Adolescent mental health and social inequality in the aftermath of COVID-19 in Bogotá, Colombia: a qualitative study using a critical ecological model.

The study documented adolescent mental health experiences across four ecological levels using a Critical Ecological Model framework.

• The four levels were: (a) personal, (b) interpersonal, (c) community, and (d) organisational/media
• Personal level themes included self-care, life plans, emotional distress, and post-pandemic coping
• Interpersonal level themes included family and peer relationships
• Community level themes included support networks, disadvantage, and violence
• Organisational/media level themes included school-based support and mental health promotion and care

The study was conducted using a qualitative approach involving direct observations and problem-centred interviews in Bogotá, Colombia.

• A total of 95 hours of field observation were conducted in public schools and socially vulnerable neighbourhoods
• 42 interviews were conducted with adolescents aged 12–18 years, 57% of whom were female
• Six school counsellors were also interviewed, most of whom were female psychologists
• Observations and interviews took place at three public schools in socially vulnerable areas of Bogotá
• Reflexive thematic analysis was used to analyse the data

Adolescents living in conditions of social inequality in Bogotá faced both pre-existing and new mental health challenges intensified by the COVID-19 pandemic.

• The COVID-19 pandemic intensified pre-existing issues and introduced new challenges to adolescent mental health
• Adolescents were living in an urban context characterised by social inequality
• The study explored both the benefits and challenges associated with the COVID-19 pandemic on adolescent mental health
• Urban settings such as Bogotá were described as megacities where many adolescents live in conditions of social inequality

Family and peer relationships at the interpersonal level were identified as key factors shaping adolescent mental health in the post-pandemic context.

• Interpersonal relationships with family and peers were identified as a distinct thematic level in the Critical Ecological Model
• Supportive environments within families were described as essential in urban settings marked by social inequality
• The pandemic context influenced the nature and quality of these interpersonal relationships

Community-level factors including support networks, disadvantage, and violence were found to shape adolescent mental health in socially vulnerable neighbourhoods.

• Community-level themes were identified as a distinct ecological level affecting adolescent mental health
• Disadvantage and violence were identified as community-level challenges facing adolescents
• Support networks at the community level were identified as a resource for adolescent mental health
• Observations were conducted directly in socially vulnerable neighbourhoods in Bogotá

Schools were identified as important organisational settings for mental health support and promotion among adolescents.

• School-based support was identified as a key theme at the organisational/media level of the Critical Ecological Model
• Six school counsellors, most of whom were female psychologists, were interviewed about their roles
• Mental health promotion and care within schools was identified as a distinct organisational theme
• Supportive environments within schools were described as essential for adolescent mental health in settings of social inequality

Adolescents demonstrated capacities to navigate challenges and support their own mental health across different contexts.

• Engaging with adolescents' perspectives highlighted both their needs and their capacities to navigate challenges
• Post-pandemic coping was identified as a theme at the personal level
• Self-care was identified as a personal-level theme reflecting adolescent agency
• The study highlighted adolescents' capacities to support mental health across different contexts

Structural strategies were identified as necessary to confront social inequalities affecting adolescent mental health in post-pandemic urban contexts.

• The study called for structural strategies to confront social inequalities
• Both individual and collective actions were identified as necessary to support adolescent mental health
• The post-pandemic context was specifically identified as a period requiring targeted structural responses
• Social, cultural, and economic dynamics rooted in structural inequality were identified as shaping environments in which young people develop