Feeling Unsafe at School and Associated Mental Health Difficulties among Children and Adolescents: A Systematic Review

Twenty-year changes of adolescent mental health and substance use: a Finnish population-based time-trend study

This time-trend study assesses changes in mental health and substance use among Finnish adolescents from 1998 to 2018. Representative samples of adolescents (N = 6,600) aged 13-16 years participated in school-based, almost identical cross-sectional studies in 1998 (n = 1,446), 2008 (n = 2,009), 2014 (n = 1,800) and 2018 (n = 1,345), respectively. The Strengths and Difficulties Questionnaire was used to assess mental health. When comparing mental health in the clinical range between 1998 and 2018, the main finding was the significant increase of emotional symptoms among females. The percentage of females in the clinical range increased from 17.5 to 30.1% during the twenty-year period. When psychopathology measures were analyzed as continuous variables, the finding of increased emotional problems was confirmed. The study clearly illustrates a linear trend, with a consistent increase in emotional problems among females and decrease in substance use among both genders. An alarming finding of steady increase of self-reported emotional problems indicates the importance of early detection and evidence-based interventions for adolescent with anxiety and depression to prevent adversities associated with these disorders.

Investigating the Interplay Between Mental Health Conditions and Social Connectedness on Suicide Risk: Findings from a Clinical Sample of Adolescents

This study examined whether school and community connectedness buffer the relationships between mental health conditions and suicide risk in a clinical sample of adolescents with histories of substance use disorders. Data from 294 adolescents were examined, with approximately 58% reporting lifetime suicidal ideation and/or prior attempts. Multinomial logistic regression was used to examine main and interaction effects on a three-category measure of suicide risk. Depression severity and panic disorder were associated with elevated suicidal ideation risk, whereas disordered eating was associated with elevated risk of attempts. Higher school-based positive peer interactions, school safety, and neighborhood social connection levels were associated with reduced suicide attempt risk. Moderation analyses revealed that high neighborhood social connection levels may partially mitigate the elevated likelihood of attempting suicide associated with disordered eating. Findings suggest clinical populations of adolescents may benefit from approaches aiming to promote social connectedness, further supporting a comprehensive approach to suicide prevention.

Adolescent mental health in Japan and Russia: The role of body image, bullying victimisation and school environment

This study examined associations between self-reported mental health problems, body image, bullying victimisation and school safety in large adolescent samples in Japan and Russia, considering the effects of gender, culture and their interactions. In both Japan and Russia, girls reported a greater number of mental health problems, less bullying victimisation and much higher body dissatisfaction than boys did. Japanese adolescents rated themselves higher on total difficulties, reported less body dissatisfaction and bullying victimisation, and rated their school safety lower than that of Russian youths. Cross-cultural differences in total difficulties and body image were qualified by gender. Body dissatisfaction, bullying victimisation and school safety all independently contributed to adolescent mental health problems. The protective effect of school safety on total difficulties was larger for girls than for boys; the strength of the association between bullying victimisation and adolescent mental health problems differed across genders and cultures. The findings indicate a need for a cross-cultural approach and provide a strong basis for targeted interventions that seek to improve adolescent mental health.

Black adolescents' racial discrimination and suicide behaviors: Testing perceived school safety as a protective moderator

The current study examined associations between Black adolescents' (Mage  = 15.55, SD = 1.23) racial discrimination and suicide behaviors (i.e., suicide ideation, suicide plan, and suicide attempts), and whether perceived school safety was a protective moderator. Furthermore, we tested gender differences in relations, which were not significant. Racial discrimination predicted greater suicide behaviors, and school safety informed less suicide behaviors. School safety moderated the relation between discrimination and suicide plan, such that at low school safety, discrimination predicted having a suicide plan but was not significant at high school safety. Furthermore, school safety moderated the relation between discrimination and suicide attempts. At low school safety, discrimination predicted more suicide attempts, but was not significant at high school safety.

