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The Health of Canada's Young People: a mental health focus

School

by Don Klinger, Adam Mills, and Allison Chapman

The importance of the school environment

Youth spend a lot of their time at school. Thus it is not surprising that their school-related experiences have a significant influence on their cognitive development, and their physical and mental health. Schools provide a "critical context for shaping children's self-esteem, self-efficacy and sense of control over their lives" (Stewart, Sun, Patterson, Lemerle, & Hardie, 2004). As children move forward into their early and later teen years, schools become more important, and the support of teachers and peer connections within schools may have an even greater influence than their home context (Stewart, 2008; Stewart et al., 2004).

Young people who feel connected with their school and have positive experiences with teachers and peers are more likely to develop strong emotional bonds and self-confidence. They are much less likely to engage in health-compromising activities or struggle with their mental health and emotional well‑being (e.g., Wold, Samdal, Nutbeam, & Kannas, 1998). Young people need to make strong connections with their peers and these peers also influence each other's school experiences and subsequent behaviours. Young people who feel less connected to school are more likely to search and connect with like-minded peers, and these peer groups tend to engage in high-risk activities (Bond et al., 2007). Similarly, young people who do not feel accepted by their peers or connected with school are the most likely to have lower levels of confidence and sense of self (King, Vidourek, Davis, & McLellan, 2002).

School is your second home because you spend so much time in it.

—Youth, Healthy Advice Workshop

Schools have an important role to play in supporting young people's learning of knowledge and skills. The social connections and experiences that occur in schools likely have a lasting influence on young people's lives and subsequent decisions.

—Bond et al., 2007; King et al, 2002

Young people who have positive perceptions of their classrooms and teachers also report more positive attitudes towards school and higher levels of achievement.

—Ma & Klinger, 2000; Wold, Samdal, Nutbeam, & Kannas, 1998

As we highlight throughout this report, there is an important population of children and youth who struggle with mental health. Our data indicate that these challenges are even more difficult if the school does not provide a safe and inviting refuge. In the long term, young people with mental health challenges are less likely to develop positive connections with teachers or their peers, are more likely to engage in risk behaviours, and have lower levels of education and social attainment (Bond, Butler, Thomas, Carlin, Glover, Bowes, & Patton, 2007; Osterman, 2000).

What are we reporting in this chapter?

In recognition of the important role that school plays in young people's lives, the HBSC study includes several measures that focus on academic achievement, school climate, and school-related interactions. On the survey items young people were asked to report on teachers' perceptions of their school performance, their most recent marks, feelings of school satisfaction, student participation and perceived fairness at the school, safety, belonging, acceptance by classmates, teachers' attitudes towards them as people, feelings of pressure, and availability of parental help and encouragement regarding school (Baker et al., 2003; Kunter et al., 2007; Midgley et al., 2000). New in 2010 was an item on the tendency for students to skip out of school or classes, a measure that is likely related to school connectivity, emotional well‑being, and risk behaviour.

Of particular importance are those differences between boys and girls and the trends that occur across grades as students transition from elementary to secondary education. These differences provide us with a deeper understanding of the various perceptions of students across gender and grade, and may provide us with further insights into differences in health related measures that are reported in other chapters. Previous iterations of the HBSC survey also enable us to report on trends over time on measures of perceived achievement and school satisfaction. Once again, these trends can help us to better understand how student's perceptions of school and learning are changing over time, and the possible links between these changes and students' physical and mental health.

Lastly, given the likely links between school experiences and mental health, we report on the associations between these factors. We believe these associations will identify areas for further exploration and research and will have important implications for school practices and policies. Certainly, these associations suggest that students' experiences at school are closely related to their sense of self, confidence, and behaviour.

Young people's educational experiences

School achievement

4.1 Students who report that teachers think their school work is good or very good, by grade and gender (%)

Figure 4.1 - Students who report that teachers think their school work is good or very good, by grade and gender (%)

[Click to enlarge Figure 4.1]

[Text Equivalent, Figure 4.1]

When asked about the quality of their school work, the majority of young people reported that teachers think their school work is good or very good (see Figure 4.1).

