{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:16:38Z","timestamp":1787940998602,"version":"build-2784847793"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012349","name":"School for Public Health Research","doi-asserted-by":"publisher","award":["PD-SPH-2015"],"award-info":[{"award-number":["PD-SPH-2015"]}],"id":[{"id":"10.13039\/501100012349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Young people are experiencing more mental health challenges, and connection to school can improve this. This study aimed to investigate adverse mental health, mental well-being, and school connectedness among secondary school students according to gender, academic year group, and socioeconomic status to identify areas for intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Self-report questionnaire data from 5193 Year 8 and 10 students (12\u221215 years) in the UK South West \u2013 School Health Research Network (SW-SHRN) were analysed. Weighted proportions and 95% Confidence Intervals (CIs) for all mental health and well-being (life satisfaction (Cantril Scale), depression (SMFQ), anxiety (GAD-7), mental well-being (SWEMWBS), loneliness (ONS measures for children)), and school connectedness outcomes were calculated, accounting for school clustering. Relationships between these and gender, academic year group, and socioeconomic status were explored using regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A high proportion of respondents reported experiencing poor mental health, such as low life satisfaction (40%) and severe symptoms of depression (33%). Levels of school connectedness were also low; 47% of respondents reported a sense of belonging in school. Across all outcome measures, there was a gender gradient, boys experienced the most favourable and non-binary students the least favourable outcomes. Similarly, regression analyses confirmed gender as an important predictor, with especially stark differences between girls and boys in symptoms of depression [AOR 3.27 (CI: 2.84\u20133.76)] and anxiety [AOR 3.07 (CI: 2.62\u20133.61)]. Feeling safe in school and classmate support were associated with lower mental health outcomes whereas feeling a lot of schoolwork pressure predicted poorer outcomes, notably symptoms of depression [AOR 4.53 (CI: 3.40\u20136.08)] and anxiety [AOR 5.34 (CI: 3.79\u20137.66)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A high proportion of students reported poor mental health, mental well-being, and low school connectedness, with notable differences by gender. Our data suggest an urgent need for action and for schools to receive specific support to reverse deteriorating student mental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355874","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:21:45Z","timestamp":1787937705000},"page":"e0355874","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of mental health, mental well-being, and school connectedness in UK secondary school students in 2021\/2022: Results from the South West - School Health Research Network pilot study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5710-8483","authenticated-orcid":true,"given":"Patricia N.","family":"Albers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Widnall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Hatch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Sharp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judi","family":"Kidger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"de Vocht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Kaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther M. F.","family":"van Sluijs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Fairbrother","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Jago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rona","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"issue":"5","key":"pone.0355874.ref001","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1093\/ije\/dyz006","article-title":"Changes in millennial adolescent mental health and health-related behaviours over 10 years: a population cohort comparison study","volume":"48","author":"P Patalay","year":"2019","journal-title":"Int J Epidemiol"},{"issue":"7","key":"pone.0355874.ref002","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s00787-021-01856-w","article-title":"The impact of COVID-19 lockdown on child and adolescent mental health: systematic review","volume":"32","author":"U Panchal","year":"2023","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"pone.0355874.ref003","unstructured":"NHS Digital. Mental Health of Children and Young People in England, 2017 London. 2018 [cited 2023 Apr 3]. Available from: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/mental-health-of-children-and-young-people-in-england\/2017\/2017"},{"key":"pone.0355874.ref004","unstructured":"NHS Digital. Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey London. 2020 [cited 2023 Apr 3]. Available from: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/mental-health-of-children-and-young-people-in-england\/2020-wave-1-follow-up"},{"key":"pone.0355874.ref005","unstructured":"NHS Digital. Mental Health of Children and Young People in England, 2023 - wave 4 follow up to the 2017 survey London. 