, social, and emotional development. In particular, real-world relationships and social interactions are characterized by four features—typical for hundreds of thousands of years—that online interactions either distort or erase.

First, real-world interactions are embodied , meaning that we use our hands and facial expressions to communicate, and we learn to respond to the body language of others. Virtual interactions, in contrast, mostly rely on language alone. No matter how many emojis are offered as compensation, the elimination of communication channels for which we have eons of evolutionary programming is likely to produce adults who are less comfortable and less skilled at interacting in person.

Second, real-world interactions are synchronous ; they happen at the same time. As a result, we learn subtle cues about timing and conversational turn taking. Synchronous interactions make us feel closer to the other person because that’s what getting “in sync” does. Texts, posts, and many other virtual interactions lack synchrony. There is less real laughter, more room for misinterpretation, and more stress after a comment that gets no immediate response.

Third, real-world interactions primarily involve one‐to‐one communication , or sometimes one-to-several. But many virtual communications are broadcast to a potentially huge audience. Online, each person can engage in dozens of asynchronous interactions in parallel, which interferes with the depth achieved in all of them. The sender’s motivations are different, too: With a large audience, one’s reputation is always on the line; an error or poor performance can damage social standing with large numbers of peers. These communications thus tend to be more performative and anxiety-inducing than one-to-one conversations.

Finally, real-world interactions usually take place within communities that have a high bar for entry and exit , so people are strongly motivated to invest in relationships and repair rifts when they happen. But in many virtual networks, people can easily block others or quit when they are displeased. Relationships within such networks are usually more disposable.

From the September 2015 issue: The coddling of the American mind

These unsatisfying and anxiety-producing features of life online should be recognizable to most adults. Online interactions can bring out antisocial behavior that people would never display in their offline communities. But if life online takes a toll on adults, just imagine what it does to adolescents in the early years of puberty, when their “experience expectant” brains are rewiring based on feedback from their social interactions.

Kids going through puberty online are likely to experience far more social comparison, self-consciousness, public shaming, and chronic anxiety than adolescents in previous generations, which could potentially set developing brains into a habitual state of defensiveness. The brain contains systems that are specialized for approach (when opportunities beckon) and withdrawal (when threats appear or seem likely). People can be in what we might call “discover mode” or “defend mode” at any moment, but generally not both. The two systems together form a mechanism for quickly adapting to changing conditions, like a thermostat that can activate either a heating system or a cooling system as the temperature fluctuates. Some people’s internal thermostats are generally set to discover mode, and they flip into defend mode only when clear threats arise. These people tend to see the world as full of opportunities. They are happier and less anxious. Other people’s internal thermostats are generally set to defend mode, and they flip into discover mode only when they feel unusually safe. They tend to see the world as full of threats and are more prone to anxiety and depressive disorders.

A simple way to understand the differences between Gen Z and previous generations is that people born in and after 1996 have internal thermostats that were shifted toward defend mode. This is why life on college campuses changed so suddenly when Gen Z arrived, beginning around 2014. Students began requesting “safe spaces” and trigger warnings. They were highly sensitive to “microaggressions” and sometimes claimed that words were “violence.” These trends mystified those of us in older generations at the time, but in hindsight, it all makes sense. Gen Z students found words, ideas, and ambiguous social encounters more threatening than had previous generations of students because we had fundamentally altered their psychological development.

Staying on task while sitting at a computer is hard enough for an adult with a fully developed prefrontal cortex. It is far more difficult for adolescents in front of their laptop trying to do homework. They are probably less intrinsically motivated to stay on task. They’re certainly less able, given their undeveloped prefrontal cortex, and hence it’s easy for any company with an app to lure them away with an offer of social validation or entertainment. Their phones are pinging constantly— one study found that the typical adolescent now gets 237 notifications a day, roughly 15 every waking hour. Sustained attention is essential for doing almost anything big, creative, or valuable, yet young people find their attention chopped up into little bits by notifications offering the possibility of high-pleasure, low-effort digital experiences.

It even happens in the classroom. Studies confirm that when students have access to their phones during class time, they use them, especially for texting and checking social media, and their grades and learning suffer . This might explain why benchmark test scores began to decline in the U.S. and around the world in the early 2010s—well before the pandemic hit.

The neural basis of behavioral addiction to social media or video games is not exactly the same as chemical addiction to cocaine or opioids. Nonetheless, they all involve abnormally heavy and sustained activation of dopamine neurons and reward pathways. Over time, the brain adapts to these high levels of dopamine; when the child is not engaged in digital activity, their brain doesn’t have enough dopamine, and the child experiences withdrawal symptoms. These generally include anxiety, insomnia, and intense irritability. Kids with these kinds of behavioral addictions often become surly and aggressive, and withdraw from their families into their bedrooms and devices.

Social-media and gaming platforms were designed to hook users. How successful are they? How many kids suffer from digital addictions?

The main addiction risks for boys seem to be video games and porn. “ Internet gaming disorder ,” which was added to the main diagnosis manual of psychiatry in 2013 as a condition for further study, describes “significant impairment or distress” in several aspects of life, along with many hallmarks of addiction, including an inability to reduce usage despite attempts to do so. Estimates for the prevalence of IGD range from 7 to 15 percent among adolescent boys and young men. As for porn, a nationally representative survey of American adults published in 2019 found that 7 percent of American men agreed or strongly agreed with the statement “I am addicted to pornography”—and the rates were higher for the youngest men.

Girls have much lower rates of addiction to video games and porn, but they use social media more intensely than boys do. A study of teens in 29 nations found that between 5 and 15 percent of adolescents engage in what is called “problematic social media use,” which includes symptoms such as preoccupation, withdrawal symptoms, neglect of other areas of life, and lying to parents and friends about time spent on social media. That study did not break down results by gender, but many others have found that rates of “problematic use” are higher for girls.

Jonathan Haidt: The dangerous experiment on teen girls

I don’t want to overstate the risks: Most teens do not become addicted to their phones and video games. But across multiple studies and across genders, rates of problematic use come out in the ballpark of 5 to 15 percent. Is there any other consumer product that parents would let their children use relatively freely if they knew that something like one in 10 kids would end up with a pattern of habitual and compulsive use that disrupted various domains of life and looked a lot like an addiction?

During that crucial sensitive period for cultural learning, from roughly ages 9 through 15, we should be especially thoughtful about who is socializing our children for adulthood. Instead, that’s when most kids get their first smartphone and sign themselves up (with or without parental permission) to consume rivers of content from random strangers. Much of that content is produced by other adolescents, in blocks of a few minutes or a few seconds.

This rerouting of enculturating content has created a generation that is largely cut off from older generations and, to some extent, from the accumulated wisdom of humankind, including knowledge about how to live a flourishing life. Adolescents spend less time steeped in their local or national culture. They are coming of age in a confusing, placeless, ahistorical maelstrom of 30-second stories curated by algorithms designed to mesmerize them. Without solid knowledge of the past and the filtering of good ideas from bad––a process that plays out over many generations––young people will be more prone to believe whatever terrible ideas become popular around them, which might explain why v ideos showing young people reacting positively to Osama bin Laden’s thoughts about America were trending on TikTok last fall.

All this is made worse by the fact that so much of digital public life is an unending supply of micro dramas about somebody somewhere in our country of 340 million people who did something that can fuel an outrage cycle, only to be pushed aside by the next. It doesn’t add up to anything and leaves behind only a distorted sense of human nature and affairs.