The significance of feeling safe for resilience of adolescents in sub-Saharan Africa

Introduction

Adolescents in sub-Saharan Africa (SSA) are exposed to several challenges and risk factors, linked to historical legacies. Sub-Saharan Africa has one of the highest rates of poverty and inequality in the world, is one of the regions most negatively affected by climate change, performs poorly on many health measures, and has high rates of different forms of violence, especially gender-based violence. These contextual challenges impact adolescent mental health outcomes, preventing them to access resilience-enabling pathways that support positive outcomes despite adversity. This study aimed to contribute to knowledge generation on resilience of young people in the understudied SSA region by investigating which variables directly (or indirectly) affect the resilience of adolescents.

Methods

Purposive sampling was used to collect quantitative survey data from 3,312 adolescents (females = 1,818; males = 1,494) between the ages of 12 and 20 years, participating in interventions implemented by a non-governmental organization, the Regional Psychosocial Support Initiative. Data were collected in Angola (385, 11.6%), Eswatini (128, 3.9%), Kenya (390, 11.8%), Lesotho (349, 10.5%), Mozambique (478, 14.4%), Namibia (296, 8.9%), South Africa (771, 23.3%), Uganda (201, 6.1%), and Zambia (314, 9.5%). The survey collected data on socio-demographic status, resilience (CYRM-R), depression (PHQ-9), self-esteem (Rosenberg Self-Esteem Scale) and feelings of safety (self-developed scale). Mental health was defined as lower levels of depression, higher levels of self-esteem and higher levels of feeling safe. A mediation analysis was conducted to investigate the relationship between the predictors (the socio-demographic variables) and the output (resilience), with the mediators being depression, self-esteem and feeling safe (which all link to mental health).

Results

This study contributes to a gap in knowledge on country-level comparative evidence on significant predictors that impact resilience outcomes (directly or indirectly) for adolescents in sub-Saharan African countries. The results indicate that, when considering all countries collectively, feeling safe is the only predictor that has a significant direct effect on overall resilience and personal resilience, but not on caregiver resilience. When considering each country separately, feeling safe has a direct effect on overall, personal and caregiver resilience for all countries; but not for South Africa and Mozambique.

Discussion

The results provide evidence on which to craft youth development interventions by measuring mediators (depression, self-esteem and feeling safe) and resilience for adolescents in sub-Saharan Africa. The overall results of the present paper point toward a contextually relevant pathway to supporting their resilience, namely, the need to systemically target the creation and/or strengthening of structures that enable adolescents to feel safe.

Socio-Emotional Competencies Required by School Counsellors to Manage Disruptive Behaviours in Secondary Schools

This article identifies the socio-emotional competencies of school counsellors working with children and adolescents. The aim is to address problems related to mental health and conflict and to implement training programmes. The study sample was composed of 149 counsellors working in schools. The instruments used were the CCPES-II (questionnaire on teacher competences) and a series of open-ended questions on conflict resolution. A mixed methodology was used, with a concurrent triangulation design with two phases: a quantitative one (QUAN) and a qualitative one (QUAL). Univariate, bivariate, and correlation quantitative analyses were performed. Parametric and non-parametric tests were applied depending on the number of dependent and independent variables. The qualitative analysis was performed with the NVivo 12 computer programme, which determines word frequencies using a classic content analysis. The results confirm the relationship between socio-emotional training and rapid response to school conflict; the generalised view that conflicts are difficult to anticipate and, thus, to prevent; and the demand for specific training in socio-emotional competences, intervention strategies, more specialised school staff, more time for intervention with and support for families, and more socio-professional recognition.

Unraveling the central and bridge psychological symptoms of people living with HIV: A network analysis

Background

People living with HIV (PLWH) experience multiple psychological symptoms. Few studies have provided information on central and bridge psychological symptoms among PLWH. This information has implications for improving the efficiency and efficacy of psychological interventions. Our study aimed to identify the central and bridge psychological symptoms of PLWH and to explore the interconnectedness among symptoms and clusters.

Methods

Our study used data from the HIV-related Symptoms Monitoring Survey, a multisite, cross-sectional study conducted during 2017-2021. We used R to visualize the network of 16 symptoms and analyzed the centrality and predictability indices of the network. We further analyzed the bridge symptoms among the three symptom clusters.

