Social Determinants and the Role of School-Based Mental Health Services in Adolescents’ Depressive Symptoms and Happiness

Adolescent mental health is a growing concern in the United States. Promoting health equity through addressing social determinants of health (SDOH) is a national priority and aligns with the Social Work Grand Challenge to "close the health gap." School-based mental health services (SBMHS) provide interdisciplinary support to enhance students' emotional, behavioral, and social functioning. This study analyzed data from 12th-grade participants in the 2022 and 2023 Monitoring the Future surveys-an annual, nationally representative, cross-sectional study-to (a) identify SDOH associated with depressive symptoms and happiness among high school seniors and (b) assess the influence of SBMHS on these outcomes. Two hierarchical regression analyses (n = 2,574 for depressive symptoms; n = 2,844 for happiness) revealed that attending schools in medium-sized cities (versus small cities) and having more friends using substances were social determinants associated with both higher depressive symptoms and lower happiness. Higher parental educational attainment and living with both parents were protective social determinants specific to depressive symptoms. SBMHS were significantly associated with reduced depressive symptoms and enhanced happiness. These findings highlight the importance of addressing social determinants of adolescent mental health and advocate for expanding SBMHS.