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Sarah Fayed xxxxxx

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Abstract

We analyze the role of education as a determinant of mental health. To do this, we leverage the age‐specific exposure to an educational reform as an instrument for years of education and find that the treated cohorts gained more education. This increase in education had an effect on mental health more than 2 decades later. An extra year of education led to a lower likelihood of reporting any symptoms related to depression (11.3%) and anxiety (9.8%). More educated people also suffered less severe symptoms - depression (6.1%) and anxiety (5.6%). These protective effects are higher among women and rural residents. The effects of education on mental well‐being that we document are potentially mediated through better physical health, improved health behavior and knowledge, and an increase in women's empowerment.

Keywords: Africa, education, mental health, Zimbabwe

1. INTRODUCTION

Mental health accounts for around seven percent of the global disease burden and 19% of all disability years (James, 2018; Rehm & Shield, 2019). In addition to being a valuable end in itself, mental well‐being is critical because it is a key determinant of a number of socio‐economic outcomes such as premature mortality (Graham & Pinto, 2019) and lower life expectancy (Wahlbeck et al., 2011), and higher risk of other communicable and non‐communicable diseases (Hobkirk et al., 2015; Prince et al., 2007). In terms of economic outcomes, people with lower psychological well‐being have a higher likelihood of being unemployed (Frijters et al., 2014), earn lower wages (Graham et al., 2004), and are less productive (Oswald et al., 2015). This makes them vulnerable to economic shocks and more likely to live in poverty (Lund et al., 2011).

The negative effects of poor mental health are exacerbated in low‐ and middle‐income countries due to under‐treatment. Estimates suggest that under‐treatment is around 76-90% in low and middle‐income countries as opposed to 35-50% in developed countries (Patel et al., 2010). Mental health is stigmatized in low‐income countries - evidence from a variety of contexts including Ethiopia (Shibre et al., 2001), India (Koschorke et al., 2014), and Nigeria (Oshodi et al., 2014) demonstrates that individuals suffering from poor mental health fear being discriminated against and being ostracized by society, and consequently under‐report these issues and have a lower likelihood of seeking appropriate treatment. The under‐reporting of mental health issues, coupled with low investment in mental health infrastructure and diminished availability of human resources results in a higher treatment gap in these countries (Mascayano et al., 2015). The high prevalence and low rates of treatment of mental disorders in developing countries creates a large welfare loss ‐ Bloom et al. (2011) estimate that by the year 2030, mental disorders are expected to lead to a loss in economic output amounting to around 20% of the global GDP. This necessitates the need to study factors that can help improve mental health. We explore the role of one such factor - education.

In particular, we examine the effect of years of education on long‐run mental health of individuals. We do so in the context of Zimbabwe. Before 1980, the country was under British colonial rule, and there were several discriminatory policies that restricted educational attainment among Black Zimbabweans. For example, primary education (grades 1-7) was free and compulsory only for White students, while Black students had to pay fees and were not required to enroll. Black students also had to take a competitive exam (for a limited number of seats) to gain admission into secondary school, while their White counterparts received automatic progression. Post‐independence (in 1980) the new government focused their efforts on improving educational outcomes, and implemented three critical reforms ‐ (1) free and compulsory primary education for all, (2) automatic progression into secondary school, and (3) the relaxing of age restrictions related to entry into primary school. These reforms benefited Black children who were of primary school‐going age at the time. Since Zimbabwean kids started school when they turned six, those who were 13 years or younger in 1980 disproportionately benefited from these policies (treatment group). Since the reform also allowed for some over‐age students to enroll in school, some children who were 14 or 15 years of age in 1980 might have also experienced some educational gains (the partially treated group). However, older individuals (16 years or above at the time) were significantly less likely to experience any such benefits, 1 and thus form our control group.

We utilize this age‐specific exposure to an educational reform in Zimbabwe in the 1980s as an instrumental variable (IV) for years of education to estimate the causal effect of schooling on later life mental health. We use an age cutoff of 15 years to define reform exposure - those who were 15 years and below in 1980 form the treated group, while those 16 years and older are considered as untreated. Our identification strategy rests on the assumption that individuals on either side of the age cutoff were, on average, conditionally indistinguishable, except for their exposure to this education policy, which led to higher levels of education among the treated. Our results indicate that the treated group eventually gained about three years of education and were 39% points more likely to attend secondary school. Our IV results suggest that this enhanced education led to better mental health later in life. We find significant effects of education on both the likelihood of having any adverse mental health related symptoms, and the severity of these symptoms. An extra year of schooling reduced the probability of reporting any symptoms related to depression (11.3%) or anxiety (9.8%) in adult life, and it also led to a decline in the severity of symptoms of both depression (6.1%), and anxiety (5.6%). Our findings suggest that the effects are larger among women and rural residents. We find evidence that improved physical health, better health‐related behavior and an increase in female empowerment might be some of the mechanisms through which education might have shaped mental health in the Zimbabwean context. We conduct a number of sensitivity analyses to show that our results are robust to various modifications in the empirical strategy, including levels at which the standard errors are clustered, and choice of bandwidth.

This paper contributes to two separate strands of literature. First, it adds to the growing evidence on the link between education and mental health. 2 While some studies find a positive impact of education on mental well‐being (Chevalier & Feinstein, 2006; Courtin et al., 2019; Crespo et al., 2014; Dursun & Cesur, 2016; Jiang et al., 2020; Lager et al., 2017; Li & Sunder, 2022; Mazzonna, 2014; Wang, 2021), others document a negative effect (Avendano et al., 2020) or null effects (Begerow & Jürges, 2021; Böckerman et al., 2021). In addition to the mixed results of education on mental health, the bulk of this literature is based on developed countries, such as the UK, USA, Canada, Germany, and Sweden. We build on this literature by introducing novel evidence on the effects of education on mental health in Africa, a context where this relationship has not yet been explored. Second, this paper adds to the vast literature exploring the effects of education on health, which largely builds on the model of health accumlation proposed by Grossman (1972) model of health accumulation. A recent review article finds that the effect of education on health outcomes (such as mortality and obesity) and health behaviors (such as smoking) is highly context specific (Galama et al., 2018). This implies that evidence from one context might not be applicable to others, especially if they vary significantly. Moreover, it is unclear a priori whether the relationship between education and health extends to mental health. Our paper adds to the growing literature on the link between education and health by bringing forth evidence on mental health, a novel and understudied outcome. 3

2. DATA AND KEY VARIABLES

The data used in this analysis comes from the World Health Survey (WHS). The WHS was conducted by the World Health Organization (WHO) across 70 countries between the years 2002 and 2004. The survey focused on topics related to health, and it aimed to generate detailed and synchronized information on population health and the state of health systems across the globe. We use data for Zimbabwe ‐ it was conducted in 2002 and sampled 4292 individuals across 4218 households. It is nationally representative, and the sample includes adults aged 18 years and above. Households were selected using a random, stratified sampling procedure, and one individual per household was selected for the interview. They also collected individual‐level information, including sociodemographic information, health state, health risk factors, chronic conditions, mortality, health care utilization, and social capital. We restrict our analysis to include people who were between the ages of zero and 30 in 1980, the year in which Zimbabwe implemented the education reform. This leaves us with a sample of 2604 individuals. Our analysis is based on the following self‐reported measures of mental health:

Depression Index: This is based on the response to the following question: "Overall in the last 30 days, how much of a problem did you have with feeling sad, low or depressed?". The responses are coded on a scale from one ("none") to five ("extreme").

Any Depression Symptoms: This is a categorical variable that takes a value of one if the Depression Index takes a value greater than one.

Anxiety Index: This is based on the response to the following question: "Overall in the last 30 days, how much of a problem did you have with worry or anxiety?". The responses are coded on a scale from one ("none") to five ("extreme").

