Nicohwilliam

School Connectedness and Suicidal Thoughts and Behaviors: A Systematic Meta-Analysis

Marisa E. Marraccini Rhode Island Hospital, Providence, Rhode Island

and Brown University

Zoe M. F. Brier Rhode Island Hospital, Providence, Rhode Island

Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsis- tencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as “school connectedness” or “connections at school” in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6 –12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] � 0.536), high-risk (OR � 0.603), and sexual minority (OR � 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR � 0.529) and suicide attempts (OR � 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools.

Impact and Implications Suicide remains a critically important public health concern among adolescents. The protective role of school connectedness against suicidal thoughts and behaviors is widely supported in the literature; however, this literature base is fragmented, varying across measures and samples. By accounting for variability across studies, this meta-analytic study reinforces the importance of enhancing school connected- ness for suicide prevention and provides school psychologists with practical rec- ommendations for screening and prevention efforts.

Keywords: school connectedness, suicide, adolescent, meta-analysis, sexual minority

Supplemental materials: http://dx.doi.org/10.1037/spq0000192.supp

This article was published Online First January 12, 2017. Marisa E. Marraccini, Bradley/Hasbro Children’s Re-

search Center of Rhode Island Hospital, Providence, Rhode Island, and Department of Psychiatry and Human Behavior and Pediatrics, Alpert Medical School of Brown University; Zoe M. F. Brier, Bradley/Hasbro Children’s Research Center of Rhode Island Hospital.

We thank Peg Dawson and Bergljot Gyda Gudmunds- dottir for their contribution to this research study.

Correspondence concerning this article should be ad- dressed to Marisa E. Marraccini, Bradley/Hasbro Children’s Research Center of Rhode Island Hospital, Coro West Build- ing, One Hoppin Street, Providence, RI 02903. E-mail: [email protected]

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School Psychology Quarterly © 2017 American Psychological Association 2017, Vol. 32, No. 1, 5–21 1045-3830/17/$12.00 http://dx.doi.org/10.1037/spq0000192

5

Suicide remains a significant public health concern, globally accounting for 8.5% of deaths among adolescents and young adults between ages 15 to 29 (World Health Organization, 2016). Considering the critical importance of suicide prevention, a large body of literature has investigated the influence of protective factors against suicidal thoughts and behaviors (STB) during adolescence. In recent years, the idea that perceived connectedness may serve as a protective factor against STB during adoles- cence has garnered considerable attention. Sci- entific inquiries have focused on adolescent connectedness to parents, family, peers, school, and communities in relation to a wide range of health behavior outcomes (Barber & Schluter- man, 2008). Understanding the influence of school connectedness on STB is especially im- portant given the critical role schools play in adolescent development and because schools are ideally situated to provide interventions reaching the vast majority of youth.

A rich literature base supports an inverse relationship between adolescent school con- nectedness and STB (e.g., Whitlock, Wyman, & Moore, 2014). Synthesis of these findings, how- ever, is limited by inconsistences in the way studies have measured and operationalized school connectedness and the wide variability of participant sample characteristics included in studies. This fragmentation limits our under- standing of the practical, theoretical, and scien- tific implications of school connectedness as a protective factor against STB. For example, are there particular categories of school connected- ness that school psychologists should prioritize over others? Are there critical subpopulations that school psychologists and researchers should target their intervention efforts toward in order to prevent STB? The meta-analytic study presented here, which elucidates the influence of measurement and sample variation on the association between school connectedness and STB, will help answer these questions.

School Connectedness: Definition and Measurement

One of the most widely accepted definitions of school connectedness was initiated by the Wingspread declaration on school connections (Blum & Libbey, 2004). As described by Wa- ters and Cross (2010), school connectedness

may be defined as “the belief by students that adults in the school community care about stu- dents’ learning and about them as individuals” (p. 165). In practice, this includes supportive academic expectations, positive teacher–student interactions, and a safe environment. Based on a review of the literature, Barber and Schluterman (2008) operationalized school connectedness to include three distinct components—interper- sonal relationships, relationship to the school, and attitudes toward school importance. Taken together, school connectedness may include (a) social affiliations: positive school relationships, feeling cared about and/or respected by adults at school, perceiving availability to interact with adults at school; (b) school belonging: feeling part of the school, feeling safe in school, feeling happy at school; (c) attitude about school im- portance: caring about school, trying to do one’s best at school; and (d) supportive learning en- vironment: clear and appropriate expectations, perceived fairness.

A wide variety of instruments are available to measure student and staff perceptions of school connectedness, spanning from single-item ques- tions (e.g., “Do you feel like you belong at this school?”) to more complex, multi-item instru- ments addressing several school connectedness categories. Most of these scales use a unit- weighted approach, averaging equally weighted items together to yield one composite score (Waters & Cross, 2010). One of the first scales to measure school connectedness was the Psy- chological Sense of School Membership Scale (PSSM; Goodenow, 1993). Although the PSSM was initially designed to yield a single school connectedness construct, factor analyses con- ducted after its development identified multiple underlying constructs (Lohmeier & Lee, 2011). Thus more recent scales, such as the School Connectedness Scale (Lohmeier & Lee, 2011), have included as many as seven components. The most commonly used instruments, how- ever, yield a unidimensional measure of school connectedness. These include instruments de- signed to measure multiple constructs with a school connectedness subscale (e.g., the Ado- lescent Family and Social Life Questionnaire; Yen & Shieh, 2005) and single item queries of school or teacher connectedness (e.g., Seil, De- sai, & Smith, 2014). One of the most widely used measures of school connectedness is the 3- to 7-item school connectedness scale developed

6 MARRACCINI AND BRIER

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for the National Longitudinal Study of Adoles- cent Health (Add Health; Resnick et al., 1997). The Add Health Scale has demonstrated satis- factory reliability when examined as a five-item construct (� � .82 to .88; Furlong, O’Brennan, & You, 2011); however, studies that use this scale may include as few as two items. Al- though the variability across these instruments highlights the richness of the school connected- ness literature to date, it also makes the compi- lation of findings across studies (e.g., meta- analytic analysis) difficult.