Results

A total of 3,985 participants were included in the analysis. The results suggested that sadness had the highest strength (r S = 9.69) and predictability (70.7%) compared to other symptoms. Based on the values of bridge strength, feeling unsafe (r bs = 0.94), uncontrollable worry (r bs = 0.82), and self-abasement (r bs = 0.81) were identified as bridge symptoms. We also found a strong correlation between sadness and self-abasement (r = 0.753) and self-loathing and self-blame (r = 0.744).

Conclusion

We found that sadness was the central psychological symptom of PLWH, indicating that sadness was the center of the psychological symptom network from a mechanistic perspective and could be a target for intervention. Deactivating bridge symptoms, including "feeling unsafe," "self-abasement," and "uncontrollable worry," could be more effective in preventing symptom activation from spreading (e.g., one symptom activating another).

‘Put students’ dreams first’: Student perspectives on secondary school climate improvement in Mongolia

Involving students in school improvement can yield many benefits for students and promote meaningful change in educational practices and policies. In this qualitative study, we centered the voices of Mongolian adolescents by soliciting their suggestions for improving safety and support in their schools. Reflexive thematic analysis was used to analyze written comments from 810 Mongolian secondary students grades 8 through 12, yielding five themes related to student voice, food, security, relationships, and holistic development. The aims of the study were to (a) identify similarities and differences between Mongolian student experiences and Western-based school climate research and (b) contribute to the dialogue about school improvement in Mongolia and other non-Western countries. Findings point to recommendations for providing adequate nutrition, ensuring safety, and meeting the basic psychological needs of students in Mongolian secondary schools.

Health Promotion Actions and School Violence-A Cluster Analysis from Finnish Comprehensive Schools

(1) Schools have a significant role in violence prevention activities. This study aimed to first identify profiles of Finnish comprehensive schools based on school violence. The second aim was to examine the associations between profiles concerning health promotion actions, reactive or punitive actions, and school characteristics. (2) The study used the large-scale, nationally representative Benchmarking System of Health Promotion Capacity-Building (BSHPCB) data (n = 2057 schools) completed by the school's principal together with a student welfare team. The data was analyzed by cluster analysis and Chi-squared and Kruskal-Wallis tests. For post hoc testing, Fisher's exact test with odds ratios and Mann-Whitney U-test were used. (3) The cluster analysis yielded five profiles of school violence: "No violence", "Adolescent violence" (violence both among pupils and from pupils towards staff, but not inappropriate behavior from school staff towards pupils), "Not known" (principals either did not respond to these questions or they did not know whether there had been any school violence incidents), "Peer violence" (school violence occurred among pupils but not from pupils towards staff, nor inappropriate behavior from school staff towards pupils), and "All violence" (all types of school violence and inappropriate behavior from school staff towards pupils). These clusters differed according to type of school and municipality. Additionally, both management and monitoring as health promotion actions were related to higher incidence of school violence whereas other actions, such as commitment, resources, common practices, and participation were not related to school violence. (4) The findings of this study indicate that schools have different profiles in terms of school violence and providing evidence and guidance for school violence prevention work.

Association Between Concussions and Suicidality in High School Students in the United States

Importance

Prior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality.

Objective

To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables.

Design

This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender.

Setting

A national sampling of U.S. high school students.

Participants

Eleven thousand two hundred sixty-two students in the YRBS database, including 5,483 boys and 5,779 girls.

Exposure(s)

Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality.

Main Outcomes and Measures

The main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis.

Results

The final sample included 11,262 participants with available data on concussion and suicidality in the last year (14–18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation [girls: OR = 1.46 (1.24, 1.73); boys: OR = 1.69 (1.41, 2.03)], planning (girls: OR = 1.39 [1.16, 1.66]; boys: OR = 1.76 [1.44, 2.14]), and attempt [girls: OR = 1.70 (1.32, 2.19); boys: OR = 3.13, (2.37, 4.15)]. These relationships became mostly non-significant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation [girls: OR = 1.11 (0.86, 1.44); boys: OR = 1.24 (0.92, 1.69)] or planning (girls: OR = 1.07 [0.82, 1.40]; boys: OR = 1.12 [0.82, 1.55]); but a significant relationship with suicide attempts in boys [OR = 1.98 (1.28, 3.04)], but not girls [OR = 1.05 (0.74, 1.49)].