Nonetheless, two interesting findings emerged. First, there was a relatively large decrease in the reported numbers between Grade 6 and 7. In many Canadian jurisdictions, this represents the time when young people transition from elementary school to middle or secondary school. In contrast, there were few changes between Grade 8 and 10, the time that most young people are in early secondary school. The result is a 10 to 20% drop in the proportion of Grade 10 children who believed their teachers thought their school work was good in comparison to Grade 6 children. Second, and across all of the grades, girls were more likely to report that teachers thought their school work was good or very good as compared to boys. The gender differences ranged between 6 and 10%. These findings were consistent with other Canadian measures of school achievement that typically reported higher levels of achievement for girls or in the cases of science and mathematics, relatively similar levels of achievement (British Columbia Ministry of Education, 2010: Council of Ministers of Education, Canada, 2008; Education Quality and Accountability Office, 2010).

4.2 Students who report that teachers think their school work is good or very good, by grade, gender, and year of survey (%)

Figure 4.2 - Students who report that teachers think their school work is good or very good, by grade, gender, and year of survey (%)

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[Text Equivalent, Figure 4.2]

Perhaps even more interesting are the trends over time (Figure 4.2). The HBSC has tracked students' perceptions of what teachers think of their school work for 20 years. Throughout this time period, the decreases in academic achievement across subsequent grades, and the higher levels of achievement reported by girls have been consistent. Of potential interest is the lack of changes in the proportion of both boys and girls with positive perceptions of their academic success.

The HBSC survey also asked young people to provide an indication of their overall achievement by reporting their average level of achievement or grade on their last report card (Figure 4.3). The analyses of these data are somewhat challenging, because grading systems vary across the country. Nevertheless, the results do provide important patterns. As with the findings related to teachers' perceptions of school work, the results illustrated that reported levels of achievement decreased slightly from Grade 6 to Grade 10. Similarly, girls reported slightly higher levels of achievement at all grade levels, providing further evidence of the existence of a small but persistent gender gap in student achievement. Across the grades, 72% of girls reported above average or excellent levels of achievement in comparison to 64% of boys. Boys were also more likely to report below average or poor levels of achievement. By Grade 10, 10% of boys considered their achievement to be below average or poor, in comparison to 6% of girls. While these proportions were relatively small, the results indicated that a significant number of youth reported they were not meeting learning expectations, which is what young people typically considered to be the average level of achievement. And while boys may be reporting lower levels of achievement, the relatively small differences were consistent with provincial achievement results across the country, and did not indicate the existence of a crisis that is often reported in the media.

4.3 Academic achievement, by grade and gender (%)

Figure 4.3 - Academic achievement, by grade and gender (%)

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[Text Equivalent, Figure 4.3]

Feelings of satisfaction, belonging, and safety

The HBSC survey includes several items associated with school satisfaction and belonging that represent the perceived learning climate in the school. A school that is considered welcoming and safe provides a better climate for young people to develop their cognitive skills, confidence, and have positive interactions with peers and teachers. In this regard, the HBSC highlights a potential challenge for our young people. While they spend much of their time at school, only a minority reported that they liked school, and these percentages declined further in the later grades. Further, boys were even less likely than girls to report that they liked school a lot, although the differences declined in the later grades. As with the achievement findings, the largest decline occurred between Grade 6 and 8, coinciding with the transition to secondary and the shift from having a single teacher to having multiple teachers. However, since this transition is not consistent across the country, the decrease may actually be associated with other factors directly related to the young people themselves. The patterns across time are less clear, with drops in girls who reported liking school in 2002, and higher proportions of girls liking school in 2006.

4.4 Students who like school a lot, by grade, gender, and year of survey (%)

Figure 4.4 - Students who like school a lot, by grade, gender, and year of survey (%)

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[Text Equivalent, Figure 4.4]

4.5 Students who agree and strongly agree with the statement "I feel I belong at this school," by grade and gender (%)

Figure 4.5 - Students who agree and strongly agree with the statement "I feel I belong at this school," by grade and gender (%)

[Click to enlarge Figure 4.5]

[Text Equivalent, Figure 4.5]

Another important perception measured by the HBSC survey is the extent to which young people reported that they felt they belonged at their school. From a positive perspective, the majority of students felt they belonged at their school (Figure 4.5), and thus they also had a sense of connection to the school.

Once again, there were relatively large drops from Grade 6 to Grade 7 and 8. The lowest reported sense of belonging was found among Grade 10 students. There was also an interesting shift in the later grades with girls reporting similar or even lower levels of belonging than the boys. Underlying these findings were the remaining 30 to 45% of young people who did not share this sense of school belonging. This points to another potential challenge for secondary schools across the country: finding ways to better connect with the young people who spend so much of their time in these environments.

