![[ Visit Client Website ]](images/banner.gif)
Depression is a highly prevalent and disabling condition among adolescents; however, fewer than half of adolescents experiencing depression receive treatment. Increasing access to mental health services, while important, is unlikely to eliminate the burden. Guided by ecosocial theory, we investigate the simultaneous effects of neighborhoods and schools as proximal determinants of adolescent depression. We further focus on zero tolerance school discipline policies, which include suspensions, expulsions, and arrests in response to perceived youth misconduct, as modifiable and understudied proximal determinants of adolescent health. We are interested in these policies not only because they are produced by racialized economic conditions that shape schools and neighborhood but because they arguably further reinforce them, with long-term implications for population health. We hypothesize that youth attending schools with more punitive discipline policies will more likely have depressive symptoms than youth attending schools with less punitive discipline policies.
Methods
We used Wave I data from Add Health, which included 11,607 adolescents nested in 2,011 neighborhoods and 122 schools. Our dependent variable was depressive symptoms, which was measured by the Center for Epidemiological Studies Depression Scale (CES-D). Following previous studies, we constructed a binary variable by coding the CES-D score of 16 or above as 1, indicating depressive symptoms. Our key predictor was a punitive school discipline summary score, which we constructed by combining school administrators’ responses to school discipline policies questions. We coded out-of-school suspension or expulsion in response to nonviolent first-time student misconduct policy items as 1, else as 0. The summed score (0–8) indicated the overall punitive school discipline summary score; a higher score indicated harsher school discipline. We controlled for multiple individual, school, and neighborhood characteristics previously shown to significantly predict depressive symptoms. We conducted the analysis using cross-classified multilevel model (CCMM), which accounted for simultaneous nesting of adolescents in their schools and neighborhoods.
Results
For every point increase in the punitive school discipline summary score, the expected probability of reporting depressive symptoms increased significantly by 3.6% (OR = 1.036, p < 0.05). In addition, variations of depressive symptoms among adolescents were driven primarily by variations across schools (13%) and secondarily by variations across neighborhoods (10%), suggesting that school-level characteristics have a larger impact than characteristics of the neighborhood on adolescent depressive symptoms. However, both levels contribute to the individual health of adolescents and likely reproduce systems of inequality within these overlapping environments.
Conclusion and Implications
Our findings validate the recommendations that school environment, and specifically school discipline policies and practices, are an important target for public health interventions. We add to evidence that reveals how attempts to achieve “law and order” in schools contribute to depression and harms the ability of all students, especially low income and students of color who are more likely to attend schools that use punitive discipline, to secure education and good health. Investing in designing and evaluating interventions that address the social determinants of depression, including punitive school discipline, could have broad impacts at a critical stage of adolescent development and beyond.