School Environment as a Social Driver of Youth Mental Health Trajectories in Mwanza, Tanzania

Mental health problems are a leading cause of learning and behavioral difficulties among children worldwide and in Tanzania where research has documented high rates of youth depression, anxiety, and suicide, 43% of the population is under the age of 15, and access to treatment services is limited. One theoretically important driver of youth mental health is the primary school environment. Schools have the potential to foster cognitive, emotional, and social functioning that, in turn, promotes mental wellbeing. Further, school experiences are thought to play a critical role in shaping the coping systems that support positive adjustment in youth who have experienced early life stressors. As such, intervening to improve school determinants holds promise as a potentially effective “upstream” prevention approach. Our understanding of what to target for intervention is limited, however, because has almost no rigorous longitudinal research has been conducted to identify specific malleable determinants of the school environment that shape mental health. Our long-term goal is to develop practical, scalable set of strategies that leverage positive aspects of schools to promote the mental health of youth in Tanzania and in other resource-limited settings. Specific aims of the study are to: (1) develop a contextually meaningful set of measurement tools to comprehensively assess the primary school environment in Tanzania; (2) examine how different dimensions of the school environment work to impact mental health trajectories of Tanzanian youth; and (3) determine how features of the school environment can be leveraged to buffer the impacts of exposure to early life stressors (violence exposure and deprivation). To accomplish these aims, we will collect data from teachers, caregivers, and students in 60 randomly selected primary schools in the Mwanza region of Tanzania. For aim 1, we will develop a robust set of observational and survey measures of the school environment, using qualitative research to investigate contextual relevance and a psychometric study to examine the validity and reliability of the adapted measures. To accomplish Aims 2 and 3, a random sample of 50 5th grade students in each of the 60 selected schools (total n=3,000) will be surveyed at 6-month intervals over 3 years for a total of 6 assessment waves. School observations and caregiver and teacher surveys will enable multi-informant assessment of key constructs. Longitudinal mediation models will assess the influence of school environment factors on mental health and examine emotional, cognitive, and social processes as explanatory mechanisms (Aim 2). Moderated mediation models will determine whether the negative mental health impacts of stressors are buffered for children in supportive school environments. Qualitative interviews with parent/child dyads will provide contextualized information about these processes (Aim 3). We expect the study will have a positive impact by identifying malleable factors in the school environment that can be targeted by whole school interventions to promote youth mental health in resource-limited settings.