Together with the achievement results, these findings suggest that young people feel less connected to school as they progress from elementary to secondary school, and that these proportions may also be declining over time. Certainly, there are persistent gender differences, but it is not at all clear that specific efforts are required to address the needs of boys over the needs of girls. There were significant numbers of boys and girls who reported they did not have confidence in their learning, felt a dislike for school and/or a lack of school belonging.

Teachers and peers at school

4.6 I feel that my teachers care about me as a person, by grade and gender (%)

Figure 4.6 - I feel that my teachers care about me as a person, by grade and gender (%)

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[Text Equivalent, Figure 4.6]

4.7 Students who think most of their teachers are friendly, by grade and gender (%)

Figure 4.7 - Students who think most of their teachers are friendly, by grade and gender (%)

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[Text Equivalent, Figure 4.7]

Teacher and peer interactions are important measures of young people's attitudes and behaviours. As presented in Figure 4.6, young people were less likely to believe "teachers care about me as a person" as they progressed through their schooling. While girls reported slightly more positive perceptions, the decreases were similar across grades, with both genders reporting approximately a 20% drop from Grade 6 through 10. By Grade 10, just over half of the students reported that they believed teachers cared about them as persons. In contrast, almost three-quarters of young people tended to think that their teachers were friendly, and these proportions were similar across all of the grades (Figure 4.7). Once again, girls were slightly more likely to report positive perceptions.

4.8 My teachers encourage me when I do school work, by grade and gender (%)

Figure 4.8 - My teachers encourage me when I do school work, by grade and gender (%)

[Click to enlarge Figure 4.8]

[Text Equivalent, Figure 4.8]

4.9 My teachers tell me how to do better on school tasks, by grade and gender (%)

Figure 4.9 - My teachers tell me how to do better on school tasks, by grade and gender (%)

[Click to enlarge Figure 4.9]

[Text Equivalent, Figure 4.9]

The HBSC survey also examined young people's perceptions of teacher helpfulness (Figure 4.8 and 4.9). The majority of students agreed that teachers encouraged their school work, thus providing students with confidence to foster their learning. Yet these proportions declined across subsequent grades. While three-quarters of Grade 6 students reported being encouraged by teachers when they did their schoolwork, less than 60% of Grade 10 students reported the same. Generally, similar levels were found between boys and girls. Even greater proportions of young people reported that teachers provided feedback to help them do better (Figure 4.9). Once again, and similar to the results shown in Figure 4.8, the proportions dropped between Grade 6 and Grade 10, and the drop appeared to be slightly larger for girls. This may reflect the fact that less attention is being given to girls by their teachers because their levels of achievement are also reported as being higher. Together, these HBSC results provide evidence that in general, young people do believe their teachers want them to be successful and are providing the support and feedback that will support their learning. Nevertheless, there are areas of concern, as almost 25% of young people reported they did not have this positive support or feedback from their teachers.

4.10 Students who feel that other students accept them as they are, by grade and gender (%)

Figure 4.10 - Students who feel that other students accept them as they are, by grade and gender (%)

[Click to enlarge Figure 4.10]

[Text Equivalent, Figure 4.10]

An important aspect of young peoples' lives at school is their interactions with their peers. In relation to school, one of the important questions on the survey asks if young people believe other students accept them as they are (Figure 4.10).

Overall, just under 75% of young people felt accepted by their peers. There were slight decreases across subsequent years, especially for girls. While the majority of young people reported feeling accepted, there were also a significant number who did not share these perceptions. What we do not know is the extent to which these students struggle with other aspects of their lives. Nevertheless, Baumeister and Leary (1995) suggest that feelings of rejection or exclusion can lead to significant negative emotions, and a review of the literature surrounding peer acceptance by Osterman (2000) indicates that failure to be accepted by one's peers at school can lead to negative experiences and outcomes in other spheres of a young person's life.

The pressures of school

Given the expectations of school, and the importance of academic achievement for future choices, it is not unexpected that a number of young people feel pressure to succeed in school. It is likely that school pressure is a complex factor. For young people who are struggling in school, it is likely that they are being pressured to improve their grades. For those who are successful, there may be ongoing pressure to maintain high levels of achievement to ensure greater academic choices through their secondary and post-secondary education.

Personally, we spend more time at school than at home and it is the place where we build most of our connections. Sometimes we cannot go to our homes or family for support and our peers are where we go.