When our public life becomes fragmented, ephemeral, and incomprehensible, it is a recipe for anomie, or normlessness. The great French sociologist Émile Durkheim showed long ago that a society that fails to bind its people together with some shared sense of sacredness and common respect for rules and norms is not a society of great individual freedom; it is, rather, a place where disoriented individuals have difficulty setting goals and exerting themselves to achieve them. Durkheim argued that anomie was a major driver of suicide rates in European countries. Modern scholars continue to draw on his work to understand suicide rates today.

Durkheim’s observations are crucial for understanding what happened in the early 2010s. A long-running survey of American teens found that , from 1990 to 2010, high-school seniors became slightly less likely to agree with statements such as “Life often feels meaningless.” But as soon as they adopted a phone-based life and many began to live in the whirlpool of social media, where no stability can be found, every measure of despair increased. From 2010 to 2019, the number who agreed that their lives felt “meaningless” increased by about 70 percent, to more than one in five.

An additional source of evidence comes from Gen Z itself. With all the talk of regulating social media, raising age limits, and getting phones out of schools, you might expect to find many members of Gen Z writing and speaking out in opposition. I’ve looked for such arguments and found hardly any. In contrast, many young adults tell stories of devastation.

Freya India, a 24-year-old British essayist who writes about girls, explains how social-media sites carry girls off to unhealthy places: “It seems like your child is simply watching some makeup tutorials, following some mental health influencers, or experimenting with their identity. But let me tell you: they are on a conveyor belt to someplace bad. Whatever insecurity or vulnerability they are struggling with, they will be pushed further and further into it.” She continues:

Gen Z were the guinea pigs in this uncontrolled global social experiment. We were the first to have our vulnerabilities and insecurities fed into a machine that magnified and refracted them back at us, all the time, before we had any sense of who we were. We didn’t just grow up with algorithms. They raised us. They rearranged our faces. Shaped our identities. Convinced us we were sick.

Rikki Schlott, a 23-year-old American journalist and co-author of The Canceling of the American Mind , writes ,

The day-to-day life of a typical teen or tween today would be unrecognizable to someone who came of age before the smartphone arrived. Zoomers are spending an average of 9 hours daily in this screen-time doom loop—desperate to forget the gaping holes they’re bleeding out of, even if just for … 9 hours a day. Uncomfortable silence could be time to ponder why they’re so miserable in the first place. Drowning it out with algorithmic white noise is far easier.

A 27-year-old man who spent his adolescent years addicted (his word) to video games and pornography sent me this reflection on what that did to him:

I missed out on a lot of stuff in life—a lot of socialization. I feel the effects now: meeting new people, talking to people. I feel that my interactions are not as smooth and fluid as I want. My knowledge of the world (geography, politics, etc.) is lacking. I didn’t spend time having conversations or learning about sports. I often feel like a hollow operating system.

Or consider what Facebook found in a research project involving focus groups of young people, revealed in 2021 by the whistleblower Frances Haugen: “Teens blame Instagram for increases in the rates of anxiety and depression among teens,” an internal document said. “This reaction was unprompted and consistent across all groups.”

How can it be that an entire generation is hooked on consumer products that so few praise and so many ultimately regret using? Because smartphones and especially social media have put members of Gen Z and their parents into a series of collective-action traps. Once you understand the dynamics of these traps, the escape routes become clear.

Social media, in contrast, applies a lot more pressure on nonusers, at a much younger age and in a more insidious way. Once a few students in any middle school lie about their age and open accounts at age 11 or 12, they start posting photos and comments about themselves and other students. Drama ensues. The pressure on everyone else to join becomes intense. Even a girl who knows, consciously, that Instagram can foster beauty obsession, anxiety, and eating disorders might sooner take those risks than accept the seeming certainty of being out of the loop, clueless, and excluded. And indeed, if she resists while most of her classmates do not, she might, in fact, be marginalized, which puts her at risk for anxiety and depression, though via a different pathway than the one taken by those who use social media heavily. In this way, social media accomplishes a remarkable feat: It even harms adolescents who do not use it.

From the May 2022 issue: Jonathan Haidt on why the past 10 years of American life have been uniquely stupid

A recent study led by the University of Chicago economist Leonardo Bursztyn captured the dynamics of the social-media trap precisely. The researchers recruited more than 1,000 college students and asked them how much they’d need to be paid to deactivate their accounts on either Instagram or TikTok for four weeks. That’s a standard economist’s question to try to compute the net value of a product to society. On average, students said they’d need to be paid roughly $50 ($59 for TikTok, $47 for Instagram) to deactivate whichever platform they were asked about. Then the experimenters told the students that they were going to try to get most of the others in their school to deactivate that same platform, offering to pay them to do so as well, and asked, Now how much would you have to be paid to deactivate, if most others did so? The answer, on average, was less than zero. In each case, most students were willing to pay to have that happen.

Social media is all about network effects. Most students are only on it because everyone else is too. Most of them would prefer that nobody be on these platforms. Later in the study, students were asked directly, “Would you prefer to live in a world without Instagram [or TikTok]?” A majority of students said yes––58 percent for each app.

This is the textbook definition of what social scientists call a collective-action problem . It’s what happens when a group would be better off if everyone in the group took a particular action, but each actor is deterred from acting, because unless the others do the same, the personal cost outweighs the benefit. Fishermen considering limiting their catch to avoid wiping out the local fish population are caught in this same kind of trap. If no one else does it too, they just lose profit.

Cigarettes trapped individual smokers with a biological addiction. Social media has trapped an entire generation in a collective-action problem. Early app developers deliberately and knowingly exploited the psychological weaknesses and insecurities of young people to pressure them to consume a product that, upon reflection, many wish they could use less, or not at all.

The trap here is that each child thinks they need a smartphone because “everyone else” has one, and many parents give in because they don’t want their child to feel excluded. But if no one else had a smartphone—or even if, say, only half of the child’s sixth-grade class had one—parents would feel more comfortable providing a basic flip phone (or no phone at all). Delaying round-the-clock internet access until ninth grade (around age 14) as a national or community norm would help to protect adolescents during the very vulnerable first few years of puberty. According to a 2022 British study , these are the years when social-media use is most correlated with poor mental health. Family policies about tablets, laptops, and video-game consoles should be aligned with smartphone restrictions to prevent overuse of other screen activities.

The trap here, as with smartphones, is that each adolescent feels a strong need to open accounts on TikTok, Instagram, Snapchat, and other platforms primarily because that’s where most of their peers are posting and gossiping. But if the majority of adolescents were not on these accounts until they were 16, families and adolescents could more easily resist the pressure to sign up. The delay would not mean that kids younger than 16 could never watch videos on TikTok or YouTube—only that they could not open accounts, give away their data, post their own content, and let algorithms get to know them and their preferences.

Most schools claim that they ban phones, but this usually just means that students aren’t supposed to take their phone out of their pocket during class. Research shows that most students do use their phones during class time. They also use them during lunchtime, free periods, and breaks between classes––times when students could and should be interacting with their classmates face-to-face. The only way to get students’ minds off their phones during the school day is to require all students to put their phones (and other devices that can send or receive texts) into a phone locker or locked pouch at the start of the day. Schools that have gone phone-free always seem to report that it has improved the culture, making students more attentive in class and more interactive with one another. Published studies back them up .

Many parents are afraid to give their children the level of independence and responsibility they themselves enjoyed when they were young, even though rates of homicide, drunk driving, and other physical threats to children are way down in recent decades. Part of the fear comes from the fact that parents look at each other to determine what is normal and therefore safe, and they see few examples of families acting as if a 9-year-old can be trusted to walk to a store without a chaperone. But if many parents started sending their children out to play or run errands, then the norms of what is safe and accepted would change quickly. So would ideas about what constitutes “good parenting.” And if more parents trusted their children with more responsibility––for example, by asking their kids to do more to help out, or to care for others––then the pervasive sense of uselessness now found in surveys of high-school students might begin to dissipate.

