Table 3. Multivariable Analyses for Risk for Depression; Social, Emotional, and Behavioral Difficulties; and Mental Well-Being in Cohort 2a.
| Student characteristics | CES-D | SDQ | WEMWBS | |||
|---|---|---|---|---|---|---|
| B (95% CI) | P value | B (95% CI) | P value | B (95% CI) | P value | |
| Age | 1.25 (0.21 to 2.29) | .02 | NA | NA | −0.59 (−1.36 to 0.18) | .13 |
| Interaction between time and age | −0.29 (−1.16 to 0.58) | .51 | NA | NA | 0.61 (−0.12 to 1.34) | .10 |
| Gender | ||||||
| Female (vs male) | 4.78 (3.71 to 5.84) | <.001 | 1.26 (0.70 to 1.82) | <.001 | −2.99 (−3.86 to −2.12) | <.001 |
| Other/prefer not to say (vs male) | 5.56 (2.47 to 8.66) | <.001 | 1.25 (−0.45 to 2.96) | .15 | −4.40 (−6.85 to −1.95) | <.001 |
| Interaction between time and female | 1.64 (0.54 to 2.73) | .003 | 1.63 (1.09 to 2.17) | <.001 | −1.42 (−2.41 to −0.43) | .005 |
| White race (vs other racial and ethnic groupsb) | NA | NA | 1.20 (0.70 to 1.70) | <.001 | NA | NA |
| Year group 10 (vs year group 9) | −1.35 (−2.61 to −0.08) | .04c | 0.19 (−0.31 to 0.69) | .46 | 0.09 (−0.74 to 0.93) | .83 |
| Interaction between time and year group 10 | NA | NA | −0.26 (−0.73 to 0.22) | .29 | NA | NA |
| Student-rated school climate | −4.47 (−5.17 to −3.78) | <.001 | −2.76 (−3.12 to −2.40) | <.001 | 3.90 (3.35 to 4.46) | <.001 |
| Interaction between time and student-rated school climate | 2.68 (1.91 to 3.44) | <.001 | 1.54 (1.19 to 1.89) | <.001 | −2.55 (−3.19 to −1.91) | <.001 |
| Low risk for mental health difficulties (vs high) | −5.96 (−7.10 to −4.82) | <.001 | −3.72 (−4.31 to −3.13) | <.001 | 3.30 (2.40 to 4.21) | <.001 |
| Interaction between time and low risk for mental health difficulties | 2.07 (0.82 to 3.32) | .001 | 0.99 (0.41 to 1.57) | .001 | −0.93 (−1.98 to 0.12) | .08 |
| Home environment | ||||||
| Household assets | −1.51 (−3.85 to 0.84) | .21 | −0.53 (−1.63 to 0.57) | .34 | 0.32 (−1.27 to 1.90) | .69 |
| Interaction between time and household assets | 2.50 (−0.02 to 5.02) | .05 | NA | NA | NA | NA |
| Studying conditions | −1.58 (−4.26 to 1.10) | .25 | −1.31 (−2.53 to −0.09) | .04c | 0.94 (−1.21 to 3.08) | .39 |
| Interaction between time and studying conditions | −1.03 (−3.96 to 1.90) | .49 | NA | NA | 0.34 (−2.10 to 2.78) | .78 |
| Home connectedness | −12.09 (−14.35 to −9.83) | <.001 | −5.83 (−6.99 to −4.67) | <.001 | 9.66 (7.87 to 11.45) | <.001 |
| Interaction between time and home connectedness | −8.95 (−11.40 to −6.51) | <.001 | −3.66 (−4.72 to −2.60) | <.001 | 6.24 (4.21 to 8.27) | <.001 |
| Home conflicts | ||||||
| Sometimes (vs lots of times) | 0.05 (−1.21 to 1.31) | .94 | 0.36 (−0.32 to 1.05) | .30 | −0.62 (−1.59 to 0.35) | .21 |
| Rarely | 0.33 (−1.08 to 1.74) | .65 | −0.27 (−1.01 to 0.48) | .48 | −0.46 (−1.57 to 0.64) | .41 |
| No/don’t know | −0.80 (−2.16 to 0.56) | .25 | −0.80 (−1.52 to −0.09) | .03c | 0.34 (−0.73 to 1.41) | .53 |
| Interaction between time and home conflicts rarely | −0.16 (−1.51 to 1.19) | .82 | 0.22 (−0.40 to 0.84) | .49 | 0.05 (−1.07 to 1.17) | .93 |
| Interaction between time and home conflicts no/don’t know | −1.01 (−2.28 to 0.26) | .12 | −0.15 (−0.73 to 0.43) | .60 | 0.32 (−0.74 to 1.39) | .56 |
| Friendships | ||||||
| Don’t know (vs yes) | 2.20 (0.13 to 4.26) | .04c | 0.32 (−0.75 to 1.38) | .56 | −2.57 (−3.90 to −1.25) | <.001 |
| No (vs yes) | 3.03 (1.49 to 4.57) | <.001 | 1.98 (1.14 to 2.82) | <.001 | −2.76 (−3.99 to −1.54) | <.001 |
| Prefer not to say (vs yes) | 1.95 (−1.33 to 5.23) | .24 | 2.06 (0.33 to 3.78) | .02 | −2.62 (−5.10 to −0.14) | .04c |
| Interaction between time and friendships, don’t know | 2.88 (0.63 to 5.14) | .01 | 1.25 (0.21 to 2.28) | .02 | NA | NA |
| Operational features of the school | ||||||
| School size | 0.0001 (−0.003 to 0.003) | .97 | NA | NA | NA | NA |