—Youth, Healthy Advice Workshop

4.11 Students who feel a lot of pressure because of school work, by grade, gender and year of survey (%)

Figure 4.11 - Students who feel a lot of pressure because of school work, by grade, gender and year of survey (%)

[Click to enlarge Figure 4.11]

[Text Equivalent, Figure 4.11]

In Grade 6 boys, roughly 10% of young people reported feeling pressure because of school work, with a higher proportion of boys reporting this perceived pressure than girls (Figure 4.11).

The perceived pressure increased somewhat in Grade 8, with boys once again generally reporting greater pressure. In Grade 10, the percentages for both genders increased again, but there was a shift between the two genders with a much larger percentage of girls reporting feeling school pressure. We certainly expect this pressure to increase in the higher grades because secondary grades become more important for future choices and directions. Grade 10 is particularly important as this is a time when young people begin to choose more specific directions for their final two years of high school. As an example, achievement results and academic decisions will have important consequences for those young people who wish to pursue post-secondary education. Perhaps the increasing pressure reported by girls is related to the increasing proportions of girls who pursue university education, where they now outnumber boys. As Figure 4.11 also illustrates, the findings appear to be relatively similar over time, especially in the years since the 1998 administration of the HBSC survey.

School attendance

4.12 Students reporting "It is definitely not like me to skip classes at school", by grade and gender (%)

Figure 4.12 - Students reporting "It is definitely not like me to skip classes at school", by grade and gender (%)

[Click to enlarge Figure 4.12]

[Text Equivalent, Figure 4.12]

The 2010 HBSC survey added a new school-related item to its list of questions. This item asked young people to report on their propensity to skip out, skip school or cut classes (Figure 4.12). Not surprisingly, the tendency to skip out increased across subsequent grades.

There were few gender differences on this measure. Given that this is a new item in the survey, there may be a challenge in interpreting these results. It is unclear if young people who skipped once or twice would place themselves high on the continuum and report it is "definitely like me." The surprisingly high percentages suggest that these results may reflect differing interpretations of the item. Perhaps what is surprising is that over 10% of Grade 6 children believe that skipping out of school is something they consider to be part of who they are; by Grade 10, it is over 40%.

Relationships between the school experience and mental health

School is an important place in young peoples' lives and their experiences at school directly and indirectly impact their mental health. Young people recognize the importance of their peers and the influence that peers have on their own sense of self and behaviours. What they may be less aware of are the impacts of other school-related factors. The following section explores the associations of these school-related factors with young people's mental health, based on measures of emotional well‑being, emotional problems, behavioural problems, and prosocial behaviour.

A lot of people that I care about go to school with me. I try to make sure I have good relationships with them.

—Youth, Healthy Advice Workshop

4.13 Students reporting high levels of emotional problems by achievement, by gender (%) 1

Figure 4.13 - Students reporting high levels of emotional problems by achievement, by gender (%) *

[Click to enlarge Figure 4.13]

[Text Equivalent, Figure 4.13]

While it is not surprising that academic achievement is associated with reduced behavioural problems and increased prosocial behaviour, we also found links with lower levels of achievement and an increased incidence of emotional problems (Figure 4.13). Girls and boys with below average levels of achievement were far more likely to report emotional problems, with girls consistently reporting higher occurrence of emotional problems.

School Climate in the HBSC is a composite variable comprised of 8 items that measure aspects of school, including liking school, finding rules and teachers fair, a sense of belonging at school, feeling that school is a nice place to be, feeling encouraged to express their own views, feeling their teachers are interested in them as a person, and feeling their teachers are friendly.

If you have a bad school climate, you are more likely to have behavioural problems.

—Youth, Healthy Advice Workshop

4.14 Students reporting high levels of emotional well‑being by school climate, by gender (%)

Figure 4.14 - Students reporting high levels of emotional well‑being by school climate, by gender (%)

[Click to enlarge Figure 4.14]

[Text Equivalent, Figure 4.14]

4.15 Students reporting high levels of prosocial behaviour by school climate, by gender (%)

Figure 4.15 - Students reporting high levels of prosocial behaviour by school climate, by gender (%)

[Click to enlarge Figure 4.15]

[Text Equivalent, Figure 4.15]

The HBSC survey provides us with an overall measure of school climate. Not surprisingly, a positive school climate provides several advantages to young people, and negative school climates create several challenges for young people (Ma & Klinger, 2000). Perhaps what is more surprising is the strong association with school climate, and students' emotional well‑being (Figure 4.14) and prosocial behaviour (Figure 4.15). Boys and girls who reported being in a school with a positive school climate also reported high levels of emotional well‑being. Similarly, boys who were in schools with a positive school climate reported levels of prosocial behaviour that were nearly twice as strong as those boys who reported being in schools with a negative school climate. The results for girls, who reported higher levels of prosocial behaviour regardless of school climate, followed the same pattern.

