title: The effect of the school environment on the emotional health of adolescents: a systematic review.
abstract: OBJECTIVE
  The evidence base for the importance of the school environment for adolescent emotional health has never been systematically reviewed. We aimed to synthesize the evidence for the effect on adolescent emotional health of (1) interventions targeting the school environment and (2) the school environment in cohort studies.
  
  
  METHODS
  Searches of Medline, Embase, PsychINFO, CINAHL, ERIC, the Social Citation Index, and the gray literature were conducted. Criteria for inclusion were (1) cohort or controlled trial designs, (2) participants aged 11 to 18 years, (3) emotional health outcomes, and (4) school environment exposure or intervention. Relevant studies were retrieved and data extracted by 2 independent reviewers.
  
  
  RESULTS
  Nine papers reporting 5 controlled trials were reviewed, along with 30 cohort papers reporting 23 studies. Two nonrandomized trials found some evidence that a supportive school environment improved student emotional health, but 3 randomized controlled trials did not. Six (20%) cohort papers examined school-level factors but found no effect. There was some evidence that individual perceptions of school connectedness and teacher support predict future emotional health. Multilevel studies showed school effects were smaller than individual-level effects. Methodological shortcomings were common.
  
  
  CONCLUSIONS
  There is limited evidence that the school environment has a major influence on adolescent mental health, although student perceptions of teacher support and school connectedness are associated with better emotional health. More studies measuring school-level factors are needed. Randomized controlled trials evaluating 1 or 2 environmental components may have more success in establishing effective and feasible interventions compared with complex whole-school programs.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK. judi.kidger@bristol.ac.uk
authors.forename: Judi
authors.initials: J
authors.lastname: Kidger
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.forename: Jenny
authors.initials: J
authors.lastname: Donovan
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000517:prevention & control* / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D012307:Risk Factors; D012574:Schools; D012931:Social Environment; D012944:Social Support