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

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