Skip to main content

Stressful psychosocial school environment and suicidal ideation in Chinese adolescents

Abstract

Purpose

Suicide is one of the leading causes of death during adolescence worldwide. This study, using a sample of Chinese adolescents, examines associations of a stressful psychosocial school environment with suicidal ideation, which were rarely investigated so far.

Methods

A total of 1,004 Chinese students (468 boys and 536 girls) from Grade 7–12 were recruited into our questionnaire survey. Psychosocial school environment was measured by the effort–reward imbalance questionnaire adapted to the school setting, and suicidal ideation was assessed by a standardized question. Multivariate logistic regression was applied, adjusting odds ratios for age, gender, grade, smoking, alcohol drinking, physical activity, family wealth, and self-rated health.

Results

In school settings, 10.86 % students reported suicidal ideation during the last 6 months, which was found to be significantly related to both effort and reward. Remarkably, effort–reward imbalance was associated with elevated risk of suicidal ideation (odds ratio = 1.77, 95 % confidence interval = 1.34–2.35).

Conclusions

This study finds significant associations between a stressful psychosocial school environment in terms of effort–reward imbalance and suicidal ideation in Chinese adolescents. Preventive actions aiming at reducing this imbalance may define a promising approach towards a healthy psychosocial school environment.

This is a preview of subscription content, access via your institution.

References

  1