Schools Dominate Research on Teen Mental Health While Neighbourhoods Stay in the Shadows

Adolescent mental health has become one of the defining public health challenges of the decade, with rising rates of depression and anxiety among young people prompting governments and health services to search urgently for the environments that shape, protect, or undermine psychological wellbeing. A new scoping review published in BMC Public Health by researchers at the University of Manchester suggests that the scientific evidence underpinning those searches is far thinner, and far more lopsided, than most policymakers would assume. Led by Kathryn O’Donoghue, with colleagues Emma Thornton, Michael Wigelsworth and Neil Humphrey, the review maps the quantitative research on how two fundamental developmental contexts, the school a teenager attends and the neighbourhood where they live, predict mental health difficulties and wellbeing between the ages of 10 and 19.

The scale of the undertaking is striking. Following the Joanna Briggs Institute guidance for scoping reviews and reporting to PRISMA standards, the team searched six databases, including ERIC and PsycINFO, for studies published since 2015. They identified and synthesised data from 269 studies, using both thematic and methods-oriented approaches to chart what has been measured, where, and how. The result is less a single headline finding than a detailed cartography of an entire research field, revealing not only what scientists know about schools and neighbourhoods but also, crucially, the structural blind spots that prevent them from understanding how these two environments interact in a young person’s daily life.

The most eye-catching imbalance concerns the distribution of research attention across contexts. Of the 269 studies reviewed, 73.2 percent focused on the school environment, while only 14.5 percent examined the neighbourhood, and just 12.3 percent considered both contexts together. In other words, for every study that looked at how the streets, services, and social fabric of a neighbourhood shape adolescent mental health, roughly five examined schools. This skew matters because adolescence is not lived in one setting at a time. A teenager who spends their days in a supportive school may still return each evening to a neighbourhood marked by deprivation, disorder, or weak community ties, and the review suggests science has barely begun to quantify that interplay.

The imbalance extends to outcomes as well as settings. Most of the studies in the review, 72.9 percent, investigated mental health outcomes, and the single most researched outcome was depression. Evidence about anxiety, broader internalising symptoms, and the positive dimensions of adolescent experience, including psychological wellbeing, life satisfaction, positive affect, and negative affect, was comparatively limited. This pattern reflects a long-standing tendency in psychological research to concentrate on psychopathology rather than flourishing, but it has practical consequences. Interventions designed to prevent depression may look very different from those designed to build life satisfaction or positive emotion, and a literature dominated by one outcome cannot easily inform strategies aimed at the full spectrum of young people’s mental health.

The review also exposes methodological constraints that go to the heart of how developmental science is done. Longitudinal designs, which follow adolescents over time and allow researchers to distinguish cause from correlation, accounted for only 29.0 percent of studies. Multilevel analyses, the statistical framework needed to separate the effect of an individual school or neighbourhood from the characteristics of the young people within them, appeared in 26.8 percent of studies, and the more sophisticated cross-classified models that can simultaneously account for both a school and a neighbourhood were almost absent, featuring in just 1.5 percent of the evidence base. Pathway analyses, which trace the mechanisms by which environmental factors exert their influence, appeared in only 16.0 percent of studies.

These numbers are not merely technical trivia. Without longitudinal data, researchers cannot establish whether a stressful school environment precedes the onset of depressive symptoms or simply co-occurs with them. Without multilevel and cross-classified models, they cannot tell whether attending a particular school matters in itself or whether schools merely concentrate young people who share similar backgrounds. And without pathway analyses, they cannot identify the modifiable mechanisms, such as peer relationships, safety perceptions, or access to green space, through which environments translate into psychological outcomes. The authors argue that these infrequent designs are fundamentally limiting understanding of developmental processes and of the influence of shared contexts, leaving the field unable to answer the question of how, not just whether, environments matter.

Within the studies that do exist, the review found that a wide range of factors have been researched across both school and neighbourhood settings, but the focus is predominantly on social-relational factors. That emphasis is understandable: relationships with teachers, peers, family members, and neighbours are intuitively central to adolescent life, and they are comparatively easy to measure with questionnaires. Yet it means that physical, structural, and material features of environments, from built infrastructure to neighbourhood socioeconomic conditions, have received far less systematic attention. A field skewed toward one category of predictor risks overlooking risk and protective factors that could be modified through planning, housing, and local government policy rather than through educational or clinical services alone.

The practical stakes of these gaps are considerable. The authors frame their conclusions around prevention: knowing which factors within school and neighbourhood environments predict, and exert influence, both positively and negatively, on adolescent mental health and wellbeing is essential for successful prevention efforts. If the evidence base is siloed, with school researchers and neighbourhood researchers largely working in parallel, then interventions may target one context while ignoring the other, and the cumulative burden of environmental risk or the buffering power of environmental support will go unmeasured. The review’s finding that only about one in eight studies considered both contexts in tandem suggests that the interaction effects, where a strong school might offset a disadvantaged neighbourhood or vice versa, remain largely invisible to science.

There is also a demographic dimension to the field’s limitations. The review deliberately focused on adolescents aged 10 to 19, the period during which the school and the neighbourhood function as two fundamental developmental systems, and during which internalising symptoms typically emerge and wellbeing often declines. Evidence generated from narrow outcome measures and narrow contexts cannot serve the full diversity of young people’s experiences. The authors note that addressing the gaps they identify is essential to identify modifiable risk and protective factors in school and neighbourhood settings, a phrase that signals the review’s ultimate purpose: not simply to catalogue what has been studied, but to redirect future research toward the questions that prevention science most needs answered.

For a research community and a public increasingly alarmed by adolescent mental health trends, the review offers a sobering message wrapped in an encouraging one. The encouraging part is that 269 quantitative studies have been published in under a decade, demonstrating genuine scientific momentum and a rich, wide-ranging body of work on the environments young people inhabit. The sobering part is that this momentum has been channelled unevenly, toward schools rather than neighbourhoods, toward depression rather than wellbeing, and toward cross-sectional snapshots rather than the longitudinal, multilevel, and mechanistic designs that could reveal how environments actually shape developing minds. Until those imbalances are corrected, the authors suggest, our understanding of which places help teenagers thrive, and which place them at risk, will remain fundamentally incomplete.

Subject of Research: School and neighbourhood predictors of adolescent internalising symptoms and wellbeing

Article Title: Neighbourhood and school predictors of adolescent internalising symptoms and wellbeing: a scoping review

Article References: O’Donoghue, K., Thornton, E., Wigelsworth, M., & Humphrey, N. (2026). Neighbourhood and school predictors of adolescent internalising symptoms and wellbeing: a scoping review. BMC Public Health. https://doi.org/10.1186/s12889-026-29462-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29462-y

Keywords: adolescence, mental health, wellbeing, school environment, neighbourhood, internalising symptoms, depression, scoping review, multilevel analysis, longitudinal research, public health, social determinants