School Connectedness and Health Risk Behaviors

Empirical evidence overwhelmingly supports the protective role of school connectedness against risky health behaviors. For example, a systematic literature review including 18 stud- ies (Markham et al., 2010) provided evidence that adolescent school connectedness protects against early and frequent sexual activity. An- other systematic review examining emotional health (Kidger, Araya, Donovan, & Gunnell, 2012) demonstrated that teacher support, gen- eral school connectedness, and additional com- ponents of school environment (i.e., happiness with school, feeling safe at school, feeling close to people at school) have an inverse relationship to negative emotional health and suicidal be- havior. Finally, a recent review of connected- ness and suicidal outcomes (Whitlock et al., 2014), which identified 10 studies focused on school context, revealed that school connected- ness was largely associated with reduced STB. As noted by the researchers, however, two stud- ies that used models accounting for multiple interactions and contexts did not indicate an inverse relationship between school connected- ness and STB, suggesting more complex inter- actions may be at play.

The protective role of school connectedness against STB has also been revealed across more vulnerable groups, such as American Indian youth with a history of sexual abuse (Pharris, Resnick, & Blum, 1997), sexual minority or lesbian, gay, bisexual, and transgendered (LGBT) youth (Duong & Bradshaw, 2014; Whitaker, Shapiro, & Shields, 2016), and stu- dents with other risk factors, such as residing in high-risk communities (e.g., Kaminski et al., 2010), experiencing physical or sexual abuse

(e.g., Eisenberg, Ackard, & Resnick, 2007), having been investigated by child welfare (He, Fulginiti, & Finno-Velasquez, 2015), engaging in sexual activity (Stone, Luo, Lippy, & McIn- tosh, 2015), and experiencing bullying (Cole- Lewis, Gipson, Opperman, Arango, & King, 2016). Although these findings are based on diverse participant samples, they underscore the critical importance of enhancing school con- nectedness to protect against STB.

Shedding light on how connectedness may protect against STB, Whitlock and colleagues (2014) proposed a model identifying three path- ways linking connectedness to STB: (a) intrap- ersonal responses and processes, encompassing perceived rejection and isolation; (b) collective responsibility and action, supporting more ave- nues for risk identification; and (c) positive norms and expectations, reinforcing help- seeking behavior and identifies STB risk as problematic. A number of foundational theoret- ical frameworks support these mechanisms, in- cluding ecological systems theory (Bronfen- brenner, 1979) and attachment theory (Ainsworth, 1979).

The Current Study

Adolescents who feel connected to their fam- ily, peers, and schools are less likely to engage in health risk behaviors. Although the former forms of connectedness (i.e., family, peers, and communities) may have critical implications for preventing STB, they are largely beyond the control of the school. School connectedness, however, is an important protective factor against STB that does fall within the purview of school psychology. Thus, the primary aim of this meta-analytic investigation is to examine the association between school connectedness and STB.

Although previous reviews have addressed the importance of adolescent connectedness in relation to STB (Whitlock et al., 2014) and additional reviews have explored school con- nectedness and school environment across a number of health outcomes (Kidger et al., 2012; Markham et al., 2010), the current study is the first to compare pooled effect sizes across stud- ies specifically examining school connectedness in relation to STB. By reviewing findings from cross-sectional and longitudinal studies that ex- amined adolescent (Grades 6 –12) school con-

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nectedness and STB, findings from this inves- tigation will answer the following questions: (a) What is the strength of association between school connectedness and STB, and (b) How does the magnitude of association differ across varying subpopulations and measures of school connectedness? The primary hypothesis is that high levels of school connectedness will relate to reduced reports of STB across general, high- risk, and sexual minority samples. It is also hypothesized that effect sizes will remain con- sistent across differing categories of school con- nectedness.

Method

Literature Search

The systematic search and retrieval process used a standardized review protocol based on Lipsey and Wilson’s (2001) meta-analysis guide and recommendations from Meta-Analy- sis Reporting Standards (APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008). The study aimed to identify and retrieve all empiri- cal studies that examined the relation between school connectedness and suicidal ideation or suicide attempts conducted at any time in any geographical location. We conducted a compre- hensive search of PsycINFO, Academic Search Premier, and PubMed from June 15, 2016 to July 24, 2016 using the search terms school, connect�, and suicid� and searched for studies in Whitlock and colleagues’ (2014) review article. We conducted a thorough examination of titles, abstracts, and full articles to assess eligibility of studies. Studies were selected for meta-analysis based on the following eligibility criteria:

1. The study investigated the association be- tween school connectedness and suicidal ideation (SI), suicide attempts (SA), or a combination of SI and SA, referred to as STB.

2. The measure of school connectedness was explicitly referred to as “school connect- edness” or “connections at school” and included at least one of the four categories described previously (affiliation, belong- ing, attitudes, environment).

3. The study was published in English.

4. The sample included youth attending school in Grades 6 –12.

We excluded studies that did not directly examine the association between school con- nectedness and SI, SA, or STB or did not report sufficient data to calculate a measure of effect between the variables of interest (e.g., studies examining school connectedness as a mediating or moderating variable only).

Data Extraction

Two review authors independently extracted and coded data based on a predetermined stan- dardized coding manual. We selected the fol- lowing moderator variables of interest a priori to test the potential for methodological factors to influence heterogeneity of effect sizes:

1. Region of recruitment (U.S. vs. interna- tional);

2. Percent Caucasian/White; 3. Percent female; 4. Timeframe of STB (past 2 weeks, past 12

months, or lifetime); and 5. Categories of school connectedness (so-

cial affiliation, school belonging, attitude about importance of school, or supportive learning environment). For each study, a dichotomous (yes/no) code was applied for each category resulting in four moder- ator variables.

To conduct sensitivity analyses examining effect sizes separately among subsamples, we also coded studies based on the population sam- pled. After accounting for eligibility criteria, two subsamples with a minimal number of stud- ies to pool effect sizes emerged:

1. Samples described as risky, including stu- dents involved in child welfare, reporting feeling isolated or involvement in bully- ing, residing in high-risk neighborhoods, and reporting being sexually active.

2. Samples described as sexual minority or LGBT youth.

We measured coder consistency for high in- ference variables (school connectedness catego- ries) with Cohen’s kappa (affiliations, � � 1; belonging, � � .842; attitude, � � 1; environ- ment, � � .842; Yeaton & Wortman, 1993).

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Disagreements were resolved through discus- sion until consensus was reached between cod- ers.

