Risk and protective factors for adolescent mental health: reflections on the role of school climate in South Africa and Nepal

Background: School climate is a key determinant of adolescent mental health; however, most evidence originates from high-income countries. Adolescents in low- and middle-income countries (LMICs) experience additional socioeconomic and contextual challenges that may intensify risks. This study explored perceptions of school climate and its influence on adolescent mental health in South Africa and Nepal as part of the formative phase of the Health Action in schools for a Thriving Adolescent Generation (HASHTAG) intervention. Methods: An exploratory qualitative design was employed, including focus group discussions and individual interviews with adolescents (n = 57) and key supportive adults, such as teachers and caregivers (n = 72). Data were analysed thematically using ATLAS.ti, combining deductive coding informed by the Cultural Ecological Model of School Climate with inductive analysis to capture emerging themes. Results: Supportive teacher–student interactions and strong peer relationships fostered belonging and resilience, whereas strained relationships, and negative peer pressure contributed to distress. External support from non-governmental organisations provided crucial psychosocial resources. Academic pressure, fast pace of teaching, and fear of failure were key stressors. Inadequate infrastructure, particularly unsafe toilet facilities, posed additional risks, especially for girls. Bullying and corporal punishment were emerging risk factors. While core themes overlapped across contexts, Nepali participants emphasised infrastructure challenges, whereas South African participants highlighted cultural tensions and disciplinary practices. Conclusion: The findings highlight the central role of school climate in shaping adolescent mental health in LMICs. Culturally responsive, school-wide interventions that strengthen relationships, teacher training, infrastructure, and support systems are essential to promote student wellbeing.