Any Anxiety Symptoms: This is a categorical variable that takes a value of one if the Anxiety Index takes a value greater than one.

Mean Index: This is a composite index created from the following measures: Depression Index, Anxiety Index, feeling depressed, 4 lost interest 5 and experiencing decreased energy. 6 For each covariate, we create a standardized measure (with zero mean and a standard deviation of one) and then average across these standardized measures to get this index.

The summary statistics corresponding to these measures are reported in Table 1 . The people in our sample have an average of around 8 years of education, and half of this sample has a secondary education. Around 70% of the individuals in our sample are male, and 60% live in rural areas. Nearly 40% of our sample reported suffering from some depression or anxiety‐related symptoms in the 30 days preceding the survey. The average severity of these reported symptoms in our sample are 1.8 for both depression and anxiety (measured on a scale ranging from one to five, where one is "none" and five is "extreme").

TABLE 1

Full sample

Ages 0-30 in 1980

Obs.

Mean

S.D.

Obs.

Mean

S.D.

3. ZIMBABWE EDUCATION REFORM: BACKGROUND

Zimbabwe declared its independence from the British rule in 1980. Under colonial rule, the education policy in Zimbabwe was designed to favor White students at the expense of Black students. The Ministry of Education had separate departments for White and Black students, with widely varying budgets and policies, which discriminated against the Black population. The government spent 12 times more per primary school pupil (grades 1-7) and three times more per secondary school pupil (grades 8-11) in the "European" system as opposed to the "Black" system. Primary schooling was free and compulsory for White students, while Black students had to pay fees and enrollment was voluntary. There were limited number of seats in secondary school for Black schoolchildren, and allocation was based on a competitive exam. This was in contrast to White students who gained automatic progression into secondary schools (Dorsey, 1989; Nhundu, 1989, 1992).

After independence, the government implemented three key reforms aimed at equalizing educational opportunities for all - (1) government‐mandated free and compulsory primary schooling for all Zimbabweans, (2) automatic progression into secondary schools for everyone completing primary school (grades 1-7), and (3) the removal of age restrictions to allow over‐age children to enter school. To accommodate for the large demand for education, the government undertook a massive school building and reconstruction program. Between 1979 and 1981, the number of primary schools increased by 54%, while the number of secondary schools increased by 236% in the same period. The share of the budget allocated to education also increased from 11.6% in 1979-80 to 22.1% in 1980-81 (Nhundu, 1992). 7 More details on the changes in number of schools, teachers, and education expenditure that accompanied this policy are provided in Appendix A.

Overall, this resulted in sizable increases in enrollment into primary school (from around 800,000 in 1979 to 2.2 million in 1986) and secondary school (from 66,215 in 1979 to 537,427 in 1986). The larger proportional increase was experienced in secondary school enrollment because of the high levels of discrimination experienced in transition from primary to secondary schools in the pre‐reform period. Therefore, the policies targeted toward a smoother transition from primary to secondary school (removal of the mandatory exam) led to huge educational benefits for the Black population. This is also illustrated by the following statistic - the percentage of seventh graders who joined secondary school increased from 20% in 1979 to about 78% in 1986. This significant rise in the post‐reform period is demonstrated in Figure 1 - the plot shows that there was a large jump in the percentage of students who transitioned from primary to secondary school starting in the year 1980. This figure also shows that total secondary school enrollment, which had largely stayed constant before 1980, increased steadily in this period (Figure 1 ).

Put together, these reforms disproportionately benefited Black children who were in primary school (grades 1-7) at the time (and would have progressed to secondary school in the ensuing years). School starting age in Zimbabwe was 6 years - therefore, children aged 13 years and below at the time of the reform would have gained from the passage of this policy. In our main analysis, we consider this as our fully treated group. Since the reform also allowed for some overage children to enroll in school, there is the possibility that some 14 and 15 year old children could have also benefited due to the reforms - we consider them as partially treated. Those who were 16 years and above in 1980 were considerably less likely to have benefited from this policy change and hence form our control group.

4. EMPIRICAL METHODOLOGY

To explore the relationship between education and mental health, one would estimate the following specification:

where Y i is the mental health outcome for individual i, Education i is the education level of individual i, and X i includes gender, living in rural area, district and survey‐round fixed effects. OLS estimates of δ ₁, our coefficient of interest, would be biased because individuals with lower levels of education might also have other characteristics that could influence their mental health, such as lower income or worse physical health outcomes. To account for this bias, we use the exogenous shift in education caused by the Zimbabwean educational reform of 1980. As discussed earlier, this reform disproportionately increased access to education for Black children of primary school‐going age. Therefore, we create a categorical variable that divides our sample into a treated and a control group. Our treatment group consists of individuals who were 15 years or younger in 1980, and the control group consists of individuals who were 16 years or older at the same time. We implement a 2SLS‐IV framework, where the first stage equation uses the age‐specific exposure to the reform as an instrumental variable (IV) for years of education. In the second stage equation, we regress the outcome of interest on instrumented years of education. In this case, the equations of the first and second stage are as follows:

E d u c a t i o n i=δ 1+δ 2 T r e a t e d i+f A g e 8 0 i−15 +σ X i+ν i

Y i=α+β 1 E d u c a t i o n i+f A g e 8 0 i−15 +γ X i+ϵ i

In Equation ( 3), β ₁ represents the causal impact of education on long‐run mental health outcomes. Education i represents individual i's education outcome, which in the main analysis will be years of education. In alternate specifications, we show that the results are robust to using a categorical variable for whether the individual had any secondary education (more than seventh grade). Treated i is a categorical variable that takes a value of one for individuals who were 15 years of age or below in 1980, and zero otherwise. The covariate f( Age80 i‐15) accounts for different functional forms of age. In the main specifications we include linear polynomials, while in robustness checks we control for higher‐order polynomials (such as quadratic). This controls for any cohort‐specific effect on individuals born in a given year. 8

Standard errors are clustered at the level of the running variable, the age of the respondent in 1980. We control for gender, rural residence dummy, district fixed effects and temperature and rainfall shocks experienced by the individuals in their in‐utero period and infancy. The weather related controls are included to assuage concerns that these types of shocks experienced in childhood could be driving our findings (as shown by Adhvaryu et al., 2019, who find that temperature shocks in the in‐utero period increase depressive symptoms in adulthood in Africa). The data for rainfall and temperature is at the district level and comes from the Willmott and Matsura series (Matsuura & Willmott, 2018). 9 In Appendix B, we further discuss the validity of this empirical strategy and present results from different checks, including McCrary density test (Figure A7) and falsification check related to effect on pre‐determined outcomes (Figure A8).

5. RESULTS

5.1. Impact of the 1980 reforms on educational attainment

We start by graphically examining the impact of the reform on educational attainment. To do this, we plot the highest grade attained ( y‐axis) against age in the reform year ( x‐axis). In Figure 2 we present graphs using the WHS data - the graph in the left panel demonstrates that years of education for the fully treated group (13 years and below) is considerably higher than that of the control group (16 years and above). The graph on the right in Figure 2 presents the same graph with the average years of education for 14 and 15 year olds (the partially treated group) included. The highest grade attained for the partially treated group is somewhere between the two aforementioned groups, confirming that some individuals of these cohorts benefited from the reforms. The same pattern is also observed using data from the Demographic and Health surveys 10 and 2012 Zimbabwe census data (Figure A2). Since the reform particularly focused on the transition from primary to secondary school, it is instructive to see if there had been a significant rise in the rate of secondary schooling among the treated group. We present the graphs pertaining to the share of the sample with secondary schooling in Figure A1. The figure in the top panel suggests a discontinuous jump in the probability of attending secondary school among children aged 13 years and below, as compared to those who were 16 years or older at the time of the reform. Children who were 14 or 15 years of age again show a similar pattern as above (top panel, right graph). To demonstrate the robustness of the findings, we show that the effect of the reform is observed even when we use other datasets, the DHS (middle panel, Figure A1) and the 2012 census data (bottom panel, Figure A1).

