Schools need to up their game on students’ mental health

The Chinese University of Hong Kong (CUHK)’s Healthy School Forum reveals alarming data on students’ mental health, which call for adoption of the WHO’s health-promoting school (HPS) framework in all schools in Hong Kong.

Poor mental health, especially in female students

At the forum, Professor Martin Wong, Director of the Centre for Health Education and Health Promotion, CUHK, shared results of his team’s population-based study, which investigated the prevalence of mental health conditions in 4,884 students from 30 primary schools (n=2,234; mean age, 10.06 years; female, 48.2 percent) and 25 secondary schools (n=2,650; mean age, 15.29 years; female, 50.3 percent). Depression was defined as a feeling of despair every day for ≥2 weeks.

Depression is found to be prevalent among both primary (27.0 percent) and secondary school (29.5 percent) students. Of note, about one in five students (primary school, 17.9 percent; secondary school, 19.4 percent) reported suicidality. [Child Care Health Dev 2024;50:e13196]

Multiple logistic regression analysis in secondary school students showed that females had significantly higher odds of developing depression (33.3 percent vs 26.7 percent; odds ratio [OR], 1.71; 95 percent confidence interval, 1.37–2.15; p<0.001) and suicidality (22.6 percent vs 16.9 percent; OR, 1.60; 95 percent CI, 1.24–2.08; p<0.001) vs males. This is consistent with a recent study by Wong’s team in secondary school students (n=791), which revealed a higher prevalence of moderate-to-severe depression in female vs male students (26.1 percent vs 16.1 percent). [Child Care Health Dev 2024;50:e13196; Wong CS, Healthy School Forum 2024]

Protective factors: Supportive school and family environment

Apart from female sex, poor academic performance, experience of being bullied, very high or low expectations from parents, worse health status, and being overweight were also risk factors for developing depression or suicidality in both primary and secondary school students. [Child Care Health Dev 2024;50:e13196]

Having close friends and being satisfied with school and family lives were protective factors. These findings highlight the need to create supportive environment in schools and families to safeguard children’s mental well-being.

Whole school, whole health

Evidence from the past decade has confirmed that implementation of WHO’s HPS framework improves the social environment of schools, enhancing students’ health literacy as well as physical, mental and spiritual health.

The Department of Health (DoH) launched the “HPS Programme” as a pilot project in 30 primary and secondary schools in June 2023. The full programme covers mental health, social well-being, healthy eating, and physical activity. [www.studenthealth.gov.hk/english/hps/hps.html] Additionally, the Education Bureau launched the 4Rs Mental Health Charter in April 2024, which covers four key elements for promoting students’ mental health, including Rest, Relaxation, Relationship, and Resilience. [www.edb.gov.hk/en/news/all.html]

“DoH will continue to collaborate with various stakeholders to expand the HPS concept to all schools in Hong Kong,” remarked Director of Health, Dr Ronald Lam. “More schools will become HPS, and together, we will achieve the ‘whole school, whole health’ target.”