Statistical Method

We conduced meta-analyses using Biostat’s Comprehensive Meta-analysis (www.meta- analysis.com; Borenstein, Hedges, Higgins, & Rothstein, 2015). A random effects model was selected a priori to account for sampling error and random effects variance (Lipsey & Wilson, 2001). The primary meta-analysis examined the average effect size of associations between school connectedness and any STB, including the mean of SI and SA in samples that included both outcomes or SI or SA in samples that included only one outcome. Two secondary meta-analyses examined associations between school connectedness and SI and SA separately. Sensitivity analyses also examined pooled ef- fect sizes separately across studies investigating school connectedness and STB among high-risk and sexual minority youth. Finally, we exam- ined qualitative findings from studies that re- ported associations between STB and school influences that were not identified as school connectedness but included overlapping mea- sures with the four categories of school connect- edness.

We calculated effect sizes measuring school connectedness and STB from descriptive data, that is, rates of occurrences, means and standard deviations, and inferential statistics, that is, odds ratio (OR) and correlation coefficients. For missing raw data necessary to compute effect size, we made a request to researchers for more information; otherwise, we excluded studies with missing data for effect size computation (k � 1). We converted final results to OR for comparing the association between school con- nectedness and STB across studies.

Because meta-analysis assumes that each measure of effect is representative of an inde- pendent study, we used a protocol to handle studies with more than one effect size and pub- lications reporting on data from the same data- set. We calculated the average of effect sizes when studies reported findings separately across individual items of school connectedness. In the case of multiple publications reporting data from the same study, we prioritized the most recent publications and those that provided suf-

ficient data. When publications used overlap- ping data sets but reported effects from different subsamples, we selected the most inclusive sample for the primary analysis and analyzed findings for the subsamples of interest sepa- rately. When data were presented separately for subgroups (i.e., males and females) within an individual study, we conducted a meta-analysis to compute the combined effect size under a fixed effects model (Borenstein, Hedges, Hig- gins, & Rothstein, 2009). Finally, we selected effect sizes that reflected cross-sectional find- ings over longitudinal findings considering the majority of included studies were cross- sectional.

We analyzed homogeneity of effect size dis- tribution with visual inspection of outliers and forest plots, as well as the Q statistic and I2

(95% confidence interval [CI]) index. Hetero- geneity is signaled by a statistically significant Q (Lipsey & Wilson, 2001) and estimated by the I2 statistic, an index between 0% and 100% (Borenstein et al., 2009), which may be inter- preted as low (I2 � 25%), moderate (I2 � 50%), or high (I2 � 75%; Higgins, Thompson, Deeks, & Altman, 2003). To measure level of publica- tion bias, we used a combination of Egger’s regression index, the funnel plot, Duval and Tweedie’s trim and fill, and Rosenthal’s fail- safe N.

The study conducted statistical tests of 8 moderators (region of recruitment, percent Cau- casian/White, percent female, STB timeframe, and the school connectedness categories of af- filiation, belonging, attitude, and environment) with weighted regression analysis (metaregres- sion) and analog to analysis of variance (ANOVA) using a mixed effects model. We used ANOVA analog to investigate potential effect size differences across studies based on STB timeframe and region. We also conducted two multiple metaregression analyses: The first model included percent Caucasian/White and percent female as moderator variables and the second model included dichotomous variables (yes/no) representing the four categories of school connectedness (affiliation, belonging, at- titude, and environment). We contacted authors for more information if specific items measur- ing school connectedness were not reported. Case analysis for studies with missing data for moderator variables was used.

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Results

Search Results

The study identified a total of 1,169 titles via the bibliographic databases PsycINFO, Aca- demic Search Premier, and Pubmed (see sup- plementary Figure S1 for PRISMA-style flow- chart). We reviewed 47 articles in full for eligibility, of which 23 were excluded from the quantitative synthesis. We maintained four of these studies in the qualitative synthesis be- cause they did not identify the measure of in- terest as “school connectedness” but included items similar to school connectedness. A total of 20 publications and 17 samples met eligibil- ity criteria of which 19 publications and 16 samples with sufficient data to calculate effect sizes were included in this study. Studies exam- ined school connectedness in relation to SI (k � 12) and SA (k � 10), with a total of 16 samples examining any form of STB (see Table 1). For more information about school connectedness and STB measures see supplementary Table S1.

Primary Analysis

The primary analysis examined STB, includ- ing SI, SA, or a combination of SI and SA, across any sample. The analysis included a total of 16 samples, resulting in between 185,088 – 191,156 participants. The range of participants represents average effect sizes taken from pub- lications that used overlapping samples with varying numbers of participants. Taken to- gether, the studies resulted in a statistically sig- nificant mean effect size of odds ratio (OR) � 0.536 (95% CI: 0.460, 0.624), p � .0001 and included effect sizes that ranged between OR � 0.215 to OR � 0.811 (see Figure 1). The het- erogeneity of variance analysis was significant, Q(15) � 515.533, p � .0001, I2 � 97.090, signifying between-study variance. None of the moderator analyses, including multiple metare- gression examining differences across school connectedness categories, were significant.

Trim and fill analysis did not recommend the imputation of any studies to reduce bias (see supplementary Figure S2a). Egger’s regression was not significant and Rosenthal’s N indicated a minimum of 4,746 studies to lead to a p value at or above alpha of .05. These findings indicate minimal risk for publication bias.

Secondary Analyses

School connectedness and suicidal ideation. When meta-analysis was conducted separately with studies examining SI as an outcome, a total of 53,618 participants from 12 samples were in- cluded. The studies generated a statistically sig- nificant mean effect size of OR � 0.529 (95% CI: 0.433, 0.647), p � .001 (see Figure 2). The heterogeneity of variance analysis was significant, Q(11) � 297.882, p � .001, I2 � 96.307, indicating between-study variance. ANOVA analog comparing studies conducted in the US, OR � 0.618 (95% CI: 0.520, 0.734), k � 10, to those that were conducted internationally, OR � 0.226 (95% CI: 0.190, 0.269), k � 2, was significant, Q(1) � 64.339, p � .001; however, the small number of stud- ies conducted internationally precludes draw- ing definitive conclusions about these differ- ences. None of the additional moderator analyses were significant.

Rosenthal’s N of 2,188 to lead to a p value at or above alpha of .05 and nonsignificant results from Egger’s regression supported minimal risk for publication bias. Trim and fill analysis rec- ommended the imputation of one study result- ing in a mean effect size of OR � 0.505 (95% CI: 0.409, 0.623) under the random effects model (see supplementary Figure S2b).

