Centre for Epidemiology and Community Medicine, Stockholm County Council, 1497, 17129, Stockholm, Sweden,
Soc Psychiatry Psychiatr Epidemiol. 2014 Apr;49(4):609-18. doi: 10.1007/s00127-013-0782-z. Epub 2013 Oct 26.
Research has demonstrated school effects on health, over and above the effects of students' individual characteristics. This approach has however been uncommon in mental health research. The aim of the study was to assess whether there are any school-contextual effects related to socioeconomic characteristics and academic performance, on the risk of hospitalization from non-fatal suicidal behaviour (NFSB).
A Swedish national cohort of 447,929 subjects was followed prospectively in the National Patient Discharge Register from the completion of compulsory school in 1989-93 (≈16 years) until 2001. Multilevel logistic regression was used to assess the association between school-level characteristics and NFSB.
A small but significant share of variation in NFSB was accounted for by the school context (variance partition coefficient <1%, median odds ratio = 1.26). The risk of NFSB was positively associated with the school's proportion of students from low socioeconomic status (SES), single parent household, and the school's average academic performance. School effects varied, in part, by school location.
NFSB seems to be explained mainly by individual-level characteristics. Nevertheless, a concentration of children from disadvantaged backgrounds in schools appears to negatively affect mental health, regardless of whether or not they are exposed to such problems themselves. Thus, school SES should be considered when planning prevention of mental health problems in children and adolescents.
研究表明，学校对健康的影响超出了学生个体特征的影响。然而，这种方法在心理健康研究中并不常见。本研究的目的是评估与社会经济特征和学业成绩相关的学校环境因素是否会对非致命性自杀行为（NFSB）的住院风险产生影响。
对 1989-93 年（约 16 岁）完成义务教育后在全国患者出院登记处进行前瞻性随访的 447929 名瑞典全国队列进行研究。使用多水平逻辑回归评估学校水平特征与 NFSB 之间的关系。
学校环境在 NFSB 方面存在小但显著的差异（方差分量系数<1%，中位数优势比=1.26）。NFSB 的风险与学校中来自低社会经济地位（SES）、单亲家庭的学生比例以及学校的平均学业成绩呈正相关。学校效应在一定程度上因学校位置而异。
NFSB 似乎主要由个体水平特征来解释。然而，学校中集中了来自弱势背景的儿童似乎会对心理健康产生负面影响，而不论他们自身是否面临这些问题。因此，在规划儿童和青少年心理健康问题的预防措施时，应考虑学校 SES。
