Abstract
There is an increasing acknowledgment that suicidal behaviors are negatively affected by school failure in adolescents and young adults. However, no systematic reviews with meta-analysis have been performed to evaluate the strength of this association. We assessed the magnitude of association of school failure as risk factor for suicide behavior in adolescents and young adults. Six international databases were searched up until January 2017. Inclusion criteria were: (1) assessment of suicide attempt or suicide; (2) case–control or cohort studies; (3) subjects aged 12–26 years; (4) school failure evaluated, which includes low academic performance, school dropout, school expulsion, and grade repetition. Random effect models were used; population attributable risks (PARs) were estimated. From 26,883 potentially eligible articles, 14 (62,298 individuals) were included. Meta-analyses could only be performed for suicide attempt. A history of school dropout (OR 6.44, 95% CI 3.03–13.65), low academic performance (OR 1.48, 95% CI 1.22–1.81), and school failure (OR 1.98, 95% CI 1.49–2.64) were significant risks of suicide attempts. Highest PAR estimates were 9.9% for school dropout, 5.1% for low academic performance, and 6.7% for any school failure. Only one study has been found for suicide, but results suggest an association with school dropout. Results show that the students who had school failure are at higher risk of suicide attempt and probably for suicide. The development of effective programs to prevent suicidal behaviors in educational settings may be an effective strategy to reduce these behaviors. However, reliable conclusions from this review are limited by the small amount of included studies for analysis.
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References
Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708–716. https://doi.org/10.1016/j.jpsychires.2008.01.016.
Bruns, E. J., Walrath, C., Glass-Siegel, M., & Weist, M. D. (2004). School-based mental health services in Baltimore: Association with school climate and special education referrals. Behavior Modification, 28(4), 491–512. https://doi.org/10.1177/0145445503259524.
Castellvi, P., Lucas-Romero, E., Miranda-Mendizábal, A., Parés-Badell, O., Almenara, J., Alonso, I., et al. (2017a). Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2017.03.035.
Castellvi, P., Miranda-Mendizabal, A., Pares-Badell, O., Almenara, J., Alonso, I., Blasco, M. J., et al. (2017b). Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies. Acta Psychiatrica Scandinavica, 135(3), 195–211. https://doi.org/10.1111/acps.12679.
De Ridder, K. A. A., Pape, K., Johnsen, R., Westin, S., Holmen, T. L., & Bjørngaard, J. H. (2012). School dropout: A major public health challenge: A 10-year prospective study on medical and non-medical social insurance benefits in young adulthood, the Young-HUNT 1 Study (Norway). Journal of Epidemiology and Community Health, 66(11), 995–1000. https://doi.org/10.1136/jech-2011-200047.
Donald, M., Dower, J., Correa-Velez, I., & Jones, M. (2006). Risk and protective factors for medically serious suicide attempts: A comparison of hospital-based with population-based samples of young adults. The Australian and New Zealand Journal of Psychiatry, 40(1), 87–96. https://doi.org/10.1080/j.1440-1614.2006.01747.x.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463.
Esch, P., Bocquet, V., Pull, C., Couffignal, S., Lehnert, T., Graas, M., et al. (2014). The downward spiral of mental disorders and educational attainment: A systematic review on early school leaving. BMC Psychiatry, 14, 237. https://doi.org/10.1186/s12888-014-0237-4.
Evans, E., Hawton, K., Rodham, K., & Deeks, J. (2005). The prevalence of suicidal phenomena in adolescents: A systematic review of population-based studies. Suicide & Life-Threatening Behavior, 35(3), 239–250.
Feigelman, W., Joiner, T., Rosen, Z., & Silva, C. (2016). Investigating correlates of suicide among male youth: Questioning the close affinity between suicide attempts and deaths. Suicide and Life-Threatening Behavior, 46(2), 191–205. https://doi.org/10.1111/sltb.12183.
Fergusson, D. M., Beautrais, A. L., & Horwood, L. J. (2003). Vulnerability and resiliency to suicidal behaviours in young people. Psychological Medicine, 33(1), 61–73.
Fergusson, D. M., & Lynskey, M. T. (1995). Childhood circumstances, adolescent adjustment, and suicide attempts in a New Zealand birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 612–622. https://doi.org/10.1097/00004583-199505000-00013.