It would be a mistake to overlook this fourth norm. If parents don’t replace screen time with real-world experiences involving friends and independent activity, then banning devices will feel like deprivation, not the opening up of a world of opportunities.

The main reason why the phone-based childhood is so harmful is because it pushes aside everything else. Smartphones are experience blockers. Our ultimate goal should not be to remove screens entirely, nor should it be to return childhood to exactly the way it was in 1960. Rather, it should be to create a version of childhood and adolescence that keeps young people anchored in the real world while flourishing in the digital age.

In recent decades, however, Congress has not been good at addressing public concerns when the solutions would displease a powerful and deep-pocketed industry. Governors and state legislators have been much more effective, and their successes might let us evaluate how well various reforms work. But the bottom line is that to change norms, we’re going to need to do most of the work ourselves, in neighborhood groups, schools, and other communities.

Read: Why Congress keeps failing to protect kids online

There are now hundreds of organizations––most of them started by mothers who saw what smartphones had done to their children––that are working to roll back the phone-based childhood or promote a more independent, real-world childhood. (I have assembled a list of many of them.) One that I co-founded, at LetGrow.org , suggests a variety of simple programs for parents or schools, such as play club (schools keep the playground open at least one day a week before or after school, and kids sign up for phone-free, mixed-age, unstructured play as a regular weekly activity) and the Let Grow Experience (a series of homework assignments in which students––with their parents’ consent––choose something to do on their own that they’ve never done before, such as walk the dog, climb a tree, walk to a store, or cook dinner).

Even without the help of organizations, parents could break their families out of collective-action traps if they coordinated with the parents of their children’s friends. Together they could create common smartphone rules and organize unsupervised play sessions or encourage hangouts at a home, park, or shopping mall.

P arents are fed up with what childhood has become. Many are tired of having daily arguments about technologies that were designed to grab hold of their children’s attention and not let go. But the phone-based childhood is not inevitable.

We didn’t know what we were doing in the early 2010s. Now we do. It’s time to end the phone-based childhood.

This article is adapted from Jonathan Haidt’s forthcoming book, The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness .

​When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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Mental health effects of education

Fjolla kondirolli.

1 University of Sussex, Brighton UK

Naveen Sunder

2 Bentley University, Waltham Massachusetts, USA

Associated Data

World Health Survey data is available online at https://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/whs/about . Demographic and Health Surveys data is available online at https://dhsprogram.com/ . Zimbabwe census data is available online at https://www.zimstat.co.zw/ .

We analyze the role of education as a determinant of mental health. To do this, we leverage the age‐specific exposure to an educational reform as an instrument for years of education and find that the treated cohorts gained more education. This increase in education had an effect on mental health more than 2 decades later. An extra year of education led to a lower likelihood of reporting any symptoms related to depression (11.3%) and anxiety (9.8%). More educated people also suffered less severe symptoms – depression (6.1%) and anxiety (5.6%). These protective effects are higher among women and rural residents. The effects of education on mental well‐being that we document are potentially mediated through better physical health, improved health behavior and knowledge, and an increase in women's empowerment.

1. INTRODUCTION

Mental health accounts for around seven percent of the global disease burden and 19% of all disability years (James,  2018 ; Rehm & Shield,  2019 ). In addition to being a valuable end in itself, mental well‐being is critical because it is a key determinant of a number of socio‐economic outcomes such as premature mortality (Graham & Pinto,  2019 ) and lower life expectancy (Wahlbeck et al.,  2011 ), and higher risk of other communicable and non‐communicable diseases (Hobkirk et al.,  2015 ; Prince et al.,  2007 ). In terms of economic outcomes, people with lower psychological well‐being have a higher likelihood of being unemployed (Frijters et al.,  2014 ), earn lower wages (Graham et al.,  2004 ), and are less productive (Oswald et al.,  2015 ). This makes them vulnerable to economic shocks and more likely to live in poverty (Lund et al.,  2011 ).

The negative effects of poor mental health are exacerbated in low‐ and middle‐income countries due to under‐treatment. Estimates suggest that under‐treatment is around 76–90% in low and middle‐income countries as opposed to 35–50% in developed countries (Patel et al.,  2010 ). Mental health is stigmatized in low‐income countries – evidence from a variety of contexts including Ethiopia (Shibre et al.,  2001 ), India (Koschorke et al.,  2014 ), and Nigeria (Oshodi et al.,  2014 ) demonstrates that individuals suffering from poor mental health fear being discriminated against and being ostracized by society, and consequently under‐report these issues and have a lower likelihood of seeking appropriate treatment. The under‐reporting of mental health issues, coupled with low investment in mental health infrastructure and diminished availability of human resources results in a higher treatment gap in these countries (Mascayano et al.,  2015 ). The high prevalence and low rates of treatment of mental disorders in developing countries creates a large welfare loss ‐ Bloom et al. ( 2011 ) estimate that by the year 2030, mental disorders are expected to lead to a loss in economic output amounting to around 20% of the global GDP. This necessitates the need to study factors that can help improve mental health. We explore the role of one such factor – education.

In particular, we examine the effect of years of education on long‐run mental health of individuals. We do so in the context of Zimbabwe. Before 1980, the country was under British colonial rule, and there were several discriminatory policies that restricted educational attainment among Black Zimbabweans. For example, primary education (grades 1–7) was free and compulsory only for White students, while Black students had to pay fees and were not required to enroll. Black students also had to take a competitive exam (for a limited number of seats) to gain admission into secondary school, while their White counterparts received automatic progression. Post‐independence (in 1980) the new government focused their efforts on improving educational outcomes, and implemented three critical reforms ‐ (1) free and compulsory primary education for all, (2) automatic progression into secondary school, and (3) the relaxing of age restrictions related to entry into primary school. These reforms benefited Black children who were of primary school‐going age at the time. Since Zimbabwean kids started school when they turned six, those who were 13 years or younger in 1980 disproportionately benefited from these policies (treatment group). Since the reform also allowed for some over‐age students to enroll in school, some children who were 14 or 15 years of age in 1980 might have also experienced some educational gains (the partially treated group). However, older individuals (16 years or above at the time) were significantly less likely to experience any such benefits, 1 and thus form our control group.

We utilize this age‐specific exposure to an educational reform in Zimbabwe in the 1980s as an instrumental variable (IV) for years of education to estimate the causal effect of schooling on later life mental health. We use an age cutoff of 15 years to define reform exposure – those who were 15 years and below in 1980 form the treated group, while those 16 years and older are considered as untreated. Our identification strategy rests on the assumption that individuals on either side of the age cutoff were, on average, conditionally indistinguishable, except for their exposure to this education policy, which led to higher levels of education among the treated. Our results indicate that the treated group eventually gained about three years of education and were 39% points more likely to attend secondary school. Our IV results suggest that this enhanced education led to better mental health later in life. We find significant effects of education on both the likelihood of having any adverse mental health related symptoms, and the severity of these symptoms. An extra year of schooling reduced the probability of reporting any symptoms related to depression (11.3%) or anxiety (9.8%) in adult life, and it also led to a decline in the severity of symptoms of both depression (6.1%), and anxiety (5.6%). Our findings suggest that the effects are larger among women and rural residents. We find evidence that improved physical health, better health‐related behavior and an increase in female empowerment might be some of the mechanisms through which education might have shaped mental health in the Zimbabwean context. We conduct a number of sensitivity analyses to show that our results are robust to various modifications in the empirical strategy, including levels at which the standard errors are clustered, and choice of bandwidth.

