An Examination of Peer Victimization and Internalizing Problems through a Racial Equity Lens: Does School Connectedness Matter?

School Nurse Leadership and the Implementation of School-Based Support for LGBTQ+ Students

In 2021, the National Association of School Nurses published an updated position statement affirming the unique position of school nurses to support the health and well-being of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) students who are faced with a variety of health disparities rooted in experiences of stigma, discrimination, and bias. The 5-year cluster randomized controlled trial "Reducing LGBTQ+ Adolescent Suicide" leveraged school nurses as leaders to facilitate the uptake of six evidence-informed, LGBTQ-supportive practices in New Mexico high schools. We analyzed 5 years of interview data from 24 school nurses in 13 intervention schools to examine what factors impacted their ability to serve as an effective leader for this initiative. Several factors including job characteristics, leadership and organizational skills, relationships and reputation, and personal commitments emerged from analysis. Contextual factors, such as working in urban or rural school, and the size of the school also influenced nurses' leadership.

Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents

BACKGROUND

We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset.

METHODS

We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode.

RESULTS

Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model.

CONCLUSION

Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.

Ecological-Systems Contributors to Internalizing Symptoms in a US Sample of Adolescents During the COVID-19 Pandemic

OBJECTIVE

Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Although rates of anxiety and depression have since improved, the general increase in the prevalence of mental health problems and disruptions to mental health services during the COVID-19 pandemic has resulted in huge gaps in care. Although research has primarily focused on proximal correlates of internalizing problems, a growing literature suggests that factors outside youths' immediate microsystems are equally crucial for their mental well-being. Thus, it is important to investigate multisystemic correlates of internalizing problems to inform individual and community-based interventions to address the current mental health burden.

METHOD

Leveraging secondary data from a nationally diverse U.S. sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths' ecologies - spanning indicators of threat and deprivation - and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, in follow-up exploratory analyses, we examined if these associations differed by adolescents' racial/ethnic groups.

RESULTS

Consistent with socioecological models, we found that indicators of threat and deprivation in the adolescents' immediate home and more distal neighborhood environments were associated with depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socioecological predictors significantly differed across racial/ethnic groups.

CONCLUSION

These findings have important implications for understanding multi-level contributors to adolescent mental health, which may inform research, practice, and policy.

Suicidal Behaviors in Early Adolescence: The Interaction Between School Connectedness and Mental Health

Previous research has identified mental health symptoms such as depression and aggression as contributing factors associated with suicidal ideation and attempts in adolescence. However, much of this work has focused on older adolescents (ages > 14) resulting in a dearth of knowledge about early adolescents under 12 years. Moreover, much less is known about school connectedness as a protective factor in the relationship between mental health symptoms and suicidal behaviors. This study examined the interaction effect between school connectedness and mental health symptoms on suicidal behaviors among early adolescents aged 9-12 years. Data were drawn from the Fragile Families and Child Wellbeing Study and yielded an analytic sample (n = 2826) that was majority male (52%), Black (53%), and with an average age of 9.3 years. Data were analyzed using multivariate logistic regression. Among participants, 2% experienced suicidal ideation, and 2% experienced suicide attempts. Black adolescents were more than five times more likely to experience a suicide attempt compared to their White peers (AOR = 5.37; 95% CI = 1.71-16.95; p = .004). There was a significant interaction effect between withdrawn depressed symptoms and school connectedness (AOR = .95; 95% CI = .91-98; p = .006), and between aggressive behavior and school connectedness (AOR = 1.02; 95% CI = 1.01-1.03; p = .001) on suicide attempts. School connectedness did not moderate the relationship between mental health symptoms and suicidal ideation. The findings have important practical implications, which are discussed.