Fried, L. E., Williams, S., Cabral, H., & Hacker, K. (2013). Differences in risk factors for suicide attempts among 9th and 11th grade youth: A longitudinal perspective. The Journal of School Nursing, 29(2), 113–122. https://doi.org/10.1177/1059840512461010.
Garnefski, N., Diekstra, R. F., & de Heus, P. (1992). A population-based survey of the characteristics of high school students with and without a history of suicidal behavior. Acta Psychiatrica Scandinavica, 86(3), 189–196.
Gili, M., Castellvi, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., et al. (2018). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. Journal of Affective Disorders, 245, 152–162. https://doi.org/10.1016/j.jad.2018.10.115.
Hishinuma, E. S., Smith, M. D., McCarthy, K., Lee, M., Goebert, D. A., Sugimoto-Matsuda, J. J., et al. (2018). Longitudinal prediction of suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific Peoples, and Asian Americans. Archives of Suicide Research, 22(1), 67–90. https://doi.org/10.1080/13811118.2016.1275992.
Hjorth, C. F., Bilgrav, L., Frandsen, L. S., Overgaard, C., Torp-Pedersen, C., Nielsen, B., et al. (2016). Mental health and school dropout across educational levels and genders: A 4.8-year follow-up study. BMC Public Health, 16, 976. https://doi.org/10.1186/s12889-016-3622-8.
Jamal, F., Fletcher, A., Harden, A., Wells, H., Thomas, J., & Bonell, C. (2013). The school environment and student health: A systematic review and meta-ethnography of qualitative research. BMC Public Health, 13, 798. https://doi.org/10.1186/1471-2458-13-798.
Kessler, R., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c.
Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. The American Journal of Psychiatry, 152(7), 1026–1032. https://doi.org/10.1176/ajp.152.7.1026.
Lager, A. C. J., & Torssander, J. (2012). Causal effect of education on mortality in a quasi-experiment on 1.2 million Swedes. Proceedings of the National Academy of Sciences of the United States of America, 109(22), 8461–8466. https://doi.org/10.1073/pnas.1105839109.
Levesque, R. J. R. (2011). Adolescent crisis. In R. J. R. Levesque (Ed.), Encyclopedia of adolescence (p. 69). New York, NY: Springer. https://doi.org/10.1007/978-1-4419-1695-2_489.
Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology, 62(2), 297–305.
Lyon, M. E., Benoit, M., O’Donnell, R. M., Getson, P. R., Silber, T., & Walsh, T. (2000). Assessing African American adolescents’ risk for suicide attempts: Attachment theory. Adolescence, 35(137), 121–134.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Grp, P. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery, 8(5), 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007.
Molla, M. T., Madans, J. H., & Wagener, D. K. (2004). Differentials in adult mortality and activity limitation by years of education in the United States at the end of the 1990s. Population and Development Review, 30(4), 625–646. https://doi.org/10.1111/j.1728-4457.2004.00035.x.
Nrugham, L., Holen, A., & Sund, A. M. (2015). Prognosis and psychosocial outcomes of attempted suicide by early adolescence: A 6-year follow-up of school students into early adulthood. The Journal of Nervous and Mental Disease, 203(4), 294–301. https://doi.org/10.1097/NMD.0000000000000281.
Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., et al. (2016). Our future: A Lancet commission on adolescent health and wellbeing. Lancet (London, England), 387(10036), 2423–2478. https://doi.org/10.1016/S0140-6736(16)00579-1.
Porta, M. (2014). A dictionary of epidemiology (6th ed.). Oxford: Oxford University Press. https://doi.org/10.1093/ije/15.2.277.
Power, E., Clarke, M., Kelleher, I., Coughlan, H., Lynch, F., Connor, D., et al. (2015). The association between economic inactivity and mental health among young people: A longitudinal study of young adults who are not in employment, education or training. Irish Journal of Psychological Medicine, 32(1), 155–160. https://doi.org/10.1017/ipm.2014.85.
Raver, C. C., Jones, S. M., Li-Grining, C., Zhai, F., Metzger, M. W., & Solomon, B. (2009). Targeting children’s behavior problems in preschool classrooms: A cluster-randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(2), 302–316. https://doi.org/10.1037/a0015302.