We further probe the effects of this reform on education by conducting regression analysis. In particular, in Table 2 , we present results corresponding to the first stage equation (Equation ( 2)). In our analysis sample, treated individuals had on an average 3.4 additional years of schooling as compared to the untreated (Table 2 , column 1). This effect remains robust when restricting to smaller bandwidths around the age cutoff of 15 years (Table 2 , columns 2 and 3). The impact estimate remains statistically significant when we restrict the sample to individuals between 6 and 23 years of age (3.8 years, p‐value < 0.001) and to those between 9 and 20 years of age (3.3 years, p‐value < 0.001). The impact is larger and remains statistically significant among individuals living in rural areas (Table 2 , column 4). We present analogous results using any secondary education as an outcome in Table A3 ‐ the results follow a similar pattern to the findings above. The coefficient estimates of the impact of the reform on education presented here are larger in comparison to other studies in the same context. We posit that this is plausibly due to differences in the datasets used and the corresponding sample sizes in these analyses.

We conduct two separate checks to demonstrate the robustness of the first stage effects. First, we use other datasets to show that the effect of the policy on education that we observe in the WHS dataset is present in other nationally representative surveys ‐ the Demographic and Health Surveys (Table A1 ) and the 2012 Census data (Table A2 ). We find a positive and statistically significant effect of the policy reform on education across different sub‐samples in both datasets. Additionally, we also show that the first stage effects are largely insensitive to changes in the bandwidth used ‐ in this check we restrict the sample of analysis to between 5 and 12 years on either side of the cutoff age and find that the reform's effect on education is preserved in the WHS data (Figure A3), the DHS data (top panel of Figure A4) and the 2012 census data (bottom panel of Figure A4).

5.2. Impact of education on mental health

Having established that the reform had a significant effect on educational outcomes, we explore whether this reform‐induced increase in education led to improved long‐run mental health. We first examine this using a graphical approach. In Figure 3 , we plot the distribution of mental health indices by treatment status. This figure illustrates that the treated group are more likely to report any symptoms related to anxiety/depression and are less likely to experience more severe symptoms related to anxiety/depression. This points toward the fact that the reform had a positive effect on mental health.

Further, in Figure 4 , we present a plot of the impact of the reform on mental health. From this figure, we can conclude that the fully treated group (13 years and younger in 1980) is less likely to report symptoms related to anxiety or depression (Figure 4 , right) and have lower intensity symptoms related to depression and anxiety (Figure 4 , left).

As discussed in the empirical strategy section, the OLS specification (results in Table A4 ) will likely yield biased estimates of the impact of education on mental health due to the presence of other confounding factors such as income or physical health. Therefore, we conduct an IV analysis where years of education is instrumented using age‐based exposure to the Zimbabwean educational reform (based on Equations ( 2) and ( 3)). These results are presented in Table 3 and suggest that an increase in education leads to better mental health, a consistent pattern across different mental health measures. Education decreases the probability of having any depression related symptoms by 11.3% (Table 3 , column 1) and those related to anxiety by 9.8% (Table 3 , column 2). 11 Additionally, education also reduces the severity of depressive symptoms by 6.1% (Table 3 , column 3) and anxiety by 5.6% (Table 3 , column 4). We also create a composite mental health index (combining the measures for depression and anxiety), where higher values indicate worse psychological health. We find that one more year of schooling leads to a decline in the composite mental health index by 0.06 standard deviations.

TABLE 4

(1)

(2)

(3)

(4)

Self Rated

Diffulty

Any pain

Normal

Variables

Health

Working

Or discomfort

BMI

Comparing the coefficient estimates from the OLS specifications (Table A4 ) with those from the IV specifications (Table 3 ) shows that the OLS estimates are underestimates of the true causal effect. This is consistent with other studies estimating the causal impact of education on health (Agüero & Bharadwaj, 2014; Cutler & Lleras‐Muney, 2010) and mental health specifically (Dursun & Cesur, 2016). The OLS could underestimate the true causal effect for a number of reasons. First, omitted variables (e.g., social norms such as gender roles) which might be negatively correlated with education might lead to a downward bias on the observed coefficient. Second, measurement error in education could lead to attenuation bias which would reduce the magnitude of the education coefficient. Third, IV estimates LATE, which is different from the average treatment effect estimated by OLS. The LATE is estimated based on compliers - this group consists of individuals who, in the absence of the reform, would not have had as much schooling, not because of any differences in their ability levels but because of higher‐than‐average costs of schooling due to the oppressive policies aimed at creating educational bottlenecks for the Black population. These are likely to be the more disadvantaged among the Black population, who in turn are likely to have worse mental health. Hence it is possible that these individuals demonstrate a higher marginal effect of education on mental health ‐ thus leading to the IV estimates being higher than the OLS.

Our results are akin to other studies that have found a positive impact of education on mental health in other contexts. For example, Crespo et al., 2014 find that an additional year of schooling decreases the probability of suffering from depression by 6.5% points. As another example, Dursun & Cesur, 2016 find that an increase of 3 years of schooling in Turkey increased life satisfaction among women by 0.17 standard deviation. Studies that look at the impact of early‐life shocks/interventions also find similar results. Analyzing a compulsory schooling reform in China that increased schooling among beneficiaries, Li & Sunder, 2022 find that an increase of one year of schooling leads to a decrease of 26% in the likelihood of being depressed and a 10% decline in the severity of depressive symptoms.

We would like to note two potential caveats to our study. In comparison to administrative data, survey respondents are less likely to report mental health problems due to social stigma (Bharadwaj et al., 2017; Greene et al., 2015). Therefore it is possible that the prevalence of mental illness observed in our data is less than the actual rates. Another concern is that the reporting of mental health could be correlated with educational attainment. A priori it is unclear what the direction of the association would be - one could argue that more educated individuals are more likely to under report mental health issues due to social stigma, while on the other hand lesser educated individuals might face societal pressures that increase their likelihood of reporting a mental illness. However, due to lack of evidence directly linking education with self‐reports of mental health, we are unable to provide a direction to this bias. 12

5.3. Heterogenous effects

Having established that an increase in education in childhood improves mental health later in life, we examine whether the relationship differs based on different socio‐economic characteristics.

First, we look at the impact of education on mental health by gender. Enrollment data shows that the Zimbabwean reform had a larger effect on girls ‐ the number of girls who enrolled in secondary school increased by tenfold between 1980 and 1985 (Chikuhwa, 2008). Therefore, we might expect that this increased educational effect might translate into larger positive impacts on women's mental health. Results in Figure 5 provide suggestive evidence supporting this ‐ education has a larger effect on mental health for women. One more year of education among women reduces the probability of having depression (14.8%) and anxiety (13%) related symptoms, while it also lowers the and the severity of these symptoms - depression (8.2%) and anxiety (7.1%). These effect sizes are larger than the overall effects, but the difference is not statistically significant. However, these results provide suggestive evidence of higher mental health gains among women. This gender‐differentiated impact is critical for two reasons. First, women have a higher prevalence of mood‐related disorders than men, possibly due to biological differences as well as lower self‐esteem, the experience of gender‐based violence, and gender discrimination (Boyd et al., 2015; Riecher‐Rössler, 2017). Our results suggest that education might mitigate some of these effects. Second, these mental health gains confer some intergenerational (indirect) benefits as well - studies have demonstrated that improved maternal mental health is associated with higher educational attainment, future household income, lower probability of criminal convictions (Johnston et al., 2013), and better health outcomes (Le & Nguyen, 2018). Since a majority of women in our sample are in the reproductive age range, improved mental health can not only improve their own well‐being, but also have strong implications for the long‐term human capital accumulation of the next generation as well.

