ObjectivesCross-national differences in long-term trends in social inequalities in adolescents’ mental health remain poorly understood, as does the impact of societal changes. We tested (1) whether the association between family socioeconomic status and psychological and somatic complaints changed between 2002 and 2022, (2) the extent to which these trends varied across countries, and (3) whether changes in income inequality, schoolwork pressure, and internet activity within countries were related to these trends.MethodsUsing data from 903,344 adolescents across 32 countries from the Health Behaviour in School-aged Children (HBSC) study between 2002 and 2022, we employed multilevel models to investigate the research questions.ResultsWe observed a nonlinear increase in psychological and somatic complaints over time. On average, social inequalities in both outcomes remained stable across countries, although the trends varied from one country to another. Only income inequality explained the differences between countries in these trends. In countries where income inequality increased over time, social inequalities in psychological complaints became smaller.ConclusionOur study highlights ongoing global disparities in adolescents’ mental health problems, urging for more effective health policies.

Previous research has reported both positive and negative associations between school socioeconomic status (SES) and internalizing problems among adolescents. Little is known about cross-national differences in this association, as well as potential mediators and moderators. Therefore, this study investigated this association using representative cross-national samples of adolescents whilst exploring the mediating role of schoolwork pressure and classmate support, and the moderating role of family SES and country-level income inequality. Using data from adolescents aged 11-15 from 44 countries, participating in the 2017/2018 Health Behaviour in School-aged Children (HBSC) study (N = 202,202), we employed multilevel regression models with cross-level interactions. School SES was operationalized as the average family affluence of adolescents within a school and psychological complaints (e.g., feeling low/depressed) were used as an indication of internalizing problems. On average across countries, adolescents in higher SES schools reported more psychological complaints, with a large effect size. However, differences in this association were observed across countries, with a positive association in 19 out of 44 countries, a negative association in one country, and nonsignificant associations in the remaining countries. Schoolwork pressure partially mediated the average association between school SES and psychological complaints, as school SES was positively associated with schoolwork pressure which was associated with more psychological complaints. Our results did not support the mediating role of classmate support. Also, we found a moderating effect of family SES, indicating a stronger positive association between school SES and psychological complaints for those with a below average family SES compared to those with an average and above average family SES. No moderating effect was observed for country-level income inequality. These findings suggest that adolescents with low family SES attending higher SES schools are especially at risk for psychological complaints, and may therefore require tailored support. A promising strategy to reduce psychological complaints entails addressing schoolwork pressure.

We investigated trends in associations between physical and social neighbourhood and school characteristics and adolescent mental health problems between 2005 and 2017. Nationally representative, repeated cross-sectional data collected in the Netherlands among primary (N = 5,871) and secondary school students (N = 20,778) were analysed through cross-classified multilevel models. Hardly any evidence was found for over-time changes in associations between neighbourhood and school characteristics and adolescent mental health problems. Findings showed that for both groups of students, only social characteristics within the two contexts were associated with adolescent mental health problems. For secondary school students, school effects were larger than neighbourhood effects, while the opposite was true for primary school students. Specifically, primary school students residing in more socially fragmented or lower socioeconomic status (SES) neighbourhoods, and lower SES schools, reported more conduct problems and peer relationship problems. For secondary school students, only the SES of the neighbourhood and the school was associated with all four aspects of mental health problems. Remarkably, the direction of the associations between neighbourhood/ school SES and adolescent mental health problems varied across the different mental health outcomes. More research is warranted to replicate our findings.

This study examined associations between characteristics of the residential neighbourhood and the school and adolescent mental health, including the moderating role of family socioeconomic status (SES) and family support. Nationally representative Dutch data from adolescents aged 12-16 (N = 6422) were analysed through cross-classified multilevel models. Findings showed that school characteristics are more strongly linked to adolescent mental health than residential neighbourhood characteristics. More specifically, higher levels of school SES were associated with more hyperactivity-inattention problems, while higher levels of school social disorder were related to more conduct problems and more peer relationship problems. Further, higher levels of school SES were associated with more emotional symptoms only for adolescents with a relatively low family SES. Higher levels of neighbourhood SES were associated with fewer peer relationship problems. Overall, there was little evidence for the moderating role of family SES or family support.