Mental Health Problems of Adolescents in Context: Exploring the role of Family, Neighbourhood, School, Country, and Time

Abstract

This dissertation investigates how adolescents’ mental health problems are shaped by the multiple layers of their context. Rather than focusing on isolated factors, it emphasizes the interconnectedness of neighbourhood, school, family, and national contexts, as well as the influence of temporal changes. Using the Health Behaviour in School-aged Children (HBSC) data, this research shows that both the school and neighbourhood are key environments for adolescents’ mental health problems, but their relative importance differs by educational type. In primary education, neighbourhood and school contexts are equally relevant, while during secondary education, school characteristics are more often related to adolescents’ mental health problems (Chapters 2 and 3). This reflects developmental changes: as adolescents grow older, they spend more time in schools beyond their immediate neighbourhoods, encounter greater academic demands, and experience increasing social autonomy. The findings consistently highlight that social characteristics of these contexts are more strongly associated with mental health problems than physical characteristics (Chapters 2 and 3). Indicators such as socioeconomic status (SES), social cohesion, and social disorder show robust links with mental health problems, whereas physical features like greenspace or air pollution are less consistently related. This underscores that adolescence is a socially sensitive developmental stage in which perceptions of belonging, comparison, and social order weigh heavily on mental well-being. One of the most striking findings concerns the dual role of school SES. On the one hand, higher school SES is associated with fewer externalizing problems such as conduct problems, likely reflecting the greater resources and organizational capacities of more affluent schools (Chapters 2 and 3). On the other hand, higher school SES is also associated with more internalizing problems, such as emotional symptoms and psychological complaints (Chapters 2, 3, and 4). This paradox appears to stem from elevated schoolwork pressure and performance expectations in high SES schools, which may create stress and contribute to mental health problems (Chapter 4). Importantly, adolescents from less affluent families are particularly vulnerable in these environments, possibly because of social comparison, perceived relative deprivation, or limited resources to cope with high expectations (Chapters 2 and 4). Our studies further reveal that social inequalities in adolescent mental health problems are persistent across time and contexts (Chapters 3 and 5). Adolescents from lower SES families report more mental health problems than their more advantaged peers, and these disparities are remarkably stable over time. Nevertheless, cross-national comparisons show important variations: while some countries exhibit stronger or weaker inequalities, societal factors such as income inequality, schoolwork pressure, and internet activity shape the degree to which inequalities manifest (Chapter 5). Notably, rising income inequality was in some cases linked to narrowing gaps in psychological complaints, suggesting complex and context-dependent dynamics. Taken together, this dissertation highlights the complex and sometimes counterintuitive ways in which contexts and inequalities shape outcomes. It demonstrates that adolescents’ mental health problems cannot be understood by focusing on individuals in isolation but must be seen in relation to the broader systems in which they grow up.