School connectedness and suicide attempts. A total of 10 studies examined school connected- ness and SA across any sample, including a total of 57,637 participants. The mean effect size of OR � 0.589 (95% CI: 0.493, 0.704), p � .0001 was statistically significant (see Figure 3). The heterogeneity of variance analysis was signifi- cant, Q(9) � 198.636, p � .0001, I2 � 95.469, indicating significant between-study variance. The multiple metaregression models were not conducted due to missing data and the presence of collinearity; none of the other moderator analyses were significant.

Trim and fill analysis recommended the im- putation of one study to reduce publication bias, resulting in a mean effect size of OR � 0.627 (95% CI: 0.525, 0.749) under the random ef- fects model (see supplementary Figure S2c). Minimal risk for publication bias was indicated by a Rosenthal’s N of 1,827 to lead to a p value at or above alpha of .05 and nonsignificant results from Egger’s regression.

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12 MARRACCINI AND BRIER

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13SCHOOL CONNECTEDNESS AND SUICIDE

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

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Sensitivity Analyses

High-risk youth. Five studies including between 9,707–10,179 participants examined school connectedness and any form of STB in high-risk samples (i.e., high risk communities, youth engaging in sexual contact, youth inves- tigated by child welfare, and youth reporting perceived disconnectedness and/or bullying ex- periences). The mean effect size taken from high-risk samples remained significant, OR � 0.603 (95% CI: 0.480, 0.757), p � .0001 (see Figure 4). The heterogeneity of variance analy- sis was significant, Q(4) � 16.249, p � .003, I2 � 75.383, indicating significant between study variance. Note that moderator analyses were not conducted due to the small number of studies included in the analysis. Rosenthal’s N of 99 to lead to a p value at or above alpha of .05 and nonsignificant results from Egger’s re- gression indicated minimal risk for publication

bias. Trim and fill analysis recommended the imputation of one study resulting in a similar mean effect size of OR � 0.634 (95% CI: 0.507, 0.792) under the random effects model (see supplementary Figure S2d).

Sexual minority youth. The analysis pool- ing effect sizes across studies examining school connectedness and any form of STB within sexual minority samples included four studies with between 2,436 –2,485 participants. The mean effect size was statistically significant, OR � 0.608 (95% CI: 0.509, 0.726), p � .0001 (see Figure 5). Heterogeneity of variance anal- ysis indicated minimal between study variance, Q(3) � 3.897, p � .273, I2 � 23.015; therefore, moderator analyses were not conducted. Anal- yses examining publication bias indicated min- imal bias across studies. Rosenthal’s N sug- gested 37 nonsignificant effect sizes would lead to a p value at or above alpha of .05 and Egger’s

Figure 1. Overview of meta-analysis of school connectedness and suicidal thoughts and behaviors in general samples (k � 16, summary odds ratio (OR) calculated with random effects model). LB � Lower Bound; UB � Upper Bound.

Figure 2. Overview of meta-analysis of school connectedness and suicidal ideation in general samples (k � 12, summary odds ratio (OR) calculated with random effects model). LB � Lower Bound; UB � Upper Bound.

14 MARRACCINI AND BRIER

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

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al li

ed pu

bl is

he rs

. T

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ar ti

cl e

is in

te nd

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le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

regression was not significant. Trim and fill analysis did not recommend the imputation of any studies (see supplementary Figure S2e).

Additional School Influences of Suicidal Thoughts and Behavior

We excluded a total of four studies from the quantitative analyses because they used similar measures of school connectedness but identified them as a different construct (e.g., school at- tachment, school engagement, school climate). In general, studies examining STB and con- structs closely aligned to school connectedness demonstrated significant bivariate associations (Borowsky, Taliaferro, & McMorris, 2013; Carter, McGee, Taylor, & Williams, 2007; De Pedro, 2012; Pharris et al., 1997).

Discussion

Findings from the present study, which pooled effect sizes across 18 samples and in- cluded nearly 200,000 participants, clearly in- dicate that students reporting a connection to their schools are significantly less likely to re- port having suicidal thoughts or report making a suicide attempt. Results support the primary

hypothesis that higher school connectedness would relate to reduced reports of STB across general (OR � 0.536), high-risk (OR � 0.603), and sexual minority (OR � 0.608) adolescents. This association was consistent across general adolescent samples when analyzed separately for suicidal ideation (OR � 0.529) and suicide attempts (OR � 0.589). This stability across a diversity of samples, as well as the finding that among general samples these associations re- mained consistent after accounting for varia- tions across ethnic and racial representation and region, underscores the importance of enhanc- ing school connectedness for all students. These findings synthesize a large and fragmented body of literature that has identified school connect- edness as an important protective factor against STB during adolescence.

The nonsignificant results from the modera- tor analyses support the second hypothesis, that effect size variability would remain stable across four categories of school connectedness (social affiliation, belonging, attitude, and envi- ronment). In other words, the association be- tween school connectedness and STB demon- strated comparable magnitudes across studies using a variety of measures of school connect-

Figure 3. Overview of meta-analysis of school connectedness and suicide attempts in general samples (k � 10, summary odds ratio (OR) calculated with random effects model). LB � Lower Bound; UB � Upper Bound.

Figure 4. Overview of meta-analysis of school connectedness and suicidal thoughts and behaviors in high-risk samples (k � 5, summary odds ratio (OR) calculated with random effects model). LB � Lower Bound; UB � Upper Bound.

15SCHOOL CONNECTEDNESS AND SUICIDE

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

ti on

or on

e of

it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

edness. Although preliminary, results suggest that a wide variety of measures of school con- nectedness may be used to support the identifi- cation of youth at-risk for STB, contributing to ongoing discussions about the best measure- ment of school connectedness.

Limitations

Although meta-analysis has a number of methodological strengths, particularly for pool- ing weighted estimates of effects to achieve greater power than individual studies, there are also important limitations to this analysis. Meta- analysis is frequently limited by reduced power for moderator variable detection (Hedges & Pigott, 2004); therefore, the finding that effect size variability did not differ based on the mod- erators of interest may be a result of limited variability as opposed to consistent findings across studies. Indeed, given the significant het- erogeneity between effect sizes indicated by the large I2 statistics, a primary limitation of the present study is that the contributors to variation across effects remain unclear.

A related limitation of meta-analysis pertains to the influence of study methodology on vari- ability of effect sizes. Although moderator anal- ysis did not support heterogeneity of effect sizes due to region of recruitment, measurement of school connectedness, and timeframe of STB, these represent only a sample of the potential differences across study methodology. For ex- ample, variability could be due to participant characteristics (age and grade of students), school characteristics (e.g., private vs. public, size, school climate, etc.), or community char- acteristics.