Reinherz, H. Z., Giaconia, R. M., Silverman, A. B., Friedman, A., Pakiz, B., Frost, A. K., et al. (1995). Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 599–611. https://doi.org/10.1097/00004583-199505000-00012.
Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., et al. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide- related behavior in young people. Crisis, 34(3), 164–182. https://doi.org/10.1027/0227-5910/a000168.
Rodriguez-Cano, T., Beato-Fernandez, L., & Llario, A. B. (2006). Body dissatisfaction as a predictor of self-reported suicide attempts in adolescents: A Spanish community prospective study. The Journal of Adolescent Health, 38(6), 684–688. https://doi.org/10.1016/j.jadohealth.2005.08.003.
Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide & Life-Threatening Behavior, 37(3), 248–263. https://doi.org/10.1521/suli.2007.37.3.248.
Sourander, A., Klomek, A. B., Niemela, S., Haavisto, A., Gyllenberg, D., Helenius, H., et al. (2009). Childhood predictors of completed and severe suicide attempts: Findings from the Finnish 1981 Birth Cohort Study. Archives of General Psychiatry, 66(4), 398–406. https://doi.org/10.1001/archgenpsychiatry.2009.21.
Stroup, D. F., Berlin, J. A., Morton, S. C., Olkin, I., Williamson, G. D., Rennie, D., et al. (2000). Meta-analysis of observational studies in epidemiology—A proposal for reporting. JAMA, 283(15), 2008–2012. https://doi.org/10.1001/jama.283.15.2008.
The Ottawa Research Institute. (2014). Newcastle-Ottawa Scale.
UNESCO. (2012). Opportunities lost: The impact of grade repetition and early school leaving. Montreal: UNESCO.
World Health Organization. (2010). Education and health go hand in hand. Retrieved April 4, 2019 from https://www.who.int/dg/speeches/2010/educationandhealth_20100920/en/.
World Health Organization (WHO). (2013). Mental health action plan 2013–2020. WHO Library Cataloguing-in-Publication DataLibrary Cataloguing-in-Publication Data. Geneva, Switzerland. ISBN 978 92 4 150602 1.
World Health Organization (WHO). (2014). Preventing suicide: A global imperative. Canadian Medical Association Journal. Geneva, Switzerland. ISBN: 978 92 4 156477 9.
Young, R., Sweeting, H., & Ellaway, A. (2011). Do schools differ in suicide risk? The influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils. bmc public Health, 11, 874. https://doi.org/10.1186/1471-2458-11-874.
Acknowledgements
Thanks to Dave MacFarlane and Victoria Mailen Arfuch for help in management of the data extraction form and data abstraction.
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This work was supported by the ISCIII-FEDER (PI13/00343); Ministry of Health, Social Services and Equality, PNSD (2015I015); Instituto de Salud Carlos III (ISCIII) (Sara Borrell, CD12/00440 and CD18/00049); ISCIII (Río Hortega, CM14/00125); Ministry of Education, Culture and Sport (FPU15/05728); UJA-FEDER (R08/06/2018), Generalitat de Catalunya (2014 SGR 748 and 2017 SGR 452), and by the Spanish Ministry of Science, Innovation and Universities, the State Research Agency (AEI), and ERDF funding thanks to PSI2017-90650-REDT grant. The corresponding author (JA) confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.
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JA and PC developed the original protocol. Three investigators (PC; AM; and OP) did the literature search in October 2013 and updated it in January 2017. Twelve investigators (JA; IA; MJB; AC; RCS; AG; MG; CL; JAP; MR; JRM; TRJ; and VSS) double-screened titles, and abstracts of all studies to establish eligibility for full-text screening, and they extracted the data independently onto a data extraction form. PC identified all the articles included from the broad review, reviewed all data extracted from previous reviewers, and conducted all analyses. PC developed the article, figures, and tables. PC, AM, and OP resolved any disagreement about eligibility for inclusion in the review and discrepancies arising during data extraction. All authors read and approved the final draft of the manuscript.
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Castellví, P., Miranda-Mendizábal, A., Alayo, I. et al. Assessing the Relationship Between School Failure and Suicidal Behavior in Adolescents and Young Adults: A Systematic Review and Meta-analysis of Longitudinal Studies. School Mental Health 12, 429–441 (2020). https://doi.org/10.1007/s12310-020-09363-0
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DOI: https://doi.org/10.1007/s12310-020-09363-0