2023 [cited 2025 Jun 7]. Available from: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/mental-health-of-children-and-young-people-in-england\/2023-wave-4-follow-up"},{"issue":"1","key":"pone.0355874.ref006","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/1754073918768878","article-title":"Understanding emotion in adolescents: a review of emotional frequency, intensity, instability, and clarity","volume":"11","author":"NH Bailen","year":"2019","journal-title":"Emot Rev"},{"issue":"1","key":"pone.0355874.ref007","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.bandc.2009.07.003","article-title":"A time of change: behavioral and neural correlates of adolescent sensitivity to appetitive and aversive environmental cues","volume":"72","author":"LH Somerville","year":"2010","journal-title":"Brain Cogn"},{"issue":"6","key":"pone.0355874.ref008","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"RC Kessler","year":"2005","journal-title":"Arch Gen Psychiatry"},{"issue":"3","key":"pone.0355874.ref009","first-page":"171","article-title":"Multiple health-risk behaviour and psychological distress in adolescence","volume":"21","author":"KP Arbour-Nicitopoulos","year":"2012","journal-title":"J Can Acad Child Adolesc Psychiatry"},{"key":"pone.0355874.ref010","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.puhe.2019.03.001","article-title":"Health inequalities, risky behaviours and protective factors in adolescents: an analysis of secondary survey data from the UK","volume":"170","author":"K Currie","year":"2019","journal-title":"Public Health"},{"key":"pone.0355874.ref011","doi-asserted-by":"crossref","first-page":"106157","DOI":"10.1016\/j.ypmed.2020.106157","article-title":"Multiple risk behaviour in adolescence is associated with substantial adverse health and social outcomes in early adulthood: findings from a prospective birth cohort study","volume":"138","author":"R Campbell","year":"2020","journal-title":"Prev Med"},{"key":"pone.0355874.ref012","doi-asserted-by":"crossref","first-page":"100742","DOI":"10.1016\/j.ssmph.2021.100742","article-title":"The gender gap in adolescent mental health: a cross-national investigation of 566,829 adolescents across 73 countries","volume":"13","author":"OLK Campbell","year":"2021","journal-title":"SSM Popul Health"},{"issue":"9","key":"pone.0355874.ref013","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s00787-022-01961-4","article-title":"Gender difference in the change of adolescents\u2019 mental health and subjective wellbeing trajectories","volume":"32","author":"Y Yoon","year":"2023","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"9","key":"pone.0355874.ref014","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s00787-022-01961-4","article-title":"Gender difference in the change of adolescents\u2019 mental health and subjective wellbeing trajectories","volume":"32","author":"Y Yoon","year":"2023","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"1","key":"pone.0355874.ref015","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00787-023-02150-7","article-title":"Understanding the relationship between gender and mental health in adolescence: the Gender Adherence Index (GAI)","volume":"33","author":"X Cela-Bertran","year":"2024","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"pone.0355874.ref016","doi-asserted-by":"crossref","DOI":"10.1037\/e557702010-001","volume-title":"Mental health of children and young people in Great Britain, 2004","author":"H Green","year":"2005"},{"issue":"1","key":"pone.0355874.ref017","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12888-018-1591-4","article-title":"Gender differences in mental health problems among adolescents and the role of social support: results from the Belgian health interview surveys 2008 and 2013","volume":"18","author":"F Van Droogenbroeck","year":"2018","journal-title":"BMC Psychiatry"},{"issue":"19","key":"pone.0355874.ref018","doi-asserted-by":"crossref","first-page":"3605","DOI":"10.3390\/ijerph16193605","article-title":"Adolescent Socioeconomic Status and Mental Health Inequalities in the Netherlands, 2001-2017","volume":"16","author":"D Weinberg","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0355874.ref019","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1002\/ajcp.12115","article-title":"The pathways between socioeconomic status and adolescent outcomes: a systematic review","volume":"59","author":"B Devenish","year":"2017","journal-title":"Am J Community Psychol"},{"issue":"5","key":"pone.0355874.ref020","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1037\/a0033716","article-title":"Subjective socioeconomic status and adolescent health: a meta-analysis","volume":"33","author":"EC Quon","year":"2014","journal-title":"Health Psychol"},{"issue":"3","key":"pone.0355874.ref021","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/eurpub\/ckp172","article-title":"Mental health problems of Dutch adolescents: the association with adolescents\u2019 and their parents\u2019 educational level","volume":"20","author":"J Havas","year":"2010","journal-title":"Eur J Public Health"},{"key":"pone.0355874.ref022","doi-asserted-by":"crossref","first-page":"510","DOI":"10.3389\/fpsyg.2020.00510","article-title":"School environments and elementary school children\u2019s well-being in Northwestern Mexico","volume":"11","author":"C Tapia-Fonllem","year":"2020","journal-title":"Front Psychol"},{"key":"pone.0355874.ref023","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.healthplace.2012.12.001","article-title":"The effects of the school environment on student health: a systematic review of multi-level studies","volume":"21","author":"C Bonell","year":"2013","journal-title":"Health Place"},{"key":"pone.0355874.ref024","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ijer.2018.01.012","article-title":"The relationships between school climate and adolescent mental health and wellbeing: a systematic literature review","volume":"88","author":"JM Aldridge","year":"2018","journal-title":"Int J Educ Res"},{"issue":"1","key":"pone.0355874.