This paper contributes to two separate strands of literature. First, it adds to the growing evidence on the link between education and mental health. 2 While some studies find a positive impact of education on mental well‐being (Chevalier & Feinstein,  2006 ; Courtin et al.,  2019 ; Crespo et al.,  2014 ; Dursun & Cesur,  2016 ; Jiang et al.,  2020 ; Lager et al.,  2017 ; Li & Sunder,  2022 ; Mazzonna,  2014 ; Wang,  2021 ), others document a negative effect (Avendano et al.,  2020 ) or null effects (Begerow & Jürges,  2021 ; Böckerman et al.,  2021 ). In addition to the mixed results of education on mental health, the bulk of this literature is based on developed countries, such as the UK, USA, Canada, Germany, and Sweden. We build on this literature by introducing novel evidence on the effects of education on mental health in Africa, a context where this relationship has not yet been explored. Second, this paper adds to the vast literature exploring the effects of education on health, which largely builds on the model of health accumlation proposed by Grossman ( 1972 ) model of health accumulation. A recent review article finds that the effect of education on health outcomes (such as mortality and obesity) and health behaviors (such as smoking) is highly context specific (Galama et al.,  2018 ). This implies that evidence from one context might not be applicable to others, especially if they vary significantly. Moreover, it is unclear a priori whether the relationship between education and health extends to mental health. Our paper adds to the growing literature on the link between education and health by bringing forth evidence on mental health, a novel and understudied outcome. 3

2. DATA AND KEY VARIABLES

The data used in this analysis comes from the World Health Survey (WHS). The WHS was conducted by the World Health Organization (WHO) across 70 countries between the years 2002 and 2004. The survey focused on topics related to health, and it aimed to generate detailed and synchronized information on population health and the state of health systems across the globe. We use data for Zimbabwe ‐ it was conducted in 2002 and sampled 4292 individuals across 4218 households. It is nationally representative, and the sample includes adults aged 18 years and above. Households were selected using a random, stratified sampling procedure, and one individual per household was selected for the interview. They also collected individual‐level information, including sociodemographic information, health state, health risk factors, chronic conditions, mortality, health care utilization, and social capital. We restrict our analysis to include people who were between the ages of zero and 30 in 1980, the year in which Zimbabwe implemented the education reform. This leaves us with a sample of 2604 individuals. Our analysis is based on the following self‐reported measures of mental health:

• Depression Index : This is based on the response to the following question: “Overall in the last 30 days, how much of a problem did you have with feeling sad, low or depressed?”. The responses are coded on a scale from one (“none”) to five (“extreme”).
• Any Depression Symptoms : This is a categorical variable that takes a value of one if the Depression Index takes a value greater than one.
• Anxiety Index : This is based on the response to the following question: “Overall in the last 30 days, how much of a problem did you have with worry or anxiety?”. The responses are coded on a scale from one (“none”) to five (“extreme”).
• Any Anxiety Symptoms : This is a categorical variable that takes a value of one if the Anxiety Index takes a value greater than one.
• Mean Index : This is a composite index created from the following measures: Depression Index, Anxiety Index, feeling depressed, 4 lost interest 5 and experiencing decreased energy. 6 For each covariate, we create a standardized measure (with zero mean and a standard deviation of one) and then average across these standardized measures to get this index.

The summary statistics corresponding to these measures are reported in Table  1 . The people in our sample have an average of around 8 years of education, and half of this sample has a secondary education. Around 70% of the individuals in our sample are male, and 60% live in rural areas. Nearly 40% of our sample reported suffering from some depression or anxiety‐related symptoms in the 30 days preceding the survey. The average severity of these reported symptoms in our sample are 1.8 for both depression and anxiety (measured on a scale ranging from one to five, where one is “none” and five is “extreme”).

Descriptive statistics

Note : This is based on data from the World Health Survey for Zimbabwe.

3. ZIMBABWE EDUCATION REFORM: BACKGROUND

Zimbabwe declared its independence from the British rule in 1980. Under colonial rule, the education policy in Zimbabwe was designed to favor White students at the expense of Black students. The Ministry of Education had separate departments for White and Black students, with widely varying budgets and policies, which discriminated against the Black population. The government spent 12 times more per primary school pupil (grades 1–7) and three times more per secondary school pupil (grades 8–11) in the “European” system as opposed to the “Black” system. Primary schooling was free and compulsory for White students, while Black students had to pay fees and enrollment was voluntary. There were limited number of seats in secondary school for Black schoolchildren, and allocation was based on a competitive exam. This was in contrast to White students who gained automatic progression into secondary schools (Dorsey,  1989 ; Nhundu,  1989 , 1992 ).

After independence, the government implemented three key reforms aimed at equalizing educational opportunities for all – (1) government‐mandated free and compulsory primary schooling for all Zimbabweans, (2) automatic progression into secondary schools for everyone completing primary school (grades 1–7), and (3) the removal of age restrictions to allow over‐age children to enter school. To accommodate for the large demand for education, the government undertook a massive school building and reconstruction program. Between 1979 and 1981, the number of primary schools increased by 54%, while the number of secondary schools increased by 236% in the same period. The share of the budget allocated to education also increased from 11.6% in 1979–80 to 22.1% in 1980–81 (Nhundu,  1992 ). 7 More details on the changes in number of schools, teachers, and education expenditure that accompanied this policy are provided in Appendix  A .

Overall, this resulted in sizable increases in enrollment into primary school (from around 800,000 in 1979 to 2.2 million in 1986) and secondary school (from 66,215 in 1979 to 537,427 in 1986). The larger proportional increase was experienced in secondary school enrollment because of the high levels of discrimination experienced in transition from primary to secondary schools in the pre‐reform period. Therefore, the policies targeted toward a smoother transition from primary to secondary school (removal of the mandatory exam) led to huge educational benefits for the Black population. This is also illustrated by the following statistic – the percentage of seventh graders who joined secondary school increased from 20% in 1979 to about 78% in 1986. This significant rise in the post‐reform period is demonstrated in Figure  1 – the plot shows that there was a large jump in the percentage of students who transitioned from primary to secondary school starting in the year 1980. This figure also shows that total secondary school enrollment, which had largely stayed constant before 1980, increased steadily in this period (Figure  1 ).

Trends in secondary school enrollment and transition for Zimbabwe. The estimates here are based on data from Riddell & Nyagura,  1991 , which in turn are curated from the UN statistical yearbooks from 1970 to 1988. The transition rate is the percentage of students who graduated from grade seven (highest grade in primary school) who end up enrolling in grade eight (secondary school). Secondary school enrollment is measured in thousands of students.

Put together, these reforms disproportionately benefited Black children who were in primary school (grades 1–7) at the time (and would have progressed to secondary school in the ensuing years). School starting age in Zimbabwe was 6 years – therefore, children aged 13 years and below at the time of the reform would have gained from the passage of this policy. In our main analysis, we consider this as our fully treated group. Since the reform also allowed for some overage children to enroll in school, there is the possibility that some 14 and 15 year old children could have also benefited due to the reforms – we consider them as partially treated. Those who were 16 years and above in 1980 were considerably less likely to have benefited from this policy change and hence form our control group.