Using Decision Trees to Examine Environmental and Behavioural Factors Associated with Youth Anxiety, Depression, and Flourishing

Modifiable environmental and behavioural factors influence youth mental health; however, past studies have primarily used regression models that quantify population average effects. Decision trees are an analytic technique that examine complex relationships between factors and identify high-risk subgroups to whom intervention measures can be targeted. This study used decision trees to examine associations of various risk factors with youth anxiety, depression, and flourishing. Data were collected from 74,501 students across Canadian high schools participating in the 2018-2019 COMPASS Study. Students completed a questionnaire including validated mental health scales and 23 covariates. Decision trees were grown to identify key factors and subgroups for anxiety, depression, and flourishing outcomes. Females lacking both happy home life and sense of connection to school were at greatest risk for higher anxiety and depression levels. In contrast with previous literature, behavioural factors such as diet, movement and substance use did not emerge as differentiators. This study highlights the influence of home and school environments on youth mental health using a novel decision tree analysis. While having a happy home life is most important in protecting against youth anxiety and depression, a sense of connection to school may mitigate the negative influence of a poor home environment.

Peer Victimization and Problematic Online Game Use Among Chinese Adolescents: The Dual Mediating Effect of Deviant Peer Affiliation and School Connectedness

Abundant evidence has proved an association between peer victimization and problematic online game use (POGU). However, the underlying mechanisms of this relation are still under-investigated. Grounded in the ecological system theory, this study examined whether deviant peer affiliation (DPA) and school connectedness mediated the association between peer victimization and adolescent POGU. A sample of 698 Chinese adolescents completed questionnaires regarding peer victimization, problematic online game use, DPA, and school connectedness, of which 51.58% were boys. Path analyses indicated that peer victimization was positively associated with problematic online game use, and this link could be mediated by deviant peer affiliation and school connectedness. The findings identify the potential underlying mechanism by which peer victimization is associated with adolescent problematic online game use, which has important implications for theory and prevention.

Connectedness to Family, School, and Neighborhood and Adolescents' Internalizing Symptoms

In the U.S., there is a strong national interest in social connectedness as a key determinant in promoting positive well-being in adolescents through building strong bonds and creating protective relationships that support adolescent mental health. To this end, this study examined whether, and to what extent, specific types of connectedness to family, school, and neighborhood were associated with internalizing symptoms (i.e., depression and anxiety) among a diverse sample of adolescents from disadvantaged backgrounds. The sample (n = 2590) was majority male (51%), with an average age of 15.6 years, and identified as Black (49%) and Hispanic/Latino (26%). The results revealed that adolescents who reported strong connections to their parent (β = -0.128, p < 0.001), school (β = -0.222, p < 0.001), and neighborhood (β = -0.116, p = 0.003) were more likely to report lower levels of depressive symptomology, with school connectedness exerting a greater influence. In addition, parent connectedness (β = -0.157, p < 0.001) and school connectedness (β = -0.166, p < 0.001) were significantly related to teen anxiety; however, neighborhood connectedness was not (β = -0.123, p = 0.087). The findings have important implications, which are discussed.

The Role of School Connectedness in Supporting the Health and Well-Being of Youth: Recommendations for School Nurses

The importance of students feeling connected in school cannot be overstated, as this perception is crucial to support their health and well-being. A lack of school connectedness can lead to adverse physical and mental health outcomes, including bully victimization. Numerous factors, including individual, social, and environmental, influence students' perceived sense of school connectedness. School nurses are well positioned to establish and maintain school connectedness due to their knowledge, accessibility to students, and familiarity with the school environment. This article details the importance of school connectedness and describes the associations between school connectedness, bullying, and mental health. In addition, we offer recommendations geared toward school nurses regarding strengthening school connectedness and promoting a culture of care and inclusivity within school environments, especially salient in the context of the COVID-19 pandemic.

The Mediating Role of Classroom Climate on School Violence

Mediation analysis has been confirmed as a very useful statistical tool in the social sciences, especially in school-related studies. This type of analysis was used in the present study to examine the mediating role of classroom climate (measured with the classroom environmental scale), categorized into three dimensions, namely involvement, affiliation, and teacher support, on the relationship between peer victimization and peer aggression. The participants consisted of 2011 adolescents (50.67% boys and 49.32% girls), aged between 12 and 18 years old (M = 14.17; SD = 1.47), enrolled in schools in Andalusia (Spain). Findings revealed a significant direct relationship of all the dimensions. They also revealed that teacher support was the only dimension that mediates in the relationship between peer violence and peer aggression. The results and their implications for improving classroom climate and school violence are discussed.