Schools with special programs, mini schools, [and] sports, create a better climate because you know people better and have more of a community.

—Youth, Healthy Advice Workshop

As reported earlier, the majority of young people reported positive interactions with their teachers. Overall, young people felt their teachers supported them; however, there was a sizable minority of young people who did not share these feelings. And this lack of support was associated with higher levels of behavioural problems (Figure 4.16) and lower levels of emotional well‑being (Figure 4.17). Regardless of the level of teacher support, boys reported greater levels of behavioural problems, while girls reported lower levels of emotional well‑being. In the case of emotional well‑being, there was a substantial drop in this percentage for both boys and girls in low teacher support environments.

4.16 Students reporting high levels of behavioural problems by teacher support, by gender (%)

Figure 4.16 - Students reporting high levels of behavioural problems by teacher support, by gender (%)

[Click to enlarge Figure 4.16]

[Text Equivalent, Figure 4.16]

4.17 Students reporting high levels of emotional well‑being by teacher support, by gender (%)

Figure 4.17 - Students reporting high levels of emotional well‑being by teacher support, by gender (%)

[Click to enlarge Figure 4.17]

[Text Equivalent, Figure 4.17]

School can influence who you are.

—Youth, Healthy Advice Workshop

4.18 Students reporting high levels of emotional well‑being by peer support, by gender (%)

Figure 4.18 - Students reporting high levels of emotional well‑being by peer support, by gender (%)

[Click to enlarge Figure 4.18]

[Text Equivalent, Figure 4.18]

4.19 Students reporting high levels of behavioural problems by peer support, by gender (%)

Figure 4.19 - Students reporting high levels of behavioural problems by peer support, by gender (%)

[Click to enlarge Figure 4.19]

[Text Equivalent, Figure 4.19]

In recognition of the importance of peer support in young people's lives, we examined the associations between peer support and emotional well‑being, and peer support and behavioural problems. Our findings mirror widely held views of the benefits of peer support on young people's mental health behaviour outcomes. The gender patterns for emotional well‑being and behavioural problems were similar to those reported above, with boys reporting higher prevalences of behavioural problems and girls lower levels of emotional well‑being where peer support was lacking. With a 26- to 24-point drop, the changes in emotional well‑being (Figure 4.18) that occur with lower levels of peer support were similar for both boys and girls. Boys who reported low levels of peer support, also reported higher levels of behavioural problems (Figure 4.19). In contrast, there was a smaller association between peer support and behavioural problems for girls.

My friends are there for me to talk about my problems.

—Youth, Healthy Advice Workshop

What young people thought about these findings

Each school day, young people interact with their peers and teachers, and the school climate largely shapes these interactions. Young people are also affected by the quality of these interactions and it is likely that both the school climate and the interactions they have on a daily basis have impacts on their mental health. The HBSC survey findings and the students at the youth engagement workshop confirmed several observations surrounding school experiences and measures of mental health. Certainly, young people recognised the importance of school and the impact it has on their lives. The following paragraphs identify the prominent trends in our findings that speak to young people's experiences at school and the impact of these experiences on their health and well‑being.

School is very important to these young people. Similar to the home environments parents create for their children, schools need to strive to create an inclusive, safe, and positive environment. Negative school climates are clearly associated with negative outcomes for young people, and lower reported levels of mental health. Young people who do not feel connected to school, whether they are boys or girls, are less likely to report comparable levels of mental health when measured against their peers who report being in schools with positive climates and high levels of teacher support. For young people, our findings illustrate the importance of schools with positive structures and policies that create a positive learning community.

Connections with peers may be a key factor in supporting mental health. Schools provide an important environment to create and build these connections. For many young people, school is also the place where they will interact most commonly and closely with their peers. Positive peer support is related to more positive emotional and behavioural outcomes, and may provide a mechanism to deal with the emotional and behavioural issues and problems that they will all face in their daily lives.

Summary and implications

Key issues of concern

  1. School is not a positive place for an important proportion of Canadian youth.
  2. Young people are increasingly reporting lower levels of achievement and satisfaction with school.
  3. As young people progress through school, they are less connected to school, at a time when their emotional well‑being is most vulnerable.

Key issues to celebrate

  1. Positive school environments and higher levels of teacher support are associated with more positive levels of mental health and lower levels of behavioural problems in young people.
  2. The majority of young people feel supported by their schools and have a sense of belonging in the school they are attending.
  3. While there are gender differences in school-related measures, these differences are relatively small.