Meta-analysis is also limited by the potential for publication bias, where null effects may not be adequately represented due to the “file drawer” effect. In addition to including disser- tations, we used a number of methods to mea-

sure publication bias (e.g., trim and fill analysis, etc.) supporting minimal publication bias within the present study. In an effort to further examine the potential for publication bias, we also cal- culated effect sizes from the publically available New York City (NYC) YRBS dataset (NYC Department of Health and Mental Hygiene, 2007; 2009) and compared them to the effect sizes we calculated from Seil and colleagues (2014) peer-reviewed article. The mean effect sizes were comparable, reinforcing the study’s statistical findings of minimal publication bias (see supplementary Table S2).

Results from the present study were also lim- ited by its cross-sectional nature. Although the findings presented here do not allow for tempo- ral inference, it is noteworthy to highlight that effect sizes calculated from the longitudinal analyses part of this study did reflect that school connectedness predicted reduced risk for STB across time, ranging between OR � 0.380 to OR � 0.774 (Kidd et al., 2006; Kidger et al., 2015; Russell & Toomey, 2013).

A final limitation concerning the present study involves its focus on bivariate analyses. Although a portion of the included studies also analyzed school connectedness as a protective factor against STB accounting for additional covariates, only direct effect sizes pertaining to school connectedness and STB were analyzed. Studies that consider multiple contexts in addi- tion to school connectedness have revealed mixed findings depending on the additional variables examined in the model. In general, however, when multiple forms of connected- ness are accounted for, parent and family con- nectedness appear to be the most salient of the connectedness protective factors against STB, whereas school connectedness is often cited as a powerful secondary protective factor for STB (e.g., Borowsky et al., 2013; Eisenberg et al., 2007). Thus, even after accounting for addi-

Figure 5. Overview of meta-analysis of school connectedness and suicide attempts in lesbian, gay, bisexual and transgendered samples (k � 4, summary odds ratio (OR) calculated with random effects model). LB � Lower Bound; UB � Upper Bound.

16 MARRACCINI AND BRIER

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

ti on

or on

e of

it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

tional critical factors associated with STB, school connectedness has shown a positive in- fluence on STB in school aged youth. Consid- ering how well suited schools are for providing prevention efforts at a population level, school connectedness remains a critically important protective factor of STB.

Implications for Research

Although preliminary research supports that school connectedness is associated with re- duced reports of suicidal ideation and attempts between 1 and 2 years later (e.g., Kidger et al., 2012; McNeely & Falci, 2004), the long-term consequences of school connectedness as a pro- tective factor against suicidal outcomes are less certain than the cross-sectional findings de- scribed here. Further research investigating school connectedness as a predictor of STB over time will help elucidate a temporal rela- tionship with STB. Longitudinal research should also identify whether or not there is a critical period of time during development when enhancing school connectedness may be the most effective for preventing suicide.

Another important avenue of research that remains relatively unexplored is school con- nectedness within clinical populations, such as youth hospitalized for STB. To date, the only program designed to support school reintegra- tion following hospitalization for STB is Bridge for Resilient Youth in Transitions (White, Langman, & Henderson, 2006). Its intensive model provides ongoing academic and social support following hospitalization, most likely contributing to enhanced feelings of school con- nectedness. Future research examining school connectedness in clinical populations will be important for the development of school transi- tion programs designed to bolster school con- nectedness.

Finally, future research addressing the lack of evidence-based preventions and interventions for improving school connectedness and preventing suicide will support practical steps toward apply- ing theoretical and empirical findings to practice. Although a recent review of the literature identi- fied four programs that demonstrated improve- ments in school connectedness to reduce risk- taking behavior (Chapman, Buckley, Sheehan, & Shochet, 2013), none of the interventions exam- ined STB as an outcome. The vast majority of

interventions also required systematic school- wide changes, supporting the need for an in- creased understanding of the efficacy of simpler intervention designs (Chapman et al., 2013). Fu- ture interventions should capitalize on the rich literature base examining school connectedness and STB to inform the most salient inquiries and evaluations should be based on meaningful (i.e., behavioral) outcomes.

Implications for Practice

School suicide prevention programs have a long history of promoting a “culture of connect- edness” in order to effectively identify youth con- sidering suicide (Lieberman, Poland, & Cowan, 2006, p. 12; Miller, 2011). By fostering trusting relationships between adults and students, stu- dents are more willing to break promises or se- crecy and seek help when they or their peers experience suicidal thoughts or behaviors (Lieber- man, Poland, & Kornfeld, 2014). Although there is a dearth of evidence-based school suicide pre- vention programs, interventions effective in pre- venting adult suicide have also targeted enhanced social connectedness and belonging (Miller, 2011). Thus, school psychologists should promote school connectedness not only as a method for intervention, but also as a way to lay the ground- work for suicide prevention efforts that rely on a culture of connectedness (Centers for Disease Control and Prevention, 2012; Lieberman et al., 2014.

According to the Wingspread Declaration, to foster school connectedness schools should maintain high and supportive academic expec- tations, fairly apply just disciplinary policies, build trusting school relationships, staff skilled teachers, support high expectations from fam- ily, and ensure that students feel connected to at least one adult in the school (Blum & Libbey, 2004). Because of their expertise in assessment and intervention and their collaborative role in the school, school psychologists are well suited to support increased school connectedness. At the whole school level, school psychologists can work closely with administrators and the school problem-solving team to promote activ- ities supporting student and adult interpersonal interactions. Collaborative efforts can also pro- vide opportunities for student ownership over school policies and school facilities (Waters, Cross, & Runions, 2009; Waters, Cross, &

17SCHOOL CONNECTEDNESS AND SUICIDE

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

ti on

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it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

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fo r

th e

pe rs

on al

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of th

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Shaw, 2010); for example, by way of student government and clubs. As consultants to faculty and staff, school psychologists can foster a col- laborative teaching environment and enhanced faculty-student relationships by encouraging faculty and staff to participate in activities out- side of the classroom (e.g., collaborating across disciplines, standing in the hallways in between class periods).