| Interaction between time and school size | −0.0002 (−0.002 to 0.002) | .87 | NA | NA | NA | NA |
| Coeducational (vs female only) | 1.11 (0.06 to 2.15) | .04c | 0.12 (−0.55 to 0.79) | .72 | −0.44 (−1.50 to 0.63) | .42 |
| Interaction between time and coeducational | NA | NA | 0.16 (−0.43 to 0.74) | .60 | −0.10 (−1.27 to 1.07) | .87 |
| School quality | ||||||
| Requires improvement (vs outstanding) | 0.02 (−2.71 to 2.74) | .99 | NA | NA | NA | NA |
| Interaction between time and school quality, requires improvement | −2.51 (−5.43 to 0.40) | .09 | NA | NA | NA | NA |
| SEL quality rating | NA | NA | −0.09 (−0.23 to 0.05) | .22 | 0.03 (−0.21 to 0.26) | .82 |
| Interaction between time and SEL quality rating | NA | NA | NA | NA | 0.07 (−0.14 to 0.28) | .52 |
| Some time at school during lockdown (vs at home) | −0.57 (−2.27 to 1.12) | .51 | 0.58 (−0.31 to 1.48) | .20 | 0.87 (−0.43 to 2.17) | .19 |
| Student-rated school climate | −5.47 (−8.24 to −2.71) | <.001 | −1.26 (−2.78 to 0.26) | .11 | 2.60 (0.31 to 4.90) | .03c |
| Characteristics of the school community | ||||||
| % SEND support | NA | NA | 0.03 (−0.03 to 0.08) | .35 | NA | NA |
| Students’ age (school level) | −0.32 (−2.55 to 1.90) | .78 | NA | NA | NA | NA |
| Interaction between time and students’ age | 2.18 (0.24 to 4.12) | .03c | NA | NA | NA | NA |
| % Students who are Whited | NA | NA | NA | NA | −0.01 (−0.03 to 0.004) | .16 |
| Interaction between time and % students who are White | NA | NA | NA | NA | 0.001 (−0.02 to 0.02) | .94 |
| Broader context | ||||||
| Urbanicity rural (vs urban) | NA | NA | NA | NA | 0.78 (−0.40 to 1.95) | .20 |
| Area-level deprivation by IMD | NA | NA | NA | NA | 0.02 (−0.10 to 0.14) | .73 |
Abbreviations: CES-D, Center for Epidemiological Studies for Depression scale; IMD, Indices of Multiple Deprivation; NA, not applicable; SDQ, Strengths and Difficulties Questionnaire; SEL, social-emotional learning; SEND, special educational needs or disabilities; WEMWBS, Warwick-Edinburgh Mental Well-Being Scale.
Multivariable analyses using multilevel linear regressions via maximum likelihood estimation and 3-level mixed-effects models for the analysis of the unique associations between student- and school-level characteristics and changes in students’ mental health and mental well-being between time point 3 (T3; September 4, 2019, to January 17, 2020) and time point 4 (T4; February 23, 2021, to June 21, 2021) during the COVID-19 pandemic, entering those factors that provided significant P values (P < .05) in the univariable analyses (eTable 5 in Supplement 1). The continuous student-level factors (age, school climate) were group mean (school level) centered; therefore, the regression coefficients represent an estimate of the differences in individual effects within schools. The continuous school-level factors were introduced as group means so that these regression coefficients represent school-level effects (ie, differences between schools).33 Regression coefficients of the interaction terms reflect changes relative to the first assessment (ie, T4 vs T3). All models controlled for design variables, trial allocation group, and the time difference (days) between T3 and T4. Variables that did not show significant univariable associations in any of the outcome variables are omitted.
The other racial and ethnic groups category includes Arab, Asian, Black/African/Caribbean, mixed/multiple ethnic groups, and other ethnic groups. This category was grouped together owing to small sample sizes.
This association was no longer significant when the multiple testing correction was applied.
Ford et al12 suggest a potential association of this variable at the school level with mental health outcomes at the student level.