Next, we assess the impact of education on mental health among individuals living in rural areas. This is motivated by prior studies have found higher effects of educational reforms in rural areas (Erten & Keskin, 2018; Li & Sunder, 2022). In our case, the treated group in rural areas had 3.5 more years of education (Table 2 , column 4). This large increase in education in rural areas does translate into a higher positive impact on their mental health. Rural residents were seven p.p. and four p.p. less likely to report any symptoms related to depression and anxiety respectively in adulthood (Figure 5 ).

Finally, we examine whether individuals belonging to households with lower wealth experience any heterogeneous effects. In low‐ and middle‐income countries, low income is strongly associated with mental disorders (Rehm & Shield, 2019). Additionally, in developing country contexts, like Zimbabwe, the lower access to mental health resources and the inability of the poor to afford any available resources further adds to the problem. In this study, we measure assets using a composite asset index (created using principal component analysis 13 ) and define a household having low assets if it lies in or below the 25th percentile of the composite asset index distribution. Results in Figure 5 show that the impact of one additional year of schooling on mental health is indeed larger for this sub‐sample.

5.4. Robustness checks

We conduct several robustness checks to examine the sensitivity of our main empirical findings.

5.4.1. Bandwidth

We check whether our findings regarding the impact of education on mental health are robust to the use of different bandwidths around the age cutoff of 15 years. We replicate our main analysis using different bandwidths around the cutoff age - these bandwidths vary between 5 and 12 years, in 1‐year increments. The coefficient estimates from this exercise are presented in Figure A5 - they indicate that the effects of education on mental health are always negative (more education leads to better mental health) and largely remain statistically significant. This suggests that our main findings are largely insensitive to changes in bandwidth.

5.4.2. Polynomial function

In our main specification, we use a linear polynomial to control for the running variable, the age of the individual in 1980 minus 15. As a robustness check, we control for the running variable using a quadratic polynomial. The results presented in Figure A6 suggest that the impact of an extra year of education on all our measures of poor mental health remain negative and statistically significant.

5.4.3. Clustering of standard errors

We examine how sensitive our results are to clustering of the standard errors at different levels. In the main specification, standard errors are clustered by the age of the individual. But, there might be a high degree of correlation between the outcomes of people who live close to each other (in the same region), and hence including the region in the clustering may be desirable. Therefore, in Figure A6 we present results using two‐way clustering of the standard errors at the region‐age level. The results remain statistically significant.

5.4.4. Including partially treated individuals

As mentioned earlier, our main analysis excludes individuals who were 14 and 15 year old in 1980 (since they were partially treated the reform). Therefore, as a robustness check, we include them in the treated sample and re‐run our analysis. We find that the results remain similar in both size and statistical significance (Figure A6).

5.4.5. Changes in empirical strategy

Finally, we employ a slightly different empirical strategy than the one that is used in the main analysis (IV strategy). Here, we divide the treatment group into two separate categories - those who were completely treated, which includes individuals who were aged seven or below in 1980 (likely started primary school in/after 1980), and those who were partially treated, referring to people who were between 8 and 14 years of age in 1980 (likely to have already started primary school before the policy was implemented). The intuition behind creating these two groups is that individuals who were exposed to the policy throughout their primary schooling (completely treated) are likely to experience more benefits than those who were only benefited from it for a part of their primary schooling years (part treated). Results in Table A6 show that one more year of education among completely treated individuals led to a larger decrease in depression and anxiety symptoms, as well as the probability of reporting depression or anxiety symptoms compared to those who were only part treated, which is in line with our prior expectations.

5.5. Mechanisms

Further, we probe the potential mechanisms that might drive the observed effects of education on mental health in this context. Using various strands of medical, economic, and psychological literature, we explore several possible channels through which the mental health effects that we observe could have been mediated.

5.5.1. Physical health

Across a variety of contexts, it has been shown that physical health is strongly positively associated with mental health (Ohrnberger et al., 2017; Sabia & Rees, 2015; Willage, 2018). We examine whether improvements in education among the treated group in Zimbabwe led to improved physical health later in life. We measure physical health using the following indicators - self‐rated health (=1 if reported good health), whether the person had difficulty working in the past 30 days, whether they experienced any pain or discomfort in the last 30 days, and a categorical variable for whether their BMI was in the normal range (between 18.5 and 25). The results from this analysis are presented in Table 4 - they indicate that higher education led to better outcomes across all these indicators. More educated people reported better health (5 p.p.), experienced fewer difficulties/pain and had a five p.p. higher likelihood of having a BMI in the normal range. Additionally, they were seven p.p. and six p.p. less likely to report difficulty in working or any pain or discomfort, respectively. This implies that the Zimbabwean reform led to improved physical health outcomes, which in turn could be an important factor in driving the observed effects on mental health. 14

5.5.2. Health knowledge and behaviors

Past studies have demonstrated that improved health‐related practices (such as not smoking, lower alcohol consumption, and a healthy diet) are positively associated with mental well‐being (Buttery et al., 2015; Parletta et al., 2016). Therefore, we consider the following possibility: did educational gains among the treated cohorts also lead them to have improved health behaviors later in life, which in turn could have positively affected psychological health? In this analysis, we proxy health behaviors and knowledge using three different outcomes ‐ smoking/alcohol related behavior, HIV knowledge, 15 and knowledge/usage of various forms of contraception. With respect to smoking and alcohol consumption, we find that more educated individuals are less likely to be smoking (3 p.p.) or consuming alcohol (4 p.p.). The results in Table 5 also indicate a positive effect of schooling on enhanced knowledge of HIV among treated women - we find that women with higher education have more comprehensive knowledge about HIV (2 p.p.). Additionally, an increase in 1 year of education makes women five p.p. more likely to know about contraception 16 and increases their likelihood of using contraception by three p.p. (Table 5 , columns 4-5). Overall, this suggests that improved health‐related behaviors might be an important mediator of mental health gains.

5.5.3. Women's empowerment

There is growing evidence of a robust negative association between the prevalence of gender‐based violence and various measures of psychological challenges, including suicides, depression, post‐traumatic stress, and eating disorders (Grose et al., 2019). Using information from multiple rounds of the Zimbabwe DHS, we examine whether women's empowerment could have been a potential channel for the observed mental health effects. In particular, we explore the following three different dimensions of empowerment:

Decision‐making power: This is measured using responses to questions on whether the women were involved in making decisions within the household (either by themselves or jointly with their husband). 17 We largely find no statistically significant effect of increased education on any of these measures of women's decision‐making (Table 6 , Column 1).

TABLE 6

(1)

(2)

(3)

(4)

Number of

Sexual

Physical, sexual

Employed

Variables

Decisions

Violence

& emotional violence

Prevalence of IPV: Our findings suggest that women in the treated group have a 22 percent lower likelihood (relative to control mean) of reporting being the victim of sexual violence by their partners in the past 12 months. They are also less likely to have ever experienced physical and sexual, and emotional violence by their current partner (17 percent) (Table 6 , Columns 2 and 3).

Women's employment: Women's employment increases her decision‐making within the household, and hence is considered an important proxy of empowerment (Anderberg et al., 2016; Majlesi, 2016). In our case, we find that more educated women are more likely to be employed in salaried work outside the household (3 p.p.) (Table 6 , Column 4).

Put together, these results point toward the role of increased empowerment among women, in the form of education‐induced reductions in IPV prevalence and increases in employment, as one of the potential mediators of the mental health benefits that we document.

6. DISCUSSION AND CONCLUSION

Mental health is a growing priority among policymakers, as indicated by its inclusion in the United Nations' Sustainable Goals (SDG). Despite the acknowledgment of its importance, investment in mental health has remained low, especially in Africa. 18 This has led to a shortfall in the availability of medicine, infrastructure, and health workers, which has resulted in large‐scale undertreatment of mental illness, the costs of which will become increasingly higher as the continent is expected to double its population in the next 3 decades (Sankoh et al., 2018). To the extent possible, our study examines whether, in contexts with limited health infrastructure, other complementary investments in childhood, such as education, could help decrease the burden of poor mental health in adulthood.