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/phr01010","article-title":"Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis","volume":"1","author":"C Bonell","year":"2013","journal-title":"Public Health Res"},{"issue":"1","key":"pone.0355874.ref026","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jadohealth.2020.09.030","article-title":"The mediating effect of school climate on adolescent mental health: findings from a randomized controlled trial of a school-wide intervention","volume":"69","author":"DR Singla","year":"2021","journal-title":"J Adolesc Health"},{"issue":"7","key":"pone.0355874.ref027","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/j.1746-1561.2004.tb08284.x","article-title":"Measuring student relationships to school: attachment, bonding, connectedness, and engagement","volume":"74","author":"HP Libbey","year":"2004","journal-title":"J Sch Health"},{"issue":"1","key":"pone.0355874.ref028","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1186\/s12889-022-14364-6","article-title":"The role of school connectedness in the prevention of youth depression and anxiety: a systematic review with youth consultation","volume":"22","author":"M Raniti","year":"2022","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0355874.ref029","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1017\/jgc.2020.3","article-title":"School connectedness and child anxiety","volume":"30","author":"PJ Pikulski","year":"2020","journal-title":"J Psychol Couns Sch"},{"issue":"2","key":"pone.0355874.ref030","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1207\/s15374424jccp3502_1","article-title":"School connectedness is an underemphasized parameter in adolescent mental health: results of a community prediction study","volume":"35","author":"IM Shochet","year":"2006","journal-title":"J Clin Child Adolesc Psychol"},{"issue":"6","key":"pone.0355874.ref031","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00038-016-0900-2","article-title":"Self-harm in adolescence: protective health assets in the family, school and community","volume":"62","author":"E Klemera","year":"2017","journal-title":"Int J Public Health"},{"issue":"1","key":"pone.0355874.ref032","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s11205-014-0842-0","article-title":"The association between school stress, life satisfaction and depressive symptoms in adolescents: life satisfaction as a potential mediator","volume":"125","author":"UK Moksnes","year":"2014","journal-title":"Soc Indic Res"},{"key":"pone.0355874.ref033","doi-asserted-by":"crossref","DOI":"10.1016\/j.jadohealth.2020.02.010","article-title":"Cross-national time trends in adolescent mental well-being from 2002 to 2018 and the explanatory role of schoolwork pressure","volume":"66","author":"A Cosma","year":"2020","journal-title":"J Adolesc Health"},{"issue":"7","key":"pone.0355874.ref034","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00127-018-1530-1","article-title":"Review of mental health promotion interventions in schools","volume":"53","author":"M O\u2019Reilly","year":"2018","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"4","key":"pone.0355874.ref035","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s10212-018-0406-9","article-title":"Effectiveness of interventions adopting a whole school approach to enhancing social and emotional development: a meta-analysis","volume":"34","author":"JM Goldberg","year":"2018","journal-title":"Eur J Psychol Educ"},{"issue":"1","key":"pone.0355874.ref036","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1108\/HE-12-2019-0058","article-title":"Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools","volume":"120","author":"K Dadaczynski","year":"2020","journal-title":"Health Educ"},{"issue":"1","key":"pone.0355874.ref037","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/BF03256138","article-title":"Health-promoting schools: evidence for a holistic approach to promoting health and improving health literacy","volume":"7","author":"A Lee","year":"2009","journal-title":"Appl Health Econ Health Policy"},{"issue":"19","key":"pone.0355874.ref038","doi-asserted-by":"crossref","first-page":"7128","DOI":"10.3390\/ijerph17197128","article-title":"Reluctancy towards help-seeking for mental health concerns at secondary school among students in the COMPASS study","volume":"17","author":"N Doan","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0355874.ref039","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1176\/appi.ps.54.1.60","article-title":"Pathways into and through mental health services for children and adolescents","volume":"54","author":"EMZ Farmer","year":"2003","journal-title":"Psychiatr Serv"},{"issue":"4","key":"pone.0355874.ref040","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/YCO.0b013e3283543976","article-title":"Mental health and the school environment: secondary schools, promotion