4. EMPIRICAL METHODOLOGY

To explore the relationship between education and mental health, one would estimate the following specification:

where Y i is the mental health outcome for individual i , Education i is the education level of individual i , and X i includes gender, living in rural area, district and survey‐round fixed effects. OLS estimates of δ 1 , our coefficient of interest, would be biased because individuals with lower levels of education might also have other characteristics that could influence their mental health, such as lower income or worse physical health outcomes. To account for this bias, we use the exogenous shift in education caused by the Zimbabwean educational reform of 1980. As discussed earlier, this reform disproportionately increased access to education for Black children of primary school‐going age. Therefore, we create a categorical variable that divides our sample into a treated and a control group. Our treatment group consists of individuals who were 15 years or younger in 1980, and the control group consists of individuals who were 16 years or older at the same time. We implement a 2SLS‐IV framework, where the first stage equation uses the age‐specific exposure to the reform as an instrumental variable (IV) for years of education. In the second stage equation, we regress the outcome of interest on instrumented years of education. In this case, the equations of the first and second stage are as follows:

In Equation ( 3 ), β 1 represents the causal impact of education on long‐run mental health outcomes. Education i represents individual i 's education outcome, which in the main analysis will be years of education. In alternate specifications, we show that the results are robust to using a categorical variable for whether the individual had any secondary education (more than seventh grade). Treated i is a categorical variable that takes a value of one for individuals who were 15 years of age or below in 1980, and zero otherwise. The covariate f( Age80 i ‐15) accounts for different functional forms of age. In the main specifications we include linear polynomials, while in robustness checks we control for higher‐order polynomials (such as quadratic). This controls for any cohort‐specific effect on individuals born in a given year. 8

Standard errors are clustered at the level of the running variable, the age of the respondent in 1980. We control for gender, rural residence dummy, district fixed effects and temperature and rainfall shocks experienced by the individuals in their in‐utero period and infancy. The weather related controls are included to assuage concerns that these types of shocks experienced in childhood could be driving our findings (as shown by Adhvaryu et al.,  2019 , who find that temperature shocks in the in‐utero period increase depressive symptoms in adulthood in Africa). The data for rainfall and temperature is at the district level and comes from the Willmott and Matsura series (Matsuura & Willmott,  2018 ). 9 In Appendix  B , we further discuss the validity of this empirical strategy and present results from different checks, including McCrary density test (Figure  A7 ) and falsification check related to effect on pre‐determined outcomes (Figure  A8 ).

5.1. Impact of the 1980 reforms on educational attainment

We start by graphically examining the impact of the reform on educational attainment. To do this, we plot the highest grade attained ( y ‐axis) against age in the reform year ( x ‐axis). In Figure  2 we present graphs using the WHS data – the graph in the left panel demonstrates that years of education for the fully treated group (13 years and below) is considerably higher than that of the control group (16 years and above). The graph on the right in Figure  2 presents the same graph with the average years of education for 14 and 15 year olds (the partially treated group) included. The highest grade attained for the partially treated group is somewhere between the two aforementioned groups, confirming that some individuals of these cohorts benefited from the reforms. The same pattern is also observed using data from the Demographic and Health surveys 10 and 2012 Zimbabwe census data (Figure  A2 ). Since the reform particularly focused on the transition from primary to secondary school, it is instructive to see if there had been a significant rise in the rate of secondary schooling among the treated group. We present the graphs pertaining to the share of the sample with secondary schooling in Figure  A1 . The figure in the top panel suggests a discontinuous jump in the probability of attending secondary school among children aged 13 years and below, as compared to those who were 16 years or older at the time of the reform. Children who were 14 or 15 years of age again show a similar pattern as above (top panel, right graph). To demonstrate the robustness of the findings, we show that the effect of the reform is observed even when we use other datasets, the DHS (middle panel, Figure  A1 ) and the 2012 census data (bottom panel, Figure  A1 ).

Effects of the Reform on Education (First Stage effects). Authors' estimate based on Word Health Survey data. The y ‐axis represents the highest grade attained by individuals in our samples and the x ‐axis represents the age in 1980 when the reform was implemented. All estimations include gender, living in rural area, fixed effects for region and survey rounds. Standard errors are clustered by the age of respondent in 1980.

We further probe the effects of this reform on education by conducting regression analysis. In particular, in Table  2 , we present results corresponding to the first stage equation (Equation ( 2 )). In our analysis sample, treated individuals had on an average 3.4 additional years of schooling as compared to the untreated (Table  2 , column 1). This effect remains robust when restricting to smaller bandwidths around the age cutoff of 15 years (Table  2 , columns 2 and 3). The impact estimate remains statistically significant when we restrict the sample to individuals between 6 and 23 years of age (3.8 years, p ‐value < 0.001) and to those between 9 and 20 years of age (3.3 years, p ‐value < 0.001). The impact is larger and remains statistically significant among individuals living in rural areas (Table  2 , column 4). We present analogous results using any secondary education as an outcome in Table  A3 ‐ the results follow a similar pattern to the findings above. The coefficient estimates of the impact of the reform on education presented here are larger in comparison to other studies in the same context. We posit that this is plausibly due to differences in the datasets used and the corresponding sample sizes in these analyses.

First stage ‐ effect of reform on years of education

Note : Results are based on data from World Health Survey from Zimbabwe. The full sample includes individuals who were between the ages of 0 and 30 in 1980. All specifications exclude those who were 14 and 15 years old in 1980, and control for categorical variables for living in a rural area, fixed effects for survey round, and region and linear age trends, and rainfall/temperature shock in the year of birth. Standard errors are clustered by the age of the respondent in 1980.

* Significant at the 10 percent level. ** Significant at the 5 percent level. *** Significant at the 1 percent level.

We conduct two separate checks to demonstrate the robustness of the first stage effects. First, we use other datasets to show that the effect of the policy on education that we observe in the WHS dataset is present in other nationally representative surveys ‐ the Demographic and Health Surveys (Table  A1 ) and the 2012 Census data (Table  A2 ). We find a positive and statistically significant effect of the policy reform on education across different sub‐samples in both datasets. Additionally, we also show that the first stage effects are largely insensitive to changes in the bandwidth used ‐ in this check we restrict the sample of analysis to between 5 and 12 years on either side of the cutoff age and find that the reform's effect on education is preserved in the WHS data (Figure  A3 ), the DHS data (top panel of Figure  A4 ) and the 2012 census data (bottom panel of Figure  A4 ).

5.2. Impact of education on mental health

Having established that the reform had a significant effect on educational outcomes, we explore whether this reform‐induced increase in education led to improved long‐run mental health. We first examine this using a graphical approach. In Figure  3 , we plot the distribution of mental health indices by treatment status. This figure illustrates that the treated group are more likely to report any symptoms related to anxiety/depression and are less likely to experience more severe symptoms related to anxiety/depression. This points toward the fact that the reform had a positive effect on mental health.

Values of mental health indices by treatment status. Based on Zimbabwe World Health Survey data. The figures plot the distribution of our measures of mental health: depression and anxiety indices, which measure the severity of symptoms related to depression and anxiety, in the top panels, and probability of having depression‐ or anxiety‐related symptoms in the bottom panels, by treatment status. Treated includes individuals aged 15 years and younger in 1980 and the untreated group consists of individuals aged 16 years and older in 1980.

Further, in Figure  4 , we present a plot of the impact of the reform on mental health. From this figure, we can conclude that the fully treated group (13 years and younger in 1980) is less likely to report symptoms related to anxiety or depression (Figure  4 , right) and have lower intensity symptoms related to depression and anxiety (Figure  4 , left).

The impact of education on mental health. Based on author calculations using World Health Survey Zimbabwe. The figures plot different measures of mental health against the running variable (age in 1980). The upper panels represent depression index (left) which measures the severity of the symptoms and an indicator variable for having any depression‐related symptoms (right). The lower panels presents graphs for similar outcomes pertaining to anxiety‐related symptoms.