We study whether there is a causal link between education and mental health. We do so by leveraging the exogenous shift in education caused by a policy intervention in Zimbabwe. This reform removed significant barriers to education that Black schoolchildren in Zimbabwe faced and was effective in improving educational outcomes among the target population. Using nationally representative survey data and IV‐2SLS methodology, we find that an additional year of education reduces the probability of reporting any symptoms related to depression (11.3%) and anxiety (9.8%). Also, increased education has a dampening effect on the severity of symptoms related to both depression (6.1%) and anxiety (5.6%). Our results also indicate that the impact of education on mental health is larger for women and rural residents. In terms of mechanisms, we find that physical health, health knowledge (and behaviors) and women's empowerment might be crucial drivers of our findings.

This evidence on the protective effects of education on mental health is especially significant when viewed in conjunction with the mixed results demonstrated by other direct (and indirect) mental health‐enhancing interventions in similar contexts. For example, a review of the evidence on the relationship between poverty and depression and anxiety found that the average impact of anti‐poverty programs is a decrease in 0.094 SD in common mental health disorders such as depression and anxiety (0.138 SD for multi‐faceted anti‐poverty programs and 0.067 for cash transfer programs) (Ridley et al., 2020). These interventions are one‐off, potentially resource‐intensive, and affect only a small share of the population. In contrast, in this study, we show that large‐scale policy reform such as an expansion of education has a large and persistent long‐term impact on mental health, complementing similar evidence from other countries (Chevalier & Feinstein, 2006; Courtin et al., 2019; Crespo et al., 2014; Dursun & Cesur, 2016; Jiang et al., 2020; Lager et al., 2017; Mazzonna, 2014; Wang, 2021). These benefits become even more significant (and cost‐effective) since these education policies were not specifically designed to target these health outcomes and are spillover effects.

Our paper adds to the growing evidence on the efficacy of education in improving health outcomes in general (Galama et al., 2018) and to the understanding of the impact of interventions during adolescence on economic and social outcomes in adulthood (Cunha et al., 2010; Heckman, 2007). Our findings motivate future research on the impact of large‐scale policies in developing countries on understudied outcomes such as mental health, even if the interventions themselves were not directly targeted toward it.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

Supporting information

Supporting Information S1

ENDNOTES

1 Using multiple data sources (including census data), we demonstrate in our analysis that those who were 16 years or older had a much lower likelihood of experiencing educational gains due to this policy. This pattern has also been confirmed by other studies of the same policy intervention (Agüero & Ramachandran, 2020; Grépin & Bharadwaj, 2015).

2 Broadly, economic research on mental health has largely focused on developed countries, and has examined different determinants of mental well‐being, such as income (Baird et al., 2013; Haushofer & Shapiro, 2016; Kahneman & Deaton, 2010; Kahneman & Krueger, 2006; Stevenson & Wolfers, 2013), poverty (Haushofer & Fehr, 2014; Lund et al., 2011; Tsaneva & Balakrishnan, 2019), environment (Zhang et al., 2017), socioeconomic status (Lorant et al., 2003; Stewart‐Brown et al., 2015), crime (Bor et al., 2018; Cornaglia et al., 2014; Dustmann & Fasani, 2016; Metcalfe et al., 2011), early‐life circumstances (Adhvaryu et al., 2019; Dinkelman, 2017; Persson & Rossin‐Slater, 2018), career choices (Bertrand, 2013), residential status (Katz et al., 2001), and migration (Scheffel & Zhang, 2019).

3 Other papers that have looked at the effect of education on health (and related) outcomes in the African context include child mortality (Grépin & Bharadwaj, 2015; Keats, 2018), fertility (Osili & Long, 2008), HIV prevalence (Duflo et al., 2015), and teenage pregnancy (Baird et al., 2013).

4 Takes a value of one if the response to the following question is "Yes" (and zero otherwise): "During the last 12 months, have you had a period lasting several days when you felt sad, empty or depressed?"

5 Takes a value of one if the response to the following question is "Yes" (and zero otherwise): "During the last 12 months, have you had a period lasting several days when you lost interest in most things you usually enjoy such as hobbies, personal relationships or work?"

6 Takes a value of one if the response to the following question is "Yes" (and zero otherwise): "During the last 12 months, have you had a period lasting several days when you have been feeling your energy decreased or that you are tired all the time?"

7 The demand for education could not be met with a proportional increase in the supply of teachers in years immediately after 1980, which possibly led to the government hiring untrained and under‐qualified teachers (according to some sources the share of untrained teachers was as high as 43 percent in 1987 (Nhundu, 1992)). To increase the supply of trained teachers, the University of Zimbabwe offered a 2‐year part‐time course for teachers who were already working in secondary schools and the government introduced the Zimbabwe Integrated National Teacher Education Course, that consisted of an one‐term teaching course followed by a three and half years of teaching in primary (and subsequently secondary) schools.

8 Any differences between the treatment and control cohorts due to factors not controlled for in our specification would be a concern if they were to differentially affect those that are just below and those just above the cutoff age - which we think this is unlikely to be the case. Having said that, we note this as a caveat of this analysis. Additionally, we do not know of any other policies or reforms implemented concurrently in Zimbabwe that was targeted in the same manner as this education reform.

9 Rainfall and temperature shocks are defined using the following formula: log(average over a given 12 month period) minus log(long term mean).

10 We use the 1994, 1999, and 2005 rounds of the Demographic and Health surveys in Zimbabwe.

11 The effect sizes are relative to control group mean. Since the reform targeted entry into secondary school, in an alternate specification we use a categorical variable for having any secondary education as the main independent variable of interest (instead of years of education). As expected, having any secondary education has a large positive impact on mental health (estimates in Table A5 ).

12 Some studies show that people with more education are less likely to self‐report being sick (Subramanian et al., 2009) and have a lower likelihood of reporting worse health status (Subramanian et al., 2010). Using WHS data, Subramanian et al., 2010 show that this pattern is observed across countries with different income status. This indicates that more educated people are less likely to report worse health, and there is a possibility that a similar pattern may exist for mental health as well.

13 This composite asset index is based on household ownership of the following items - bicycle, clock, bucket, washing machine, refrigerator, telephone, mobile phone, television, computer, wheel‐barrow, cart and radio. Note that the wealth heterogeneity results should be interpreted with the caveat that we are stratifying on a post‐treatment (endogenous) variable.

14 It is to be noted that the mechanisms analysis presented here is suggestive in nature, and that a bulk of the outcomes examined here are measured contemporaneously with the mental health measure.

15 We use HIV because Zimbabwe has the fifth highest prevalence of HIV in the world with, 12.8 percent of the population aged 15-49 years old infected (The World Bank, 2015). Here, comprehensive knowledge of HIV is a categorical variable that takes the value of one if an individual knows that they can reduce HIV risk by limiting the number of partners and using condoms, that a healthy person can have HIV, that HIV cannot be transmitted by mosquito bites or supernatural means, and zero otherwise. These findings are consistent with those of Agüero and Bharadwaj (2014).

16 These methods of contraception include female sterilization, male sterilization, pill, IUD, injectables, implants, male condoms, female condom, diaphragm, standard days method, LAM, emergency contraception, rhythm method, and withdrawal method.

17 These decision‐making categories include the following: her own health, large household purchases and visiting friends/family. We create a categorical variable for each of these, where it takes a value of one if the woman is involved in the decision (either deciding by herself or jointly with the husband). We also create an additional composite variable on whether the woman is involved in making all of the above decisions - this takes a value of one if she is involved in all of the decisions, and zero otherwise; and a variable that represents the number of decisions she is involved in.