and pathways to care","volume":"25","author":"S Kutcher","year":"2012","journal-title":"Curr Opin Psychiatry"},{"key":"pone.0355874.ref041","volume-title":"Education, education, mental health: Supporting secondary schools to play a central role in early intervention mental health services","author":"C Thorley","year":"2016"},{"issue":"20","key":"pone.0355874.ref042","doi-asserted-by":"crossref","first-page":"13711","DOI":"10.3390\/ijerph192013711","article-title":"Creation of a pilot school health research network in an English education infrastructure to improve adolescent health and well-being: a study protocol","volume":"19","author":"CA Sharp","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0355874.ref043","doi-asserted-by":"crossref","DOI":"10.18546\/RFA.02.1.03","article-title":"Improving young people\u2019s health and well-being through a school health research network: reflections on school\u2013researcher engagement at the national level","volume":"2","author":"G Hewitt","year":"2018","journal-title":"Research for All"},{"key":"pone.0355874.ref044","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13034-020-00341-7","article-title":"Children and young people\u2019s experiences of completing mental health and wellbeing measures for research: learning from two school-based pilot projects","volume":"14","author":"O Demkowicz","year":"2020","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"2","key":"pone.0355874.ref045","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"PA Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"pone.0355874.ref046","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"PA Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"pone.0355874.ref047","volume-title":"R: A language and environment for statistical computing","author":"RC Team","year":"2021","edition":"4.1.1"},{"key":"pone.0355874.ref048","unstructured":"Education Df. Alternative Provision Statutory guidance for local authorities: Department for Education. 2013 [cited 2023 Feb 22]. Available from: https:\/\/www.gov.uk\/government\/publications\/alternative-provision"},{"key":"pone.0355874.ref049","first-page":"131","article-title":"The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) study: origins, concept, history and development 1982-2008","author":"International HBSC Network Coordinating Committee","year":"2009","journal-title":"Int J Public Health"},{"key":"pone.0355874.ref050","volume-title":"Social determinants of health and well-being among young people: Health Behaviour in School-aged Children (HBSC) study: international report from the 2009\/2010 survey","author":"C Currie","year":"2012"},{"issue":"1","key":"pone.0355874.ref051","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11121-018-0969-3","article-title":"A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement: The School Health Research Network (SHRN) in Wales","volume":"22","author":"S Murphy","year":"2021","journal-title":"Prev Sci"},{"key":"pone.0355874.ref052","unstructured":"Office for National Statistics. Ethnic group, national identity and religion. Measuring equality: A guide for the collection and classification of ethnic group, national identity and religion data in the UK.: Open Government Licence v3.0. 2020. Available from: https:\/\/www.ons.gov.uk\/methodology\/classificationsandstandards\/measuringequality\/ethnicgroupnationalidentityandreligion"},{"key":"pone.0355874.ref053","unstructured":"Office for Nation Statistics. Measuring loneliness: guidance for use of the national indicators on surveys. 2018. [cited 2022 Dec 12]. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/wellbeing\/methodologies\/measuringlonelinessguidanceforuseofthenationalindicatorsonsurveys"},{"key":"pone.0355874.ref054","unstructured":"Ministry of Housing CLG. English indices of deprivation 2025: statistical release: Ministry of Housing, Communities & Local Government. 2025 [cited 2026]. Available from: https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2025\/english-indices-of-deprivation-2025-statistical-release"},{"issue":"10","key":"pone.0355874.ref055","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"pone.0355874.ref056","article-title":"Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents","author":"AA Old","year":"1995","journal-title":"Epidemiol Psychiatr Sci"},{"key":"pone.0355874.ref057","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1477-7525-7-15","article-title":"Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey","volume":"7","author":"S Stewart-Brown","year":"2009","journal-title":"Health Qual Life Outcomes"},{"issue":"2","key":"pone.0355874.ref058","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1007\/s11205-013-0507-4","article-title":"Reliability and validity of an adapted version of the cantril ladder for use with adolescent samples","volume":"119","author":"KA Levin","year":"2013","journal-title":"Soc Indic Res"},{"issue":"1","key":"pone.0355874.ref059","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1207\/s15327752jpa5201_2","article-title":"The multidimensional scale of perceived social support","volume":"52","author":"GD Zimet","year":"1988","journal-title":"J Pers Assess"},{"key":"pone.0355874.ref060","unstructured":"Lumley T. Analysis of Complex Survey Samples. 