Adolescent Suicide Ideation: Schools Make a Difference

Background

Suicide is a primary cause of death in adolescents and young adults. Suicide mortality rates increase from .7 in 100,000 among children 5-14 years old to 7.5 among adolescents 15-19 year olds. Suicide ideation increases dramatically from the age of 12,  until the age of 18, reaching a lifetime prevalence rate of more than 16%. Despite the importance of school experiences for adolescents, only a few studies attempted to conceptualize and investigate empirically the relationships between school context characteristics and suicide ideation. These studies did not address fully the multilevel nature of student experiences embedded within schools.

The present study employs a multi-level perspective and investigates the contribution of both school-level attributes and individual student attributes to student suicide-ideation. 

Methods

School-level data for this study were drawn from the school database of California Department of Education (Enrollment, Percentage of students eligible for Free and Reduced Lunch, Racial composition, and Academic Performance Index (API)). Student-level data were taken from the California Healthy Kids Survey (CHKS), a bi-annual survey conducted in all school districts in California. Analyses were first conducted on surveys administered in 2011-2012 to 790 schools with 345,203 9^th and 11th graders.  Analyses were then replicated on surveys administered in 2009-2010 to 860 schools with 406,313 students.

The CHKS self-report questionnaire consists of a series of structured scales with acceptable to high internal consistencies. The following variables were measured: Victimization, Discrimination-based harassment or bullying, Involvement with guns and gangs, and school climate (Adult Support and Belongingness), and academic behaviors and achievement (cutting classes and grades). Suicide-ideation was assessed using the item- During the past 12 months, did you ever seriously consider suicide?

 Findings

About 20% of the students reported suicide ideation. In the analytical sample, suicide ideation was predicted by both individual- (R²= .20) and school-level predictors (R² = .55). Strongest individual predictors were being a female (OR=0.48 for males), school belongingness (OR=.76), moderate victimization (OR=2.12), gang membership (OR=1.47) and discrimination-based victimization (OR=1.42). African American students had lower rates compared with Whites (OR=0.86), whereas Asians (OR=1.13) had higher rates. Strongest school-level predictors were low proportion of male students (beta=-.31), high proportion of Hispanic students (beta=0.25), high school-level of discrimination-based victimization (beta=.35) and high school-level moderate victimization (beta=.30). SES, school academic achievements, and school size were not associated with ideation. School climate was also not predictive of ideation. The findings in the replication sample were essentially the same.

Conclusions and discussion

The findings indicate that suicide ideation levels among high schoolers is high. This is of special concern given the association between ideation and suicide attempts. Further, there is clear evidence that schools are contexts that are associated with ideation. Prevention efforts targeting individual students need to expand their focus and identify schools with potentially high number of students with suicide ideation, such as schools with high levels of moderate victimization and  discrimination-based  victimization. Prevention efforts should also aim at changing the contexts of schools. Violence prevention efforts may have added benefit in reducing suicide-ideation.