As discussed in the empirical strategy section, the OLS specification (results in Table  A4 ) will likely yield biased estimates of the impact of education on mental health due to the presence of other confounding factors such as income or physical health. Therefore, we conduct an IV analysis where years of education is instrumented using age‐based exposure to the Zimbabwean educational reform (based on Equations ( 2 ) and ( 3 )). These results are presented in Table  3 and suggest that an increase in education leads to better mental health, a consistent pattern across different mental health measures. Education decreases the probability of having any depression related symptoms by 11.3% (Table  3 , column 1) and those related to anxiety by 9.8% (Table  3 , column 2). 11 Additionally, education also reduces the severity of depressive symptoms by 6.1% (Table  3 , column 3) and anxiety by 5.6% (Table  3 , column 4). We also create a composite mental health index (combining the measures for depression and anxiety), where higher values indicate worse psychological health. We find that one more year of schooling leads to a decline in the composite mental health index by 0.06 standard deviations.

IV regressions – education and mental health

Note : Any Depression Symptoms and Any Anxiety Symptoms are categorical variables measuring whether the respondent suffered from any depressive or anxiety related symptoms. Depression Index and Anxiety index are measured on a scale of 1–5, where 5 represents more severe symptoms. The sample includes individuals who were between the ages of 0 and 30 in 1980. All specifications exclude those who were 14 and 15 years old in 1980, and control for categorical variables for living in a rural area, fixed effects for survey round, region and linear age trends, and rainfall/temperature shock in the year of birth. The control mean here refers to the mean of the outcome variable among those who were 16–30 years of age at the time of the reform. Results are based on data from World Health Survey from Zimbabwe. Standard errors are clustered by the age of the respondent in 1980.

* Significant at 10 percent. ** Significant at 5 percent. *** Significant at 1 percent.

Mechanisms – Physical health

Note : The sample consists of individuals who were between 0 and 30 years of age in 1980 (excluding 14 and 15 year old). The control mean here refers to the mean of the outcome variable among those who were 16–30 years of age at the time of the reform. Standard errors are clustered by the age of the respondent in 1980.

Source : World Health Survey Zimbabwe.

Comparing the coefficient estimates from the OLS specifications (Table  A4 ) with those from the IV specifications (Table  3 ) shows that the OLS estimates are underestimates of the true causal effect. This is consistent with other studies estimating the causal impact of education on health (Agüero & Bharadwaj,  2014 ; Cutler & Lleras‐Muney,  2010 ) and mental health specifically (Dursun & Cesur,  2016 ). The OLS could underestimate the true causal effect for a number of reasons. First, omitted variables (e.g., social norms such as gender roles) which might be negatively correlated with education might lead to a downward bias on the observed coefficient. Second, measurement error in education could lead to attenuation bias which would reduce the magnitude of the education coefficient. Third, IV estimates LATE, which is different from the average treatment effect estimated by OLS. The LATE is estimated based on compliers – this group consists of individuals who, in the absence of the reform, would not have had as much schooling, not because of any differences in their ability levels but because of higher‐than‐average costs of schooling due to the oppressive policies aimed at creating educational bottlenecks for the Black population. These are likely to be the more disadvantaged among the Black population, who in turn are likely to have worse mental health. Hence it is possible that these individuals demonstrate a higher marginal effect of education on mental health ‐ thus leading to the IV estimates being higher than the OLS.

Our results are akin to other studies that have found a positive impact of education on mental health in other contexts. For example, Crespo et al.,  2014 find that an additional year of schooling decreases the probability of suffering from depression by 6.5% points. As another example, Dursun & Cesur,  2016 find that an increase of 3 years of schooling in Turkey increased life satisfaction among women by 0.17 standard deviation. Studies that look at the impact of early‐life shocks/interventions also find similar results. Analyzing a compulsory schooling reform in China that increased schooling among beneficiaries, Li & Sunder,  2022 find that an increase of one year of schooling leads to a decrease of 26% in the likelihood of being depressed and a 10% decline in the severity of depressive symptoms.

We would like to note two potential caveats to our study. In comparison to administrative data, survey respondents are less likely to report mental health problems due to social stigma (Bharadwaj et al.,  2017 ; Greene et al.,  2015 ). Therefore it is possible that the prevalence of mental illness observed in our data is less than the actual rates. Another concern is that the reporting of mental health could be correlated with educational attainment. A priori it is unclear what the direction of the association would be – one could argue that more educated individuals are more likely to under report mental health issues due to social stigma, while on the other hand lesser educated individuals might face societal pressures that increase their likelihood of reporting a mental illness. However, due to lack of evidence directly linking education with self‐reports of mental health, we are unable to provide a direction to this bias. 12

5.3. Heterogenous effects

Having established that an increase in education in childhood improves mental health later in life, we examine whether the relationship differs based on different socio‐economic characteristics.

First, we look at the impact of education on mental health by gender. Enrollment data shows that the Zimbabwean reform had a larger effect on girls ‐ the number of girls who enrolled in secondary school increased by tenfold between 1980 and 1985 (Chikuhwa,  2008 ). Therefore, we might expect that this increased educational effect might translate into larger positive impacts on women's mental health. Results in Figure  5 provide suggestive evidence supporting this ‐ education has a larger effect on mental health for women. One more year of education among women reduces the probability of having depression (14.8%) and anxiety (13%) related symptoms, while it also lowers the and the severity of these symptoms – depression (8.2%) and anxiety (7.1%). These effect sizes are larger than the overall effects, but the difference is not statistically significant. However, these results provide suggestive evidence of higher mental health gains among women. This gender‐differentiated impact is critical for two reasons. First, women have a higher prevalence of mood‐related disorders than men, possibly due to biological differences as well as lower self‐esteem, the experience of gender‐based violence, and gender discrimination (Boyd et al.,  2015 ; Riecher‐Rössler,  2017 ). Our results suggest that education might mitigate some of these effects. Second, these mental health gains confer some intergenerational (indirect) benefits as well – studies have demonstrated that improved maternal mental health is associated with higher educational attainment, future household income, lower probability of criminal convictions (Johnston et al.,  2013 ), and better health outcomes (Le & Nguyen,  2018 ). Since a majority of women in our sample are in the reproductive age range, improved mental health can not only improve their own well‐being, but also have strong implications for the long‐term human capital accumulation of the next generation as well.

Heterogeneous impacts of education on mental health. The definitions of the mental health measures are the same as those used in Table  3 . The sample includes women who were between the ages of 0 and 30 in 1980. All specifications exclude those who were 14 and 15 years old in 1980, and control for categorical variables for living in a rural area, fixed effects for survey round, region, linear age trends, and rainfall/temperature shock in the year of birth. Results are based on data from World Health Survey from Zimbabwe. Standard errors are clustered by the age of the respondent in 1980.

Next, we assess the impact of education on mental health among individuals living in rural areas. This is motivated by prior studies have found higher effects of educational reforms in rural areas (Erten & Keskin,  2018 ; Li & Sunder,  2022 ). In our case, the treated group in rural areas had 3.5 more years of education (Table  2 , column 4). This large increase in education in rural areas does translate into a higher positive impact on their mental health. Rural residents were seven p.p. and four p.p. less likely to report any symptoms related to depression and anxiety respectively in adulthood (Figure  5 ).

Finally, we examine whether individuals belonging to households with lower wealth experience any heterogeneous effects. In low‐ and middle‐income countries, low income is strongly associated with mental disorders (Rehm & Shield,  2019 ). Additionally, in developing country contexts, like Zimbabwe, the lower access to mental health resources and the inability of the poor to afford any available resources further adds to the problem. In this study, we measure assets using a composite asset index (created using principal component analysis 13 ) and define a household having low assets if it lies in or below the 25th percentile of the composite asset index distribution. Results in Figure  5 show that the impact of one additional year of schooling on mental health is indeed larger for this sub‐sample.

5.4. Robustness checks

We conduct several robustness checks to examine the sensitivity of our main empirical findings.