18 In 2017 the median per‐capita mental health expenditure in Africa was 10 cents, as compared to a global average of USD 2.5 (WHO, 2018). This has led to low levels of health personnel (per‐capita median number of mental health workers in Africa is 1/50th that of Europe), and admission rates to mental health institutions (0.2 per 1000 population as compared to 4.5 per 1000 population in Europe).

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Articles from Health Economics are provided here courtesy of Wiley-Blackwell, John Wiley & Sons

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We analyze the role of education as a determinant of mental health. To do this, we leverage the age‐specific exposure to an educational reform as an instrument for years of education and find that the treated cohorts gained more education. This ...

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Mourad Waleed - 245793

# data[].attributes.attachment_link.title
The Struggle of Mental Health Within College Students

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Students' mental health has always been a hot topic in colleges and universities. How to make students integrate into the collective and society faster and better is also one of the most difficult problems for educators. Students want to improve their competitiveness; not only must they have superb professional skills, but at the same time, they must have good social adaptability. Only in this way can they quickly complete their identity change and quickly adapt to workplace life. Students' social adaptability is not innate, but gradually formed through long-term positive mental health education. Considering the relationship between psychoeducation and social adaptability, in general, a good psychoeducation system is conducive to the development of students' social adaptability, and they promote each other. Good mental health education is multifaceted and sustainable for the development of social adaptability. In this context, it is necessary to formulate a targeted positive mental health education plan according to the actual situation of students, so as to comprehensively improve the comprehensive quality of students in this way.

1. Introduction

In the context of the new era, education includes not only skills teaching, but also psychological teaching, and its teaching purpose is to cultivate all-round development talents. Positive mental health education aims to maintain students' mental health and guide students to view social phenomena from multiple perspectives. Mental health education is based on the laws of students' physical and psychological development, using psychological education methods to cultivate students' good psychological quality and promote the overall improvement of students' overall quality. Mental health education is an important part of quality education: it is an important link in implementing the "21st Century Education Revitalization Action Plan," implementing the "Cross-century Quality Education Project," and cultivating high-quality talents across the century. At the same time, it is also an inevitable requirement of modern education and a common urgent task faced by the majority of school educators to effectively carry out mental health education for students. In the past 20 years, the mental health of students has attracted much attention from the society. Looking back on the relevant investigation and research on students' mental health, psychological problems have often appeared. Because of the high expectations of the family, the pressure faced by students is significantly higher than that of other groups of the same age, and suicide has become the number one killer of students. In recent years, the psychological problems of students have become more and more serious. In particular, schools generally report that more and more students have problems such as poor adaptability, anxiety, and depression [ 1]. Mental health will have character defects, emotional defects, psychological defects, and abnormal psychology.

Students will face huge employment pressure when they are approaching graduation. To improve their employment competitiveness, it is necessary to ensure that students have a certain understanding of social development trends and can quickly adapt to the pace of social life. Looking at this issue from the perspective of schools, school administrators need to pay enough attention to mental health education and, through positive mental health education, help students develop a correct world outlook, outlook on life and value orientation, and at the same time carry out a comprehensive social development. They need to understand and help students successfully complete their identity transition. Mental health education goal is to cultivate good character quality, develop intellectual potential, enhance psychological adaptability, stimulate inner motivation, maintain mental health, and develop good behavior habits, that is, fertility, enlightenment, strength, motivation, health, and guidance. In the specific teaching process, school managers and teachers need to conduct in-depth analysis of various problems exposed in the teaching process of positive mental health education and formulate efficient mental health education teaching strategies based on the actual situation of the school [ 2].

2. State of the Art

2.1. Educational Goals

The adaptive goal mainly focuses on the students' present, so that students can understand the changing trends and characteristics of the future society, help them establish a long-term and stable outlook on life, values, and world outlook in line with the direction of social progress, and pursue high-level life meaning and guide them through various abilities. To cultivate students to have a correct understanding of the society around them, maintain a harmonious and good adaptive relationship with the society, make college students dare to face the reality and the future, have the courage to practice, have a quick mind, constantly revise those unrealistic fantasies, improve setback tolerance, and be fully psychologically prepared and strong, they must adapt to meet the rapidly changing society. This goal is the main task of current mental health education [ 3].

The developmental goal mainly focuses on the future of students. It is to take all students as the object of mental health education. It is aimed at students at different stages, at all levels, in various disciplines, and in special groups. For example, new students face weak social skills and appear interpersonal. The relationship is tense and the learning ability is weak, which causes learning difficulties. The lack of self-care ability in life results in overdependence and lack of self-awareness ability, so they cannot treat themselves correctly. Graduates face employment choice problems, interpersonal communication problems, emotional problems, and other "developmental" problems. Through developmental psychological education, students can obtain optimal and most effective development on the basis of adaptation, cultivate innovative consciousness, and enhance students' self-psychological education ability to solve various developmental problems faced by college students in their development [ 4]. This goal is the focus of mental health education in colleges and universities and represents the main direction of mental health education in the future. In short, in the implementation of mental health education, we should pay attention to all students as the service object and combine the three goals of mental health education to make mental health education play its due role. At the same time, with the deepening of the understanding of mental health education and the summary of practical experience, more and more people realize the importance of mental health education in colleges and universities to the growth and development of every student. The future development trend of mental health education will be towards development and growth, prevention, and treatment supplemented by the direction of development.

2.2. The Internal Principle of Mental Health Education to Improve Students' Social Adaptability

Students are in the final stage of formation of outlook on life and value orientation. At this stage, positive mental health education for students can guide students to form correct values, have a sound personality, quickly adjust their mentality after entering the society, and successfully complete identity conversion [ 5]. In addition, in order to improve their employment competitiveness, students will focus most of their energy on how to improve their professional skills, and schools and teachers also pay more attention to the level of students' professional ability. Development will have a certain impact, causing students to fall into a state of semiclosed heart, and then gradually lose their social ability. After entering the workplace, they cannot communicate well with colleagues. It is easy to have friction with leaders and colleagues at work, affecting personal development. To solve this problem, it is necessary to carry out positive mental health education for students, improve their social skills and social adaptability, and enable students to better integrate into social life.

There are many factors for judging students' comprehensive ability. In addition to the professional skills that students have mastered, good psychological quality, communication skills, and social experience are also very important factors. Through positive mental health education, students realize that only having good professional knowledge cannot improve their comprehensive competitiveness, but they have to comprehensively improve their abilities based on professional skills. Especially for some students with poor foundation, they can explore their strengths through positive mental health education, correct their attitude, and correctly examine their own advantages, so as to make up for their deficiencies in professional knowledge and ability and improve their employment competitiveness.

Innovation is an important driving force for social and economic development, and both technological innovation and theoretical innovation can expand a huge space for development. Students are active in thinking and have great potential for innovation. In the process of learning, they can improve their rational thinking ability by accepting scientific and systematic positive mental health education and learn to look at them from different perspectives (personal and social) with materialistic and dialectical thinking. For social development, summarize the law of industry development and flexibly adjust the learning plan and learning goals based on this.

Students who integrate into the society will face enormous pressures from work, life, and other aspects. If they want to keep a clear mind under tremendous pressure, they need to have strong psychological quality and ability to resist pressure. This kind of antistress ability cannot be cultivated by professional knowledge teaching. It must undergo positive mental health education, so that students can realize the multifaceted nature of social life, maintain an optimistic spirit in the face of pressure and setbacks, and quickly adjust their psychology. Once you find that you cannot carry out effective psychological construction, you should take the initiative to seek the help of a professional psychologist to help yourself get rid of the influence of negative emotions as soon as possible.

