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      Do schools differ in suicide risk? the influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils

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      BMC Public Health
      BioMed Central

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          Abstract

          Background

          Rates of suicide and poor mental health are high in environments (neighbourhoods and institutions) where individuals have only weak social ties, feel socially disconnected and experience anomie - a mismatch between individual and community norms and values. Young people spend much of their time within the school environment, but the influence of school context (school connectedness, ethos and contextual factors such as school size or denomination) on suicide-risk is understudied. Our aim is to explore if school context is associated with rates of attempted suicide and suicide-risk at age 15 and self-harm at age 19, adjusting for confounders.

          Methods

          A longitudinal school-based survey of 1698 young people surveyed when aged 11, (primary school), 15 (secondary school) and in early adulthood (age 19). Participants provided data about attempted suicide and suicide-risk at age 15 and deliberate self-harm at 19. In addition, data were collected about mental health at age 11, social background (gender, religion, etc.), and at age 15, perception of local area (e.g. neighbourhood cohesion, safety/civility and facilities), school connectedness (school engagement, involvement, etc.) and school context (size, denomination, etc.). A dummy variable was created indicating a religious 'mismatch', where pupils held a different faith from their school denomination. Data were analysed using multilevel logistic regression.

          Results

          After adjustment for confounders, pupils attempted suicide, suicide-risk and self-harm were all more likely among pupils with low school engagement (15-18% increase in odds for each SD change in engagement). While holding Catholic religious beliefs was protective, attending a Catholic school was a risk factor for suicidal behaviours. This pattern was explained by religious 'mismatch': pupils of a different religion from their school were approximately 2-4 times more likely to attempt suicide, be a suicide-risk or self-harm.

          Conclusions

          With several caveats, we found support for the importance of school context for suicidality and self-harm. School policies promoting school connectedness are uncontroversial. Devising a policy to reduce risks to pupils holding a different faith from that of their school may be more problematic.

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          Most cited references30

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          Youth suicide risk and preventive interventions: a review of the past 10 years.

          To review critically the past 10 years of research on youth suicide. Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.
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            Toward an ecological/transactional model of community violence and child maltreatment: consequences for children's development.

            In recent decades it has become increasingly apparent that violence affects a significant proportion of families in the United States (Bureau of Justice Statistics 1983). Violence, in fact, is becoming a defining characteristic of American society. A recent comparison of the rates of homicide among 21 developed nations indicates that the United States has the highest homicide rate in the world, and its rate is more than four times higher than the next highest rate (Fingerhut and Kleinman 1990). What is even more alarming is the high incidence of violent death and injury for children and adolescents in the United States. Acts of violence are the cause of death for over 2000 children between the ages of 0 and 19 years each year, and more than 1.5 million children and adolescents are abused by their adult caretakers each year (Christoffel 1990).
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              Epidemiology of depressive mood in adolescents: an empirical study.

              The epidemiology and correlates of depressive mood were measured in a representative sample of public high school students in New York State and a subsample matched to their parents. Depressive mood was measured by a self-reported scale validated in a clinical sample. Adolescents with a diagnosis of major depressive disorder scored higher than those with other psychiatric diagnoses. In the general adolescent sample, ex differences in depressive mood paralleled those previously reported for adults, with girls scoring higher than boys. Adolescents reported higher depressive mood than their parents, with the differences greater in daughter-mother than in son-father pairs. If judged by mood differences, adolescence was a stressful period in the life cycle. Lowest levels of adolescent depressive mood correlated with high levels of attachment both to parents and to peers. Sex differences in depressive mood in adolescents may be accounted for by masked depression and increased delinquency among boys as compared with girls.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2011
                17 November 2011
                : 11
                : 874
                Affiliations
                [1 ]MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK
                Article
                1471-2458-11-874
                10.1186/1471-2458-11-874
                3280202
                22093491
                f61e0507-84f1-4ec9-9f35-02e5f214c80e
                Copyright ©2011 Young et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 January 2011
                : 17 November 2011
                Categories
                Research Article

                Public health
                Public health

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