5.4.1. Bandwidth

We check whether our findings regarding the impact of education on mental health are robust to the use of different bandwidths around the age cutoff of 15 years. We replicate our main analysis using different bandwidths around the cutoff age – these bandwidths vary between 5 and 12 years, in 1‐year increments. The coefficient estimates from this exercise are presented in Figure  A5 – they indicate that the effects of education on mental health are always negative (more education leads to better mental health) and largely remain statistically significant. This suggests that our main findings are largely insensitive to changes in bandwidth.

5.4.2. Polynomial function

In our main specification, we use a linear polynomial to control for the running variable, the age of the individual in 1980 minus 15. As a robustness check, we control for the running variable using a quadratic polynomial. The results presented in Figure  A6 suggest that the impact of an extra year of education on all our measures of poor mental health remain negative and statistically significant.

5.4.3. Clustering of standard errors

We examine how sensitive our results are to clustering of the standard errors at different levels. In the main specification, standard errors are clustered by the age of the individual. But, there might be a high degree of correlation between the outcomes of people who live close to each other (in the same region), and hence including the region in the clustering may be desirable. Therefore, in Figure  A6 we present results using two‐way clustering of the standard errors at the region‐age level. The results remain statistically significant.

5.4.4. Including partially treated individuals

As mentioned earlier, our main analysis excludes individuals who were 14 and 15 year old in 1980 (since they were partially treated the reform). Therefore, as a robustness check, we include them in the treated sample and re‐run our analysis. We find that the results remain similar in both size and statistical significance (Figure  A6 ).

5.4.5. Changes in empirical strategy

Finally, we employ a slightly different empirical strategy than the one that is used in the main analysis (IV strategy). Here, we divide the treatment group into two separate categories – those who were completely treated, which includes individuals who were aged seven or below in 1980 (likely started primary school in/after 1980), and those who were partially treated, referring to people who were between 8 and 14 years of age in 1980 (likely to have already started primary school before the policy was implemented). The intuition behind creating these two groups is that individuals who were exposed to the policy throughout their primary schooling (completely treated) are likely to experience more benefits than those who were only benefited from it for a part of their primary schooling years (part treated). Results in Table  A6 show that one more year of education among completely treated individuals led to a larger decrease in depression and anxiety symptoms, as well as the probability of reporting depression or anxiety symptoms compared to those who were only part treated, which is in line with our prior expectations.

5.5. Mechanisms

Further, we probe the potential mechanisms that might drive the observed effects of education on mental health in this context. Using various strands of medical, economic, and psychological literature, we explore several possible channels through which the mental health effects that we observe could have been mediated.

5.5.1. Physical health

Across a variety of contexts, it has been shown that physical health is strongly positively associated with mental health (Ohrnberger et al.,  2017 ; Sabia & Rees,  2015 ; Willage,  2018 ). We examine whether improvements in education among the treated group in Zimbabwe led to improved physical health later in life. We measure physical health using the following indicators – self‐rated health (=1 if reported good health), whether the person had difficulty working in the past 30 days, whether they experienced any pain or discomfort in the last 30 days, and a categorical variable for whether their BMI was in the normal range (between 18.5 and 25). The results from this analysis are presented in Table  4 – they indicate that higher education led to better outcomes across all these indicators. More educated people reported better health (5 p.p.), experienced fewer difficulties/pain and had a five p.p. higher likelihood of having a BMI in the normal range. Additionally, they were seven p.p. and six p.p. less likely to report difficulty in working or any pain or discomfort, respectively. This implies that the Zimbabwean reform led to improved physical health outcomes, which in turn could be an important factor in driving the observed effects on mental health. 14

5.5.2. Health knowledge and behaviors

Past studies have demonstrated that improved health‐related practices (such as not smoking, lower alcohol consumption, and a healthy diet) are positively associated with mental well‐being (Buttery et al.,  2015 ; Parletta et al.,  2016 ). Therefore, we consider the following possibility: did educational gains among the treated cohorts also lead them to have improved health behaviors later in life, which in turn could have positively affected psychological health? In this analysis, we proxy health behaviors and knowledge using three different outcomes ‐ smoking/alcohol related behavior, HIV knowledge, 15 and knowledge/usage of various forms of contraception. With respect to smoking and alcohol consumption, we find that more educated individuals are less likely to be smoking (3 p.p.) or consuming alcohol (4 p.p.). The results in Table  5 also indicate a positive effect of schooling on enhanced knowledge of HIV among treated women – we find that women with higher education have more comprehensive knowledge about HIV (2 p.p.). Additionally, an increase in 1 year of education makes women five p.p. more likely to know about contraception 16 and increases their likelihood of using contraception by three p.p. (Table  5 , columns 4–5). Overall, this suggests that improved health‐related behaviors might be an important mediator of mental health gains.

Mechanisms – Health knowledge and behaviors

Source : DHS Zimbabwe 1994, 1999, 2005.

5.5.3. Women's empowerment

There is growing evidence of a robust negative association between the prevalence of gender‐based violence and various measures of psychological challenges, including suicides, depression, post‐traumatic stress, and eating disorders (Grose et al.,  2019 ). Using information from multiple rounds of the Zimbabwe DHS, we examine whether women's empowerment could have been a potential channel for the observed mental health effects. In particular, we explore the following three different dimensions of empowerment:

Mechanisms – Women's empowerment

Note : Sexual violence is an indicator that takes the value of one if the woman experienced sexual violence from her partner in the last 12 months, and zero otherwise. Sexual & physical & emotional violence is an indicator that takes a value of one if the woman has ever experienced sexual, physical, and emotional violence from her partner, and zero otherwise. The sample consists of individuals who were between 0 and 30 years of age in 1980 (excluding 14 and 15 year old). The control mean here refers to the mean of the outcome variable among those who were 16–30 years of age at the time of the reform. Standard errors are clustered by the age of the respondent in 1980.

• Prevalence of IPV: Our findings suggest that women in the treated group have a 22 percent lower likelihood (relative to control mean) of reporting being the victim of sexual violence by their partners in the past 12 months. They are also less likely to have ever experienced physical and sexual, and emotional violence by their current partner (17 percent) (Table  6 , Columns 2 and 3).

Put together, these results point toward the role of increased empowerment among women, in the form of education‐induced reductions in IPV prevalence and increases in employment, as one of the potential mediators of the mental health benefits that we document.

6. DISCUSSION AND CONCLUSION

Mental health is a growing priority among policymakers, as indicated by its inclusion in the United Nations' Sustainable Goals (SDG). Despite the acknowledgment of its importance, investment in mental health has remained low, especially in Africa. 18 This has led to a shortfall in the availability of medicine, infrastructure, and health workers, which has resulted in large‐scale undertreatment of mental illness, the costs of which will become increasingly higher as the continent is expected to double its population in the next 3 decades (Sankoh et al.,  2018 ). To the extent possible, our study examines whether, in contexts with limited health infrastructure, other complementary investments in childhood, such as education, could help decrease the burden of poor mental health in adulthood.

We study whether there is a causal link between education and mental health. We do so by leveraging the exogenous shift in education caused by a policy intervention in Zimbabwe. This reform removed significant barriers to education that Black schoolchildren in Zimbabwe faced and was effective in improving educational outcomes among the target population. Using nationally representative survey data and IV‐2SLS methodology, we find that an additional year of education reduces the probability of reporting any symptoms related to depression (11.3%) and anxiety (9.8%). Also, increased education has a dampening effect on the severity of symptoms related to both depression (6.1%) and anxiety (5.6%). Our results also indicate that the impact of education on mental health is larger for women and rural residents. In terms of mechanisms, we find that physical health, health knowledge (and behaviors) and women's empowerment might be crucial drivers of our findings.