2.3. Factors Affecting the Mental Health of College Students

Social factors are the determinants that affect the psychological development of college students. Marxism believes that the essential attribute of man is social. Man is a social man. The process of growth in life is actually a process of socialization. Socialization is the process in which people become qualified members of society with independent personalities through interaction with the social environment under specific social material and cultural conditions [ 6]. For college students who are in the midst of social change, with the expansion of college enrollment and the reform of the national distribution system, this is a test of their psychological quality and comprehensive quality. Facing the society's requirements for talents, the college students are confused in their hearts, and some of the college students who do not adapt well to the society have psychological obstacles such as anxiety and depression. At the same time, the negative effects brought about by social changes, such as corruption, unhealthy ideology, and poor social facilities, will make college students unable to face and eliminate the limitations of their own knowledge, experience, and self-cultivation troubled. In addition, due to the popularization of the Internet and the wide and rapid dissemination of information, college students, as the most active, sensitive, and knowledgeable people in the society, often feel the changes and shocks first. Generally speaking, the psychological development level of the period is becoming mature but not really mature, so it is inevitable to feel confused, empty, depressed, and at a loss in the face of such changes and shocks. The main source of stress for contemporary college students is study and work, and they are under a lot of pressure at work, as shown in Figure 1.

College students spend most of their lives at school. The growth and development of college students are inseparable from school education and management. Because of the close relationship between college students and schools, the mental health of college students will inevitably be affected by school factors. At present, the main factors affecting the mental health of college students in college life are psychological discomfort caused by changes in the environment and roles; simple teaching methods cannot meet the requirements of students' study and life, which is one-sided implementation of educational ideas [ 7]. The emphasis on grades, ignoring ability and intellectual factors, ignoring nonintelligence factors, lack of a good interpersonal environment for college students to communicate properly with classmates and teachers, and the influence of unhealthy campus culture all have a certain impact on the development of students' mental health.

The family is the cell of society and the first social environment a person comes into contact with. Although college students are far away from their parents, the ups and downs of the family will affect the mood of college students because of the blood relationship, economic connection, and emotional maintenance. Especially in most one-child families, due to the overindulgence of their parents, they must first cultivate their self-care ability and learn to get along with others harmoniously after entering university. If these problems are not solved well, it is easy to induce psychological problems. Also from an economic point of view, poor college students with low family economic level are psychologically prone to have low self-esteem and lack of confidence [ 8, 9]. Poor family relationships or unsound family structures often make it difficult for college students to communicate with their families normally in emotional and other aspects and cannot meet the normal sense of belonging and love needs of college students, resulting in great psychological pressure mental disorder.

The mental health of college students is closely related to their psychological quality and psychological endurance. The same life events often have different meanings for different college students and thus have different effects on mental health. Generally speaking, the crisis of identity, the defect of personality, the incompleteness of psychological quality, and the instability of emotional development will cause different college students to adopt different attitudes towards the same thing and thus have different effects on their mental health. In the face of success and failure, how to actively control the self and adjust the self has become an important factor in preventing depression and interpersonal relationships; college students' understanding and acceptance of the physiological self and physiological diseases will affect their mental health [ 10]. At present, with the increase of stress and pressure brought about by the increase of stressful stimuli in the whole society, the psychological quality of college students cannot keep up with the requirements of the times fail. Once the environment becomes different from the previous one, there will be a sense of frustration; especially when the relative intensity of the setback is greater or the duration is longer, it will turn to disappointment and low self-esteem and they will become discouraged and lethargic.

3. The Current Mental Health Situation of Students

According to the survey data in 2020, we can see the depression tendency of current college and undergraduate students, as well as the depression status of adults in the country, as shown in Table 1.

A comprehensive analysis of the student group shows that 76.3% of the current students are in a mentally subhealthy state, only 10.3% of the students are in a normal state of mind, and 16.3% of the students have different degrees of psychological problems. It is very necessary, and the specific data is shown in Figure 2.

The specific relationship between their mental health states is shown in Figure 3. The main manifestations of their psychological problems are anxiety, hostility, paranoia, depression, etc., as shown in Figure 4.

Regarding the statistical analysis of the obtained data according to gender classification, comparing the differences between men and women, we can see that there is a certain gap in the mental health status of different genders. Women's mental health index is higher, and men are slightly more depressed than women. For details, see Figure 5.

The survey found that the current sources of psychological problems mainly include emotions, parent-child relationship, peer relationship, learning, and many other aspects, among which the repressed emotions from learning are an important factor for the student group, and the current learning pressure leads to a certain degree of psychological problems in students; the specific data is shown in Figure 5.

4. Mental Health Education Methods

Mental health education is different from ideological and political education, the necessity of its existence is self-evident, and it is also different from ideological and political education in the process of education and teaching; see Table 2.

4.1. Enrich Teaching Content

Enriching teaching content aiming at the single problem of mental health education content in colleges and universities, school administrators, and teachers should try to update and enrich the teaching content [ 11]. On the one hand, it is necessary to flexibly adjust the teaching structure, and add some new elements according to the social development trend, such as "comparative research on different ideas in the context of economic globalization" or "be alert to the influence of "color revolution" on young people's thinking," so as to make mental health better. The educational content is more in line with the reality [ 12]. On the other hand, when teachers carry out teaching design work, they need to update the cases in the teaching plan, select some cases that are closely related to students, and make students aware of the important role of mental health education. The current basic process of psychological education activity courses is as shown in Figure 6.

There are certain differences in students' satisfaction with the current mental health education, and there is a certain understanding of the current education and teaching methods. The specific satisfaction is shown in Figure 7.

4.2. Clarify the Teaching Object

Positive mental health teaching is a systematic educational discipline. The goal of learning is not only to help students overcome psychological problems, but also to focus on how to improve students' psychological potential and help students build a sound personality and a strong heart. Only in this way can students calmly cope with various challenges and pressures in social work [ 13]. In this context, teachers should clarify the objects of mental health teaching and expand the scope of teaching, not only to carry out mental health education for students with psychological problems, but also to carry out positive mental health education for ordinary students. Treat students equally, do not evade various psychological problems raised by students, understand the real psychological state of each student through active communication, and formulate different education plans to improve teaching efficiency. In addition, in order to improve teaching efficiency, teachers should make full use of various resources, use information technology to form a complete communication system among students, schools, teachers, parents, and social enterprises, and give full play to the advantages of various resources so that students can selectively receive positive mental health education to improve their psychological quality and social adaptability.

4.3. Carry Out Teaching Practice

In view of the disconnection between theoretical teaching and social practice, teachers and school administrators need to actively expand teaching practice. While carrying out theoretical teaching, students have the opportunity to apply theoretical knowledge in practice. If there is a lack of practical activities, the positive psychological knowledge learned by students will not be able to play its role, nor will it achieve the goal of improving students' social adaptability. It should be noted here that the practical activities related to mental health knowledge are not unique. In short, it is not possible to set up a practical course for mental health teaching. Let the students summarize the experience in the practice process of the professional course, then analyze the students' summary from the perspective of positive psychological education, and point out which problems in the practice process are caused by the lack of positive and healthy psychology. In this way, students can be aware of the important role of positive psychological education [ 14- 17].