Particular care should also be taken to identify and support students most at risk to suicide, in- cluding those who feel disconnected from school and who may be less likely to engage in school activities. In addition to educating students, fac- ulty, and staff about suicide warning signs, schools should consider supplementing existing school-wide surveys with a simple measure of school connectedness (i.e., items from the Add Health Survey; Resnick et al., 1997) to identify high-risk youth. Once high-risk students are iden- tified, the school psychologist or another desig- nated staff member may decide a more thorough suicide risk assessment is warranted. When con- ducting these assessments, it is important that the practitioner maintain a connection to the student by being empathic, supportive, and respectful (Lieberman et al., 2014).

Depending on the nature of the student’s risk, school psychologists may implement a targeted intervention designed to increase school con- nectedness or they may refer the student for outside services. For example, school psychol- ogists may consider interventions like Check and Connect, a program that is used to increase school engagement by using systematic moni- toring by way of an assigned mentor (Alvarez & Anderson-Ketchmark, 2010), as well as school- based mentoring programs, which have shown potential for improving student connections, re- duced absenteeism, and disciplinary referrals (Gordon, Downey, & Bangert, 2013). Even in more extreme cases that may require outside services, school psychologists should continue to support student connectedness given that both quality and accessibility of adult relation- ships are critical factors in preventing adoles- cent suicide (Seeley, Rohde, & Jones, 2010).

Conclusion

Results from the present study indicate that students reporting a connection to school are less likely to report having suicidal thoughts or

report making a suicide attempt. Although there are other important protective factors associated with STB, prevention and intervention efforts aimed at bolstering school related influences of STB remain critically important because schools serve the vast majority of youth. There- fore, findings from the present study support recent calls to increase school connectedness across schools worldwide (Blum & Libbey, 2004; Murray & Pianta, 2007). Because find- ings were stable across multiple categories of school connectedness, schools administering school connectedness assessments to aid with suicide prevention efforts should be encouraged to select the simplest and most accessible in- strument. Future research focused on develop- ing and evaluating interventions that target school connectedness to prevent STB will fill a significant gap in the literature.

References

Ainsworth, M. D. (1979). Infant—mother attach- ment. American Psychologist, 34, 932–937. http:// dx.doi.org/10.1037/0003-066X.34.10.932

Alvarez, M. E., & Anderson-Ketchmark, C. (2010). Review of an evidence-based school social work intervention: Check & Connect. Children & Schools, 32, 125–127. http://dx.doi.org/10.1093/ cs/32.2.125

APA Publications and Communications Board Working Group on Journal Article Reporting Stan- dards. (2008). Reporting standards for research in psychology: Why do we need them? What might they be? American Psychologist, 63, 839 – 851. http://dx.doi.org/10.1037/0003-066X.63.9.839

Barber, B. K., & Schluterman, J. M. (2008). Con- nectedness in the lives of children and adolescents: A call for greater conceptual clarity. The Journal of Adolescent Health, 43, 209 –216. http://dx.doi .org/10.1016/j.jadohealth.2008.01.012

Beck-Cross, C. (2012). Individual, family, school, And community predictors Of high school male suicidal behaviors: An analysis of 2010 Iowa Youth Survey data (Doctoral dissertation). Drake University, Des Moines, Iowa. Retrieved from http://www.proquest.com/products-services/ dissertations/Dissertations-Abstract-International .html

Blum, R. W., & Libbey, H. P. (2004). Wingspread declaration on school connections. The Journal of School Health, 74, 233–234. http://dx.doi.org/10 .1111/j.1746-1561.2004.tb08279.x

Bollen, K. A., & Hoyle, R. H. (1990). Perceived cohesion: A conceptual and empirical examina-

18 MARRACCINI AND BRIER

T hi

s do

cu m

en t

is co

py ri

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d by

th e

A m

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an P

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ic al

A ss

oc ia

ti on

or on

e of

it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

tion. Social Forces, 69, 479 –504. http://dx.doi.org/ 10.1093/sf/69.2.479

Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta- analysis. Chichester, UK: Wiley. http://dx.doi.org/ 10.1002/9780470743386

Borenstein, M., Hedges, L. V., Higgins, J., & Roth- stein, H. R. (2015). Biostat: Comprehensive meta- analysis (Version 3) [Computer software]. Re- trieved from http://www.meta-analysis.com

Borowsky, I. W., Taliaferro, L. A., & McMorris, B. J. (2013). Suicidal thinking and behavior among youth involved in verbal and social bullying: Risk and protective factors. Journal of Adolescent Health, 53(Suppl.), S4 –S12. http://dx.doi.org/10 .1016/j.jadohealth.2012.10.280

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Re- trieved from http://www.hup.harvard.edu/

Carter, M., McGee, R., Taylor, B., & Williams, S. (2007). Health outcomes in adolescence: Associa- tions with family, friends and school engagement. Journal of Adolescence, 30, 51– 62. http://dx.doi .org/10.1016/j.adolescence.2005.04.002

Centers for Disease Control and Prevention. (2012). Strategic direction for the prevention of suicidal behavior: Promoting individual, family, and community connectedness to prevent suicidal behavior. Retrieved from http://www.cdc.gov/ ViolencePrevention/pdf/Suicide_Strategic_Di rection_Full_Version-a.pdf

Chapman, R. L., Buckley, L., Sheehan, M., & Shochet, I. (2013). School-based programs for in- creasing connectedness and reducing risk behav- ior: A systematic review. Educational Psychology Review, 25, 95–114. http://dx.doi.org/10.1007/ s10648-013-9216-4

Cole-Lewis, Y. C., Gipson, P. Y., Opperman, K. J., Arango, A., & King, C. A. (2016). Protective role of religious involvement against depression and suicidal ideation among youth with interpersonal problems. Journal of Religion and Health, 55, 1172–1188. http://dx.doi.org/10.1007/s10943-016- 0194-y

De Pedro, K. M. T. (2012). The role of school climate in the mental health and victimization of students in military-connected schools (Doctoral disserta- tion). Available from ProQuest Dissertations and Theses database (UMI No. 3551471).

Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, J., Aragon-Logan, E., & Smith, K. (2012). Na- tional Survey of Child and Adolescent Well-Being (NSACW): NSCAWII combined waves 1–2 data file user’s manual, restricted release version. Ithaca, NY: Cornell University, National Data Ar- chive on Child Abuse and Neglect.