Conclusions and Relevance

There was an association between concussion and suicidality in U.S. high school students; however, after controlling for other variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a significant relationship between concussion and attempts in boys.

Relationship between Self-Reported Neighborhood Safety and Happiness and Life Satisfaction among Women in Low-Middle Income Countries

Measures related to subjective well-being such as perceived happiness and life satisfaction are becoming increasingly popular among health researchers due to their strong correlation with longevity and all-cause mortality. Previous studies have focused on the role of environmental safety on female empowerment. However, not much is known about the impact of environmental risk factors such as perceived safety on subjective well-being, especially in the low-middle-income countries (LMICs). The present study aims to investigate the association between self-reported safety and self-reported happiness and life satisfaction among women in selected LMICs in Asia and Africa. Methods: We analyzed cross-sectional data from eleven countries on 186,388 women aged 15–49 years from the sixth round of the Multiple Indicator Cluster Survey. The outcome measures were self-reported happiness and life satisfaction, and their associations with the safety indicators (i.e., feeling unsafe in the neighborhood and at home) were calculated using generalized ordered logit models by adjusting for relevant sociodemographic factors. Results: The highest percentage of feeling very unsafe both in the neighborhood (39.3%) and at home (26.5%) was reported in Iraq, while Tonga had the highest percentage of reporting both feeling very safe in the neighborhood (55.3%) and at home (54.9%). The odds of self-reported worsening life satisfaction were higher among women who reported feeling very unsafe in the neighborhood [OR = 1.43, 95% CI = 1.36,1.50] and at home [OR = 1.13, 95% CI = 1.08,1.19]. Feeling of being very unsafe in the neighborhood [OR = 1.16, 95% CI = 1.10,1.22] and at home [OR = 1.65, 95% CI = 1.57,1.74] also showed strong positive association with self-reported unhappiness. Conclusions: Our findings from eleven LMICs across Asia and Africa indicate that lack of environmental safety may negatively impact subjective well-being among women. Further research is necessary to explore the root causes of insecurity and design intervention programs aiming to promote women’s psychosocial health and well-being.

Feeling Unsafe at School Among Adolescents in 13 Asian and European Countries: Occurrence and Associated Factors

BACKGROUND

Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic.

METHODS

The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals.

FINDINGS

The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries.

CONCLUSION

The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.

Feeling unsafe as a source of psychological distress in early adolescence

RATIONALE

Symptoms of psychological distress at an early age have proved to undermine adolescents' academic achievements, as well as their personal and social well-being. The literature acknowledges a wide range of risk factors that cause psychological distress, while at the same time emphasizing the role of social support as a protective factor. On the other hand, feelings of unsafety as a possible source of psychological distress have been so far largely overlooked in the literature.

OBJECTIVE

The present study explores the consequences of a specific stressor (feeling unsafe) and asks whether social support can act as a moderator in the association between subjective unsafety and psychological distress.

METHODS

A multi-group structural equation model was run with a sample of 2876 young adolescents aged 10-12 enrolled in educational centers in the city of Barcelona, Spain.

RESULTS

The results show that direct exposure to sibling violence at home and bullying at school are significant predictors of psychological distress, regardless of biological sex. The hypothesis of a negative correlation of subjective perceptions of unsafety on psychological distress is also supported, although neighborhood-based risk factors emerge as a greater source of distress for females than for males. The involvement of supportive adults is associated with lower levels of perceptions of unsafety and distress in both groups, but girls seem capable of drawing more effectively on alternative sources of support, specifically their peers, to enhance their safety at school and in the neighborhood.

CONCLUSION

Overall, gender differences in our model overlap with socio-environmental inequalities (low income, exposure to violence and conflictual public spaces), thus suggesting that an intervention into the root causes of these inequalities could contribute to lowering psychological distress in early adolescence.