In the context of rising concerns about the mental health of young people, the MYRIAD trial is a meticulous, large-scale study with the aim of investigating the impact of a mindfulness intervention on mental health outcomes for 28,885 eleven- to fourteen-year-old pupils across 85 participating mainstream secondary schools.

Using the baseline data from the MYRIAD trial, the authors of this study ‘The Role of Schools in Early Adolescents’ Mental Health: Findings From the MYRIAD Study’ (Ford et al, 2021), analyse how a variability in school led factors affected the variability of mental health concerns for the young people at the outset of the trial.

Methods

The MYRIAD baseline data considered three aspects of pupil mental health collected at the start of the trial:

1. Psychopathology was collected via a Strength and Difficulties Questionnaire (SDQ) (Goodman et al, 1998),
2. levels of depression were assessed using the Centre for Epidemiological Studies for Depression Scale (CES-D) (Radloff, 1991), and
3. wellbeing was assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) (Clarke et al, 2011).

Three separate school led factors were also considered:

1. Context included whether the school was urban or rural and where it featured on the Multiple Index of Deprivation 2015.
2. The characteristics of the school community included factors such as ethnicity, the number of pupils eligible for free school meals and the numbers supported at different levels of special educational needs and disabilities.
3. Finally, the operational features of the school included the total number of pupils, pupil; teacher ratio, whether the school was single or mixed sex, OFSTED grade, the quality of provision for social and emotional learning (SEL) and a teacher rated judgment of school climate.

Results

The authors found that the difference in school led factors accounted for only 2.4% variation in psychopathology, 1.6% variation in depression and 1.4% variation in wellbeing. Results included:

• Eligibility for free school meals (FSM) was associated with more concerning psychopathology scores.
• White British pupils were positively associated with psychopathology along with lower levels of wellbeing.
• Schools regarded as having a positive climate (teacher rated) had lower psychopathology scores amongst pupils.
• Urban location was positively associated with pupil depression, however area led deprivation had no significant impact on any of the wellbeing measures. The authors suggest that this indicates ‘better mental health and well-being among pupils attending schools located in rural areas, irrespective of whether the area surrounding the school is affluent or deprived’ (Ford T. et al, 2021).

Conclusions

The authors conclude that:

While the direct influence of schools on mental health seems to be small, this does not negate schools as a setting in which mental health can be improved via universal and targeted interventions.
– Ford et al (2021)

The authors conclude that the influence of schools on pupil mental health seems to be small. Their conclusion that schools can be the setting for positive intervention seems to be based largely on the positive effect of the school climate (teacher-rated) on pupil mental health found within the analysis.

Strengths and limitations

Both the strengths and limitations of the study are related to its secondary nature as part of the MYRIAD trial. The large-scale sample size and the meticulous, statistical rigour coming from a trial such as MYRIAD is a huge strength. It leads to some interesting results around the way that variations in school led factors may affect variations in mental health presentation amongst the participating schools and pupils.

The authors are clear and upfront about the limitations of using the MYRIAD data for the purpose of this study. No schools judged by OFSTED to be inadequate were included in the sample and only mainstream schools with a structured way of delivering Social and Emotional Learning (SEL) were included. The authors also recognise that uptake amongst pupils was 90% and that the missing 10% may contain a significant number of pupils with high level mental health concerns.

Also missing from the authors considerations, however, are pupils who may have already left the school during their first two years, either permanently or into alternative provision. Also missing from the data are pupils who the participating schools thought may not be suitable for the study. It is possible that amongst this cohort, the greatest level of mental health concern may be found. Due to the nature of the participants in the MYRIAD study there is also no group providing data on children who do not attend the type of mainstream school in the study. For example, children attending non-mainstream settings or children not attending school at all. The time of the school year in which these baseline measures were collected is also not mentioned as a consideration. It is possible that school climate and each of the measures of wellbeing collected may vary considerably depending on the time of school year.

Implications for practice

There is a discourse where schools are seen only in a protective capacity to mitigate against the cumulative risk factors present in a child’s life. This can be seen in the Department for Education’s guidance on ‘Mental Health and Behaviour in Schools’ (DfE, 2018) where a host of risk factors (of a child presenting with social, emotional and mental health needs) are listed without any mention of the wider educational policy that is universal in the lives of almost all children in the UK and all of the 28,885 children in this study.

I believe that if we use this report to conclude that schools only have a small impact on mental health, we are adding to that discourse. If there is a rising concern about the mental health of young people in all these schools, I suggest policy makers ask which of their universal policies may contribute to these concerns rather than simply consider schools as places where interventions can be implemented.

As the analysis in this study only looks at variations between schools rather than the impact of schooling itself, there is nothing here that negates attending mainstream school as being detrimental to the mental health of some young people.

Indeed, it is possible that concluding schools only have a small (albeit significant) impact on mental health may be akin to claiming that smoking cigarettes only has a small (albeit significant) impact on physical health.

Statement of interests

Chris Fielding has been working in primary school education for around 30 years. For the majority of that time, he was a class teacher and then the headteacher of two mainstream primary schools. He has been the academy lead at the Forwards Centre, a primary aged pupil referral unit since 2016.

Links

Primary paper

Ford, T, Degli Esposti M, Crane C. et al (2021) The Role of Schools in Early Adolescents’ Mental Health: Findings From the MYRIAD Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2021,Mar 4

Other references

Clarke A, Friede T, Putz R, et al. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health 2011;11(1):487

Department for Education (2018) Mental health and behaviour in schools. [Online] [Accessed on 2^nd November 2021]

Goodman R, Meltzer H, Bailey V. The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version. European Child Adolescent Psychiatry. 1998;7(3):125-130

Radloff LS. The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. J Youth Adolescent. 1991;20(2):149-166. doi:10.1007/BF01537606

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