Evidencing the relational and situated aspects of complex social systems affecting health: introducing an integrated mixed methods approach to understand school mental health

Existing strategies for assessing adolescent mental health overlook the complex social and emotional contexts that young people navigate. Traditional methods focus on individuals, with less consideration of social and environmental factors. This paper presents a novel approach to understand relational and situated aspects of social systems and their influence on adolescent wellbeing.We developed data collection and analysis approaches to embed relational and situational information in remote qualitative walking interviews, participatory systems workshops, agent-based models, quantitative psychometric instruments, and social network surveys. These methods were tested on constructs of stress, loneliness, and mental health stigma in Scottish secondary schools. Mixed methods integration used system mapping software, follow the thread method, and the extended Pillar Integration Process.We integrated data from 13 interviews, 3 student-staff workshops (n=63), and 334 survey participants to determine level of support for five high level themes; pillar integration uncovered three additional themes. Stress showed greater between-situation variability than for loneliness, with little evidence for situational variability in stigma. Analysis uncovered ten stress response profiles reflecting individual differences in situation-specific stressors, and three loneliness profiles reflecting higher and lower loneliness across all situations. Integration focussed on how response profiles were patterned by friendship group, gender, and school year.A relational and situated approach to mental health can provide new insights for health promotion in schools. We present a methodological toolkit to assist researchers, intervention developers and school staff to understand influences on mental health and identify points of change tailored to specific social and spatial settings.