2022. Available from: https:\/\/cran.r-project.org\/web\/packages\/survey\/survey.pdf"},{"key":"pone.0355874.ref061","first-page":"1","article-title":"Loneliness and self-harm in adolescents during the first national COVID-19 lockdown: results from a survey of 10,000 secondary school pupils in England","author":"G Geulayov","year":"2022","journal-title":"Curr Psychol"},{"issue":"11","key":"pone.0355874.ref062","doi-asserted-by":"crossref","first-page":"6768","DOI":"10.3390\/ijerph19116768","article-title":"Impact of school and peer connectedness on adolescent mental health and well-being outcomes during the COVID-19 pandemic: a longitudinal panel survey","volume":"19","author":"E Widnall","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0355874.ref063","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1002\/cpp.574","article-title":"Mental health of children and adolescents in 12 European countries-results from the European KIDSCREEN study","volume":"15","author":"European KIDSCREEN Group","year":"2008","journal-title":"Clin Psychol Psychother"},{"issue":"10185","key":"pone.0355874.ref064","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1016\/S0140-6736(19)31013-X","article-title":"Adolescence and mental health","volume":"393","author":"SJ Blakemore","year":"2019","journal-title":"The Lancet"},{"issue":"3","key":"pone.0355874.ref065","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1683","article-title":"Health and care utilization of transgender and gender nonconforming youth: a population-based study","volume":"141","author":"GN Rider","year":"2018","journal-title":"Pediatrics"},{"issue":"1","key":"pone.0355874.ref066","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s13034-024-00822-z","article-title":"Mental health of non-binary youth: a systematic review and meta-analysis","volume":"18","author":"D Klinger","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"6","key":"pone.0355874.ref067","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1177\/070674371506000604","article-title":"Associations of school connectedness with adolescent suicidality: gender differences and the role of risk of depression","volume":"60","author":"DB Langille","year":"2015","journal-title":"Can J Psychiatry"},{"issue":"6","key":"pone.0355874.ref068","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1007\/s12187-017-9524-1","article-title":"School, peer and family relationships and adolescent substance use, subjective wellbeing and mental health symptoms in Wales: a cross sectional study","volume":"11","author":"GF Moore","year":"2018","journal-title":"Child Indic Res"},{"issue":"4","key":"pone.0355874.ref069","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1177\/0044118X13504419","article-title":"Trajectories of school connectedness across the middle school years: Examining the roles of adolescents\u2019 internalizing and externalizing problems","volume":"48","author":"A Loukas","year":"2016","journal-title":"Youth Soc"},{"issue":"8","key":"pone.0355874.ref070","article-title":"Peer victimization and loneliness: The moderating role of school connectedness by gender","volume":"18","author":"JV Carney","year":"2020","journal-title":"J School Counseling"},{"issue":"5","key":"pone.0355874.ref071","doi-asserted-by":"crossref","first-page":"4274","DOI":"10.3390\/ijerph20054274","article-title":"Understanding how school-based interventions can tackle LGBTQ+ youth mental health inequality: a realist approach","volume":"20","author":"E McDermott","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0355874.ref072","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1038\/s41380-021-01161-7","article-title":"Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies","volume":"27","author":"M Solmi","year":"2022","journal-title":"Mol Psychiatry"},{"issue":"4","key":"pone.0355874.ref073","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1080\/02643944.2019.1665091","article-title":"GCSE exam stress: student perceptions of the effects on wellbeing and performance","volume":"37","author":"T Roome","year":"2019","journal-title":"Pastoral Care Educ"},{"key":"pone.0355874.ref074","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ypmed.2016.02.010","article-title":"Does socioeconomic status moderate the relationships between school connectedness with psychological distress, suicidal ideation and attempts in adolescents?","volume":"87","author":"H Sampasa-Kanyinga","year":"2016","journal-title":"Prev Med"},{"issue":"6","key":"pone.0355874.ref075","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/S0277-9536(02)00120-X","article-title":"A new theory of health promoting schools based on human functioning, school organisation and pedagogic practice","volume":"56","author":"WA Markham","year":"2003","journal-title":"Soc Sci Med"},{"issue":"2","key":"pone.0355874.ref076","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/1741143207087771","article-title":"Twenty years of progress? English education policy 1988 to the present","volume":"36","author":"G Whitty","year":"2008","journal-title":"Educ Manage Admin Leadership"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355874","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:21:56Z","timestamp":1787937716000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355874"}},"subtitle":[],"editor":[{"given":"Harikrishnan","family":"U","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":76,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355874","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}