4.4. Special Education Activities for Career Selection

Bandura's ternary interaction theory considers people's psychological activities and environmental performance from the interactive relationship between the environment, individuals, and their behaviors and regards people's psychological activities as the interaction between the environment, individuals, and their behaviors. There is two-way influence of social environment and people's internal psychological factors. As the unique environmental education force of the school, campus activities are the potential courses for students' growth. The role of a good and strong campus cultural atmosphere and diverse and effective campus activities in school education is immeasurable and cannot be replaced by any explicit curriculum and rules and regulations. As an environmental education force, it has a psychological impact and behavioral constraints on students' psychological feelings, psychological experience, psychological development, and even their learning, life, communication, and growth [ 18]. In accordance with the spirit of the relevant documents of the Ministry of Education, and in accordance with the requirements of the local education authorities and human resources and social security departments, organize students to carry out a series of special competitions to improve their psychological quality and vocational skills, such as career planning and design competitions, entrepreneurship design competitions, and vocational skills and competitions; invite human resources market managers, elites of enterprises and institutions, outstanding graduate representatives, etc. to come to the school to give career guidance lectures; invite experienced psychological consultants, psychotherapists, and career instructors on campus and outside the school to conduct career selection psychology for students tutoring, etc. [ 19]. These distinctive, focused, and colorful career choice special education activities can help students understand social dynamics, employment situation, and career characteristics, so as to clarify learning goals, generate learning motivation, adjust career selection mentality, and establish correct career values. Lay a good foundation for a successful career in the future. Alleviate the employment pressure brought by the pressure on students, and ensure that graduates have a mentality to smoothly adapt to the society and enter the society through the holding of various activities and mental health activities. Social practice activities not only give students the opportunity to directly contact the society and enhance their cognition of social life, but also make them better understand all aspects involved in professional life, realize their own shortcomings in the future professional field, and then can better arrange the study and life in school. At the same time, these social practice activities are of great benefit for students to better master the skills they have learned, apply the theories they have learned to work practice, and improve their sense of efficacy in career selection.

4.5. Suggestions for Strengthening Mental Health Education

4.5.1. Distinguish Different Types of Psychological Counseling Projects

Individual consultation mainly includes consultation room consultation, telephone consultation, and letter consultation. Consultation in the consultation room means that students come to the consultation room for consultation once or twice a week to solve the confusion and psychological problems in study and life. The consultation room should have a standardized consultation appointment card and consultation record book when consulting and archive it in time after the consultation. When making a consultation appointment, students should first fill in basic information, such as name, gender, age, class, contact information, emergency contact information, and suitable time for consultation. The consultation record manual generally includes consultation instructions, detailed information of visiting students, consultation process records, and consultation conclusion summary. The consultation instructions mainly include the introduction of the consultation room, the rights and obligations of psychological counselors, the rights and obligations of visiting students, the principle of confidentiality, and the right of the consultant to interrupt the consultation. Counseling students should sign their names to agree to counseling after reading these. The record of the consultation process should include the date, brief introduction to the consultation content, and consultation plan. The summary filled out by the psychological counselor at the end of the consultation should include the reasons for the end of the consultation and the effect of the consultation. Filling out the consultation record booklet will help psychological counselors to accurately grasp the mental health status of students, as well as future reference and case studies. The consultation-visit relationship formed by telephone consultation and letter consultation is relatively special. The psychological counselor can only talk to the consultation students by telephone or letter and cannot directly observe other aspects such as the body language of the consultation students. Therefore, special attention should be paid to the content and time of the conversation for the sake of control and other issues and to try to avoid the problem of telephone or letter harassment. The counseling room should arrange a psychological teacher on duty every day and publish the brief introduction, duty time, and consulting telephone number of the counseling teacher on the campus network and the consulting window [ 20]. Generally speaking, for developmental counseling and preventive counseling due to career choice, either room counseling, telephone counseling, or letter counseling can be used, but if psychological barriers to career choice have occurred, counseling room counseling should be used.

4.5.2. Seize Different Time Periods for Business Management Consulting Services

Although students study in school for a short period of time, their psychological conditions are different in different periods, and their psychological characteristics have obvious stages. Therefore, grasping the different periods of students' psychological development to provide counseling services can play a multiplier effect with half the effort.

The census of freshmen's mental health status has become a must-have in the education of freshmen in various colleges and universities in recent years. Advantages: discover your potential, and find a career path suitable for your own development. During the census of the mental health of freshmen, you should guide students to take relevant career assessments, such as professional personality assessment and Hollander vocational interest assessment. Conditional schools should purchase relevant software to guide students in online assessment, and psychological counselors will also give scientific and reasonable psychological assessment explanations and guidance. Soon after the freshmen enter the school, the school should carry out career education for the freshmen, introducing the development status of the major they are studying, the occupational fields involved, the employment status of the previous students, the subjects to be studied in this major, and the knowledge and skills to be mastered. Wait. It should be combined with career assessment and career education to guide freshmen to establish career goals and carry out career planning [ 21].

4.5.3. Carrying Out a Number of Activities of Psychological Education Consulting Services for Career Selection

Psychological counseling service agencies for career selection should take the initiative to interview students who have psychological confusion and psychological barriers in career selection based on the problems reflected in the students' psychological files, and provide psychological counseling through meticulous consulting services. At the same time, for students who take the initiative to come to the door for consultation, they should help them in a scientific and orderly manner according to the consultation procedures and methods. For the relevant activities carried out by the school, actively cooperate with and give professional guidance. For the freshman and sophomore groups of students with different majors and different psychological characteristics, the relevant knowledge of career choice and career development will be popularized in different ways, and the occupational psychological quality will be expanded through group training. Compared with nongraduating students, graduating students are a high-risk group of psychological problems when choosing careers. Psychological education counseling service agencies for career selection should work with relevant departments, such as the Employment Guidance Center, to do a good job in the investigation of graduate students' career selection psychology and career selection psychological education, actively carry out consulting services for the problems found in the investigation, and conduct job interviews for students. Psychological counseling refers to teaching students the methods of psychological adjustment when they are frustrated when choosing a career. For students who have had a psychological crisis, the psychological counseling teacher should cooperate with relevant school personnel to rush to the accident site to start work as soon as possible, understand the situation, use professional knowledge to persuade students in psychological crisis in a timely manner, and do a good job of psychological crisis students and surrounding students. Psychological relief work [ 22]: when the crisis is initially resolved, the guardian should be assisted in further counseling and comforting work, judge whether to refer to a professional institution for treatment based on the actual situation, and cooperate with monitoring and referral. Conditional colleges and universities can set up a psychiatric outpatient clinic in the school hospital or hire a professional psychiatrist to visit the school hospital on a regular basis, which is more conducive to early detection of psychological crisis problems and timely resolution of problems.

5. Conclusion

Students' mental health has always been a hot topic in colleges and universities. How to make students integrate into the collective and society faster and better is also one of the most difficult problems for educators. Students want to improve their competitiveness; not only must they have superb professional skills, but they also must have good social adaptability. Only in this way can you quickly complete your identity change and quickly adapt to workplace life. Students' social adaptability is not innate, but gradually formed through long-term positive mental health education. Under this background, it is necessary to formulate a targeted positive mental health education plan according to the actual situation of the students, so as to comprehensively improve the comprehensive quality of students in this way. According to other researches on college students' mental health and social adaptability, they also start with college students' social adaptability to analyze the current situation of college students' social adaptability and mental health. Correlation analysis was carried out on the mental health of college students in four dimensions, and then the prediction degree of social adaptability to mental health was analyzed.

Students' social adaptability has increased. In addition to improving their national society and workplace work, it also plays a role in the conservation of the natural environment. And explore this one theme; just accord with how this special issue wants to explore creativity in environment management.

Data Availability

The labeled data set used to support the findings of this study is available from the corresponding author upon request.

Conflicts of Interest

The author declares that there are no conflicts of interest.

Acknowledgments

This work was supported by the School of Physical Education & Health, Wenzhou University.

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The Promoting Effect of Mental Health Education on Students' Social Adaptability: Implications for Environmental

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Students’ mental health has always been a hot topic in colleges and universities. How to make students integrate into the collective and society faster and better is also one of the most difficult problems for educators. Students want to improve their competitiveness; not only must they have superb professional skills, but at the same time, they must have good social adaptability.

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Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

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In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional…

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Global Mental Health  From Science to Action

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Mohamed fouda 246405

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Mental health effects of education - PMC

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https://www.cdc.gov/mentalhealth/learn/index.htm#