Duong, J., & Bradshaw, C. (2014). Associations be- tween bullying and engaging in aggressive and suicidal behaviors among sexual minority youth: The moderating role of connectedness. The Jour- nal of School Health, 84, 636 – 645. http://dx.doi .org/10.1111/josh.12196

Eisenberg, M. E., Ackard, D. M., & Resnick, M. D. (2007). Protective factors and suicide risk in ado- lescents with a history of sexual abuse. The Jour- nal of Pediatrics, 151, 482– 487. http://dx.doi.org/ 10.1016/j.jpeds.2007.04.033

Furlong, M. J., O’brennan, L. M., & You, S. (2011). Psychometric properties of the Add Health School Connectedness Scale for 18 sociocultural groups. Psychology in the Schools, 48, 986 –997. http://dx .doi.org/10.1002/pits.20609

Goodenow, C. (1993). The psychological sense of school membership among adolescents: Scale de- velopment and educational correlates. Psychology in the Schools, 30, 79 –90. http://dx.doi.org/10 .1002/1520-6807(199301)30:1�79::AID-PIT S2310300113�3.0.CO;2-X

Gordon, J., Downey, J., & Bangert, A. (2013). Ef- fects of a school-based mentoring program on school behavior and measures of adolescent con- nectedness. The School Community Journal, 23, 227–250. Retrieved from http://www.schoolcom munitynetwork.org/SCJ.aspx

Govender, K., Naicker, S. N., Meyer-Weitz, A., Fan- ner, J., Naidoo, A., & Penfold, W. L. (2013). Associations between perceptions of school con- nectedness and adolescent health risk behaviors in South African high school learners. The Journal of School Health, 83, 614 – 622. http://dx.doi.org/10 .1111/josh.12073

He, A. S., Fulginiti, A., & Finno-Velasquez, M. (2015). Connectedness and suicidal ideation among adolescents involved with child welfare: A national survey. Child Abuse & Neglect: The In- ternational Journal, 42, 54 – 62. http://dx.doi.org/ 10.1016/j.chiabu.2015.02.016

Hedges, L. V., & Pigott, T. D. (2004). The power of statistical tests for moderators in meta-analysis. Psychological Methods, 9, 426 – 445. http://dx.doi .org/10.1037/1082-989X.9.4.426

Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327, 557– 560. http://dx.doi.org/10.1136/bmj.327.7414.557

Kaminski, J. W., Puddy, R. W., Hall, D. M., Cash- man, S. Y., Crosby, A. E., & Ortega, L. A. (2010). The relative influence of different domains of so- cial connectedness on self-directed violence in ad- olescence. Journal of Youth and Adolescence, 39, 460 – 473. http://dx.doi.org/10.1007/s10964-009- 9472-2

Kidd, S., Henrich, C. C., Brookmeyer, K. A., David- son, L., King, R. A., & Shahar, G. (2006). The

19SCHOOL CONNECTEDNESS AND SUICIDE

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

ti on

or on

e of

it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

social context of adolescent suicide attempts: In- teractive effects of parent, peer, and school social relations. Suicide and Life-Threatening Behavior, 36, 386 –395. http://dx.doi.org/10.1521/suli.2006 .36.4.386

Kidger, J., Araya, R., Donovan, J., & Gunnell, D. (2012). The effect of the school environment on the emotional health of adolescents: A systematic review. Pediatrics, 129, 925–949. http://dx.doi .org/10.1542/peds.2011-2248

Kidger, J., Heron, J., Leon, D. A., Tilling, K., Lewis, G., & Gunnell, D. (2015). Self-reported school experience as a predictor of self-harm during ad- olescence: A prospective cohort study in the South West of England (ALSPAC). Journal Of Affective Disorders, 173, 163–169. http://dx.doi.org/10 .1016/j.jad.2014.11.003

Langille, D. B., Asbridge, M., Cragg, A., & Rasic, D. (2015). Associations of School Connectedness With Adolescent Suicidality: Gender Differences and the Role of Risk of Depression. The Canadian Journal of Psychiatry/La Revue canadienne de psychiatrie, 60, 258 –267.

Lieberman, R., Poland, S., & Cowan, K. (2006). Sui- cide prevention and intervention. Principal Leader- ship, 7, 11–15. Retrieved from http://www.nasp online.org/assets/documents/Resources%20and %20Publications/Handouts/Families%20and%20 Educators/Suicide%20Intervention%20in%20Secon dary%20Schoools%20NASSP%20Oct%202006.pdf

Lieberman, R., Poland, S., & Kornfeld, C. (2014). Best practices in suicide prevention and interven- tion. In P. L. Harrison & A. Thomas (Eds.), Best practices in school psychology: System-level ser- vices (pp. 273–288). Bethesda, MD: National As- sociation of School Psychologists.

Lipsey, D. W., & Wilson, D. B. (2001). Practical meta-analysis (Vol. 49). Thousand Oaks, CA: Sage Publications.

Logan, J. E. (2009). Prevention factors for suicide ideation among abused pre/early adolescent youths. Injury Prevention, 15, 278 –280. http://dx .doi.org/10.1136/ip.2008.020966

Logan, J. E., Crosby, A. E., & Hamburger, M. E. (2011). Suicidal ideation, friendships with delin- quents, social and parental connectedness, and dif- ferential associations by sex: Findings among high-risk pre/early adolescent population. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 32, 299 –309. http://dx.doi.org/10 .1027/0227-5910/a000091

Lohmeier, J. H., & Lee, S. W. (2011). A school connectedness scale for use with adolescents. Ed- ucational Research and Evaluation, 17, 85–95. http://dx.doi.org/10.1080/13803611.2011.597108

Markham, C. M., Lormand, D., Gloppen, K. M., Peskin, M. F., Flores, B., Low, B., & House, L. D. (2010). Connectedness as a predictor of sexual and

reproductive health outcomes for youth. Journal of Adolescent Health, 46(Suppl.), S23–S41. http://dx .doi.org/10.1016/j.jadohealth.2009.11.214

McNeely, C., & Falci, C. (2004). School connected- ness and the transition into and out of health-risk behavior among adolescents: A comparison of so- cial belonging and teacher support. The Journal of School Health, 74, 284 –292. http://dx.doi.org/10 .1111/j.1746-1561.2004.tb08285.x

Miller, D. N. (2011). Child and adolescent suicidal behavior: School-based prevention, assessment, and intervention. New York, NY: Guilford Press.

