Adolescent Mental Health and Health-Related Behaviors Across Language-Based School Systems in South Tyrol, Italy

Adolescents growing up in multilingual regions experience diverse educational contexts that may shape their daily routines and psychosocial environments, but their independent relevance for mental health remains unclear. South Tyrol, with its parallel German-, Italian-, and Ladin-language school systems, provides a unique setting to examine these associations. This study assessed whether school language and home–school language mismatch are associated with mental health, psychosomatic symptoms, and health-related behaviors among adolescents. We analyzed data from a population-based survey of 2005 adolescents aged 11–19 years who provided self-reported information on mental health, psychosomatic complaints, school stress, social support, digital behaviors, lifestyle, and sleep. Group comparisons by school language were conducted using general linear models and χ² tests with effect sizes. Multivariable regression analyses examined the independent association of home–school language mismatch with mental health outcomes, adjusting for sociodemographic and educational factors and further incorporating sleep-related behaviors. Mental health outcomes, psychosomatic symptoms, and most health-related behaviors showed little variation by school language, with generally small effect sizes. Home–school language mismatch was associated with slightly higher depressive symptom scores in unadjusted analyses but was not independently associated with mental health outcomes after adjustment. In contrast, weekly sleep problems emerged as the strongest correlate of depressive symptoms, accounting for a substantial proportion of explained variance. These findings indicate that adolescent mental health in this multilingual context is shaped less by the language of schooling itself than by broader behavioral and developmental factors, highlighting sleep-related behaviors as a central and modifiable target for prevention.