Commentary

The HBSC survey presents evidence of both the positive outcomes and challenges for Canadian youth in our schools. While school may not be a favourite place for young people, the majority of them report being successful at school. Most young people believe they are doing well in school, and they feel supported by teachers and their peers. Nonetheless, there are significant proportions of young people who do not report such positive school-related interactions, and these numbers appear to be increasing over time.

The grade associated patterns are also troubling. While it may not be surprising for adolescents to feel less connected to school than younger children, the different structures of schools in elementary and secondary programs may serve to reinforce this lack of connection. Certainly, the most significant decreases in young people's positive perceptions of school seem to occur in the transition from elementary to secondary school. These decreases then remain relatively constant until Grade 10.

While there may be relatively minor differences between boys and girls in terms of their learning in school, we did find larger differences in the associations between school-related factors and mental health. There are much larger negative mental health outcomes that occur for those boys and girls who report less positive school experiences. It is these youth that require society's focus and attention. Can we create school environments and supportive school climates that will build these young people's emotional well‑being, while also limiting the onset of negative health outcomes?

Given the findings of the HBSC survey, it is important that we continue to examine the role of school in young people's lives, with particular focus on how schools can provide a climate that better supports the emotional well‑being and development of our youth as they progress through each grade.

References

  • Baker, J.J.A., Dilly, L.L.J., Aupperlee, J.J.L. & Patil, S.S.A. (2003). The Developmental context of school satisfaction: Schools as psychologically healthy environments. School Psychology Quarterly, 18:206.
  • Baumeister, R. & Leary, M. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117:497-529.
  • British Columbia Ministry of Education (2010). Provincial Reports. http://www.bced.gov.bc.ca/reporting/prov_data_summary.php . Accessed April 2011.
  • Bond, L., Butler, H., Thomas, L., Carlin, J., Glover, S., Bowes, G. & Patton, G. (2007). Social and school connectedness in early secondary school as predictors of late teenage substance abuse, mental health, and academic outcomes. Journal of Adolescent Health, 40:357.e9-357. e18.
  • Council of Ministers of Education, Canada. (2008). PCAP-2007: Report on the assessment of 13-year-olds in reading, mathematics, and science. Toronto: Council of Ministers of Education, Canada.
  • Education Quality and Accountability Office. (2010). EQAO's provincial secondary school report on the results of the Grade 9 assessment of mathematics and the Ontario secondary school literacy test, 2009-2010. Toronto: Queen's Printer for Ontario.
  • King, K., Vadourek, R., Davis, B. & McLellan, W. (2002). Increasing self-esteem and school connectedness through a multi-dimensional mentoring program. Journal of School Health, 72: 294-299.
  • Kunter, M., Baumert, J., & Köller, O. (2007). Effective classroom management and the development of subject-related interest. Learning and Instruction, 17:494-509.
  • Ma, X. & Klinger, D.A. (2000). Hierarchical linear modeling of student and school effects on academic achievement. Canadian Journal of Education, 24:41-55.
  • Midgley, C., Maehr, M. L., Hruda, L.Z., Anderman, E., Anderman, L., Freeman, K. E., Gheen, M., Kaplan, A., Kumar, R., Middleton, M. J., Nelson, J., Roeser, R., & Urdan, T. (2000). Manual for the Patterns of Adaptive Learning Scales. Ann Arbor: University of Michigan.
  • Osterman, K. (2000). "Students' Need for Belonging in the School Community." Review of Educational Research, 70:323-367.
  • Stewart, D. E., Sun, J., Patterson, C., Lemerle, K., & Hardie, M.W. (2004) Promoting and building resilience in primary school communities: Evidence from a comprehensive 'health promoting school' approach. International Journal of Mental Health Promotion, 6:26-31.
  • Stewart, D. E. (2008). Implementing mental health promotion in schools: A process evaluation. International Journal of Mental Health Promotion, 10:32-41.
  • Wold, B., Samdal, O., Nutbeam, D., & Kannas, L. (1998). Achieving health and educational goals through schools: A study of the importance of school climate and the students' satisfaction with school. Health Education Research, 13:383-397.

  1. 24% of boys who report excellent marks in the past year (mostly As/above 85% /or level 4) report relatively high levels of emotional health problems, compared with 33% of girls who report excellent marks. A full explanation of how to interpret the figures that relate to mental health is provided in Chapter 1.