This evidence on the protective effects of education on mental health is especially significant when viewed in conjunction with the mixed results demonstrated by other direct (and indirect) mental health‐enhancing interventions in similar contexts. For example, a review of the evidence on the relationship between poverty and depression and anxiety found that the average impact of anti‐poverty programs is a decrease in 0.094 SD in common mental health disorders such as depression and anxiety (0.138 SD for multi‐faceted anti‐poverty programs and 0.067 for cash transfer programs) (Ridley et al.,  2020 ). These interventions are one‐off, potentially resource‐intensive, and affect only a small share of the population. In contrast, in this study, we show that large‐scale policy reform such as an expansion of education has a large and persistent long‐term impact on mental health, complementing similar evidence from other countries (Chevalier & Feinstein,  2006 ; Courtin et al.,  2019 ; Crespo et al.,  2014 ; Dursun & Cesur,  2016 ; Jiang et al.,  2020 ; Lager et al.,  2017 ; Mazzonna,  2014 ; Wang,  2021 ). These benefits become even more significant (and cost‐effective) since these education policies were not specifically designed to target these health outcomes and are spillover effects.

Our paper adds to the growing evidence on the efficacy of education in improving health outcomes in general (Galama et al.,  2018 ) and to the understanding of the impact of interventions during adolescence on economic and social outcomes in adulthood (Cunha et al.,  2010 ; Heckman,  2007 ). Our findings motivate future research on the impact of large‐scale policies in developing countries on understudied outcomes such as mental health, even if the interventions themselves were not directly targeted toward it.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

Supporting information

Supporting Information S1

Kondirolli, F. , & Sunder, N. (2022). Mental health effects of education . Health Economics , 31 ( S2 ), 22–39. 10.1002/hec.4565 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

1 Using multiple data sources (including census data), we demonstrate in our analysis that those who were 16 years or older had a much lower likelihood of experiencing educational gains due to this policy. This pattern has also been confirmed by other studies of the same policy intervention (Agüero & Ramachandran,  2020 ; Grépin & Bharadwaj,  2015 ).

2 Broadly, economic research on mental health has largely focused on developed countries, and has examined different determinants of mental well‐being, such as income (Baird et al.,  2013 ; Haushofer & Shapiro,  2016 ; Kahneman & Deaton,  2010 ; Kahneman & Krueger,  2006 ; Stevenson & Wolfers,  2013 ), poverty (Haushofer & Fehr,  2014 ; Lund et al.,  2011 ; Tsaneva & Balakrishnan,  2019 ), environment (Zhang et al.,  2017 ), socioeconomic status (Lorant et al.,  2003 ; Stewart‐Brown et al.,  2015 ), crime (Bor et al.,  2018 ; Cornaglia et al.,  2014 ; Dustmann & Fasani,  2016 ; Metcalfe et al.,  2011 ), early‐life circumstances (Adhvaryu et al.,  2019 ; Dinkelman,  2017 ; Persson & Rossin‐Slater,  2018 ), career choices (Bertrand,  2013 ), residential status (Katz et al.,  2001 ), and migration (Scheffel & Zhang,  2019 ).

3 Other papers that have looked at the effect of education on health (and related) outcomes in the African context include child mortality (Grépin & Bharadwaj,  2015 ; Keats,  2018 ), fertility (Osili & Long,  2008 ), HIV prevalence (Duflo et al.,  2015 ), and teenage pregnancy (Baird et al.,  2013 ).

4 Takes a value of one if the response to the following question is “Yes” (and zero otherwise): “During the last 12 months, have you had a period lasting several days when you felt sad, empty or depressed?”

5 Takes a value of one if the response to the following question is “Yes” (and zero otherwise): “During the last 12 months, have you had a period lasting several days when you lost interest in most things you usually enjoy such as hobbies, personal relationships or work?”

6 Takes a value of one if the response to the following question is “Yes” (and zero otherwise): “During the last 12 months, have you had a period lasting several days when you have been feeling your energy decreased or that you are tired all the time?”

7 The demand for education could not be met with a proportional increase in the supply of teachers in years immediately after 1980, which possibly led to the government hiring untrained and under‐qualified teachers (according to some sources the share of untrained teachers was as high as 43 percent in 1987 (Nhundu,  1992 )). To increase the supply of trained teachers, the University of Zimbabwe offered a 2‐year part‐time course for teachers who were already working in secondary schools and the government introduced the Zimbabwe Integrated National Teacher Education Course, that consisted of an one‐term teaching course followed by a three and half years of teaching in primary (and subsequently secondary) schools.

8 Any differences between the treatment and control cohorts due to factors not controlled for in our specification would be a concern if they were to differentially affect those that are just below and those just above the cutoff age – which we think this is unlikely to be the case. Having said that, we note this as a caveat of this analysis. Additionally, we do not know of any other policies or reforms implemented concurrently in Zimbabwe that was targeted in the same manner as this education reform.

9 Rainfall and temperature shocks are defined using the following formula: log(average over a given 12 month period) minus log(long term mean).

10 We use the 1994, 1999, and 2005 rounds of the Demographic and Health surveys in Zimbabwe.

11 The effect sizes are relative to control group mean. Since the reform targeted entry into secondary school, in an alternate specification we use a categorical variable for having any secondary education as the main independent variable of interest (instead of years of education). As expected, having any secondary education has a large positive impact on mental health (estimates in Table  A5 ).

12 Some studies show that people with more education are less likely to self‐report being sick (Subramanian et al.,  2009 ) and have a lower likelihood of reporting worse health status (Subramanian et al.,  2010 ). Using WHS data, Subramanian et al.,  2010 show that this pattern is observed across countries with different income status. This indicates that more educated people are less likely to report worse health, and there is a possibility that a similar pattern may exist for mental health as well.

13 This composite asset index is based on household ownership of the following items – bicycle, clock, bucket, washing machine, refrigerator, telephone, mobile phone, television, computer, wheel‐barrow, cart and radio. Note that the wealth heterogeneity results should be interpreted with the caveat that we are stratifying on a post‐treatment (endogenous) variable.

14 It is to be noted that the mechanisms analysis presented here is suggestive in nature, and that a bulk of the outcomes examined here are measured contemporaneously with the mental health measure.

15 We use HIV because Zimbabwe has the fifth highest prevalence of HIV in the world with, 12.8 percent of the population aged 15–49 years old infected (The World Bank,  2015 ). Here, comprehensive knowledge of HIV is a categorical variable that takes the value of one if an individual knows that they can reduce HIV risk by limiting the number of partners and using condoms, that a healthy person can have HIV, that HIV cannot be transmitted by mosquito bites or supernatural means, and zero otherwise. These findings are consistent with those of Agüero and Bharadwaj ( 2014 ).

16 These methods of contraception include female sterilization, male sterilization, pill, IUD, injectables, implants, male condoms, female condom, diaphragm, standard days method, LAM, emergency contraception, rhythm method, and withdrawal method.

17 These decision‐making categories include the following: her own health, large household purchases and visiting friends/family. We create a categorical variable for each of these, where it takes a value of one if the woman is involved in the decision (either deciding by herself or jointly with the husband). We also create an additional composite variable on whether the woman is involved in making all of the above decisions – this takes a value of one if she is involved in all of the decisions, and zero otherwise; and a variable that represents the number of decisions she is involved in.

18 In 2017 the median per‐capita mental health expenditure in Africa was 10 cents, as compared to a global average of USD 2.5 (WHO,  2018 ). This has led to low levels of health personnel (per‐capita median number of mental health workers in Africa is 1/50th that of Europe), and admission rates to mental health institutions (0.2 per 1000 population as compared to 4.5 per 1000 population in Europe).

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