Murray, C., & Pianta, R. C. (2007). The importance of teacher-student relationships for adolescents with high incidence disabilities. Theory into Prac- tice, 46, 105–112. http://dx.doi.org/10.1080/ 00405840701232943

Neumark-Sztainer, D., Story, M., French, S. A., & Resnick, M. D. (1997). Psychosocial correlates of health compromising behaviors among adoles- cents. Health Education Research, 12, 37–52. http://dx.doi.org/10.1093/her/12.1.37

New York City Department of Health and Mental Hygiene in collaboration with the NYC Depart- ment of Education. (2007). Youth Risk Behavior Survey. Retrieved from http://www1.nyc.gov/site/ doh/data/data-sets/nyc-youth-risk-behavior-survey .page

New York City Department of Health and Mental Hygiene in collaboration with the NYC Depart- ment of Education. (2009). Youth Risk Behavior Survey. Retrieved from http://www1.nyc.gov/site/ doh/data/data-sets/nyc-youth-risk-behavior-survey .page

Pharris, M. D., Resnick, M. D., & Blum, R. W. (1997). Protecting against hopelessness and suicid- ality in sexually abused American Indian adoles- cents. Journal of Adolescent Health, 21, 400 – 406. http://dx.doi.org/10.1016/S1054-139X(97)00 166-3

Resnick, M. D., Bearman, P. S., Blum, R. W., Bau- man, K. E., Harris, K. M., Jones, J., . . . the Findings from the National Longitudinal Study on Adolescent Health. (1997). Protecting adolescents from harm. Journal of the American Medical As- sociation, 278, 823– 832. http://dx.doi.org/10 .1001/jama.1997.03550100049038

Russell, S. T., & Toomey, R. B. (2013). Risk and protective factors for suicidal thoughts among sex- ual minority youth: Evidence from the Add Health study. Journal of Gay & Lesbian Mental Health, 17, 132–149. http://dx.doi.org/10.1080/19359705 .2012.753398

Sampasa-Kanyinga, H., & Hamilton, H. A. (2016). Does socioeconomic status moderate the relation- ships between school connectedness with psycho- logical distress, suicidal ideation and attempts in adolescents? Preventive Medicine: An Interna-

20 MARRACCINI AND BRIER

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an P

sy ch

ol og

ic al

A ss

oc ia

ti on

or on

e of

it s

al li

ed pu

bl is

he rs

. T

hi s

ar ti

cl e

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

tional Journal Devoted to Practice and Theory, 87, 11–17. http://dx.doi.org/10.1016/j.ypmed.2016.02 .010

Seeley, J. R., Rohde, P., & Jones, L. (2010). School- based prevention and intervention for depression and suicidal behavior. In M. R. Shinn & H. M. Walker (Eds.), Interventions for achievement and behavior problems in a three-tier model including RTI (pp. 363–396). Bethesda, MD: National Asso- ciation of School Psychologists.

Seil, K. S., Desai, M. M., & Smith, M. V. (2014). Sexual orientation, adult connectedness, substance use, and mental health outcomes among adoles- cents: Findings from the 2009 New York City Youth Risk Behavior Survey. Journal Information, 104, 1950 –1956. http://dx.doi.org/10.2105/AJPH .2014.302050

Stone, D. M., Luo, F., Lippy, C., & McIntosh, W. L. (2015). The role of social connectedness and sex- ual orientation in the prevention of youth suicide ideation and attempts among sexually active ado- lescents. Suicide & Life-Threatening Behavior, 45, 415– 430. http://dx.doi.org/10.1111/sltb.12139

Tang, T. C., Ko, C. H., Yen, J. Y., Lin, H. C., Liu, S. C., Huang, C. F., & Yen, C. F. (2009). Suicide and its association with individual, family, peer, and school factors in an adolescent population in southern Taiwan. Suicide & Life-Threatening Be- havior, 39, 91–102. http://dx.doi.org/10.1521/suli .2009.39.1.91

Vaux, A. (1988). Social support: Theory, research, and intervention. New York, NY: Praeger Publish- ers.

Waters, S., & Cross, D. (2010). Measuring students’ connectedness to school, teachers, and family: Validation of three scales. School Psychology Quarterly, 25, 164 –177. http://dx.doi.org/10.1037/ a0020942

Waters, S. K., Cross, D. S., & Runions, K. (2009). Social and ecological structures supporting adoles- cent connectedness to school: A theoretical model. The Journal of School Health, 79, 516 –524. http:// dx.doi.org/10.1111/j.1746-1561.2009.00443.x

Waters, S., Cross, D., & Shaw, T. (2010). Does the nature of schools matter? An exploration of se- lected school ecology factors on adolescent per- ceptions of school connectedness. British Journal

of Educational Psychology, 80, 381– 402. http://dx .doi.org/10.1348/000709909X484479

West, P. H. S. A. L., Sweeting, H., & Leyland, A. (2004). School effects on pupils’ health behav- iours: Evidence in support of the health promoting school. Research Papers in Education, 19, 261– 291. http://dx.doi.org/10.1080/02671522.2004 .10058645

Whitaker, K., Shapiro, V. B., & Shields, J. P. (2016). School-based protective factors related to suicide for lesbian, gay, and bisexual adolescents. The Journal of Adolescent Health, 58, 63– 68. http://dx .doi.org/10.1016/j.jadohealth.2015.09.008

White, H., Langman, N., & Henderson, S. (2006). A school-based transition program for high-risk ad- olescents. Psychiatric Services, 57, 1211. http://dx .doi.org/10.1176/ps.2006.57.8.1211

Whitlock, J., Wyman, P. A., & Moore, S. R. (2014). Connectedness and suicide prevention in adoles- cents: Pathways and implications. Suicide and Life-Threatening Behavior, 44, 246 –272. http://dx .doi.org/10.1111/sltb.12071

World Health Organization. (2016). World health statistics 2016: Monitoring health for the SDGs, sustainable development goals. Retrieved from http://www.who.int/gho/publications/world_ health_statistics/2016/en/

Yeaton, W. H., & Wortman, P. M. (1993). On the reliability of meta-analytic reviews the role of in- tercoder agreement. Evaluation Review, 17, 292– 309. http://dx.doi.org/10.1177/0193841X9301 700303

Yen, C.-F., & Shieh, B.-L. (2005). Suicidal ideation and correlates in Taiwanese adolescent metham- phetamine users. Journal of Nervous and Mental Disease, 193, 444 – 449. http://dx.doi.org/10.1097/ 01.nmd.0000168243.59956.dd

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. http:// dx.doi.org/10.1186/1471-2458-11-874

Received September 6, 2016 Revision received November 24, 2016

Accepted November 30, 2016 �

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