Student and School Correlates of Anxiety and Depression Symptoms in Public Education: Evidence from Large-Scale Administrative Data in Brazil
1
Institute for Health Policy Studies (IEPS), Rio de Janeiro, Brazil
2
Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
3
Leme Lab - Laboratory for Violence Reduction, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2561
ABSTRACT
BACKGROUND:
Mental health problems among children and adolescents are a major public health concern, particularly in low- and middle-income countries. However, evidence on how individual, school, and contextual factors jointly shape students’ mental health remains limited. This study analyzes correlates of anxiety and depression symptoms among public-school students in Brazil, using data from the inclusion of the Revised Child Anxiety and Depression Scale – 11 items (RCADS-11) in the 2024 Pernambuco State Education Assessment System, conducted in a northeastern state marked by socioeconomic inequalities.
METHODS:
We analyze more than 250,000 student-level observations from grades 5 and 9 of elementary education and grade 12 of upper secondary education. The dataset combines RCADS-11 scores with information on students’ sociodemographic characteristics, academic performance, and school attributes, including infrastructure quality, socioeconomic composition, and academic proficiency. Linear regression models with grade fixed effects and standard errors clustered at the school level are estimated, identifying conditional associations after controlling for student- and school-level covariates.
RESULTS:
Female students, students with prior grade repetition, and those exposed to socioeconomic vulnerability present significantly higher levels of anxiety and depression symptoms. In contrast, access to learning resources at home and higher individual academic performance are associated with better mental health outcomes. School characteristics remain strongly associated with students’ mental health after accounting for individual background and grade fixed effects. Better school infrastructure, higher average school socioeconomic status, and higher academic proficiency are consistently correlated with lower RCADS-11 scores.
CONCLUSIONS:
The findings underscore the combined role of individual vulnerability and school environments in shaping students’ mental health and the importance of continuous monitoring. Public policies addressing social determinants of health—such as Brazil’s National Policy for Psychosocial Care in School Communities—and investments in school infrastructure and learning conditions may help reduce anxiety and depression symptoms, particularly among socioeconomically disadvantaged students.
Mental health problems among children and adolescents are a major public health concern, particularly in low- and middle-income countries. However, evidence on how individual, school, and contextual factors jointly shape students’ mental health remains limited. This study analyzes correlates of anxiety and depression symptoms among public-school students in Brazil, using data from the inclusion of the Revised Child Anxiety and Depression Scale – 11 items (RCADS-11) in the 2024 Pernambuco State Education Assessment System, conducted in a northeastern state marked by socioeconomic inequalities.
METHODS:
We analyze more than 250,000 student-level observations from grades 5 and 9 of elementary education and grade 12 of upper secondary education. The dataset combines RCADS-11 scores with information on students’ sociodemographic characteristics, academic performance, and school attributes, including infrastructure quality, socioeconomic composition, and academic proficiency. Linear regression models with grade fixed effects and standard errors clustered at the school level are estimated, identifying conditional associations after controlling for student- and school-level covariates.
RESULTS:
Female students, students with prior grade repetition, and those exposed to socioeconomic vulnerability present significantly higher levels of anxiety and depression symptoms. In contrast, access to learning resources at home and higher individual academic performance are associated with better mental health outcomes. School characteristics remain strongly associated with students’ mental health after accounting for individual background and grade fixed effects. Better school infrastructure, higher average school socioeconomic status, and higher academic proficiency are consistently correlated with lower RCADS-11 scores.
CONCLUSIONS:
The findings underscore the combined role of individual vulnerability and school environments in shaping students’ mental health and the importance of continuous monitoring. Public policies addressing social determinants of health—such as Brazil’s National Policy for Psychosocial Care in School Communities—and investments in school infrastructure and learning conditions may help reduce anxiety and depression symptoms, particularly among socioeconomically disadvantaged students.
| eISSN: | 2654-1459 |
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