Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Israel.
Suzzane Dworak-Peck School of Social Work University of Southern California, CA.
J Pediatr. 2018 May;196:251-257. doi: 10.1016/j.jpeds.2017.12.070. Epub 2018 Mar 12.
To assess the between-school variation in suicide ideation and to estimate the contribution of school-level attributes, student-level characteristics, and 2 cross-level interactions (school by student) to student suicide ideation.
A secondary analysis of the California Healthy Kids Survey in 2 large and representative samples of California high schools and students: 2009-2011 and 2011-2013. This is a population sample of all public high school students (grades 9 and 11) in California. Analyses were first conducted on surveys administered in the 2011-2013 academic years to 790 schools with 345 203 students and replicated on surveys administered in 2009-2011 to 860 schools with 406 313 students.
School-level suicide ideation rates ranged between 4% and 67%, with a median of 19.3% and mean of 20.0% (SD, 5.7%). Student suicide ideation was explained by student-level characteristics (R = .20) and to a larger extent by school-level attributes (R = .55). Student-level characteristics predictive of suicide ideation included, sex, ethnic and racial affiliation, victimization, and perceptions of school climate. In both samples, school size and average level of academic achievement were not associated with rates of school suicide ideation. Schools with a larger number of girls and higher levels of victimization had higher rates of suicide ideation in both samples. The hypotheses regarding cross-level interactions were not confirmed.
Differences among schools in student suicide ideation are meaningful. The findings suggest an emphasis on the role of schools in prevention programs, public health campaigns to reduce suicide, multilevel research, and theory development.
评估自杀意念在学校间的差异，并估计学校层面的属性、学生层面的特征以及 2 个交叉层面的交互作用（学校与学生）对学生自杀意念的贡献。
对加利福尼亚州健康儿童调查（California Healthy Kids Survey）在加利福尼亚州 2 所大型且具有代表性的高中和学生样本中的二次分析：2009-2011 年和 2011-2013 年。这是加利福尼亚州所有公立高中学生（9 年级和 11 年级）的总体样本。首先对 2011-2013 学年进行的调查进行分析，涉及 790 所学校的 345203 名学生，并对 2009-2011 学年进行的调查进行了复制，涉及 860 所学校的 406313 名学生。
学校层面的自杀意念率在 4%至 67%之间，中位数为 19.3%，平均值为 20.0%（标准差，5.7%）。学生自杀意念由学生层面的特征（R²=0.20）和更大程度上的学校层面的属性（R²=0.55）解释。预测自杀意念的学生层面的特征包括性别、种族和民族归属、受害情况以及对学校氛围的看法。在两个样本中，学校规模和平均学业成绩与学校自杀意念率无关。女孩人数较多和受害情况较严重的学校在两个样本中自杀意念率较高。关于交叉层面交互作用的假设未得到证实。
学生自杀意念在学校间存在差异，且差异具有统计学意义。研究结果表明，学校在预防计划、减少自杀的公共卫生运动、多层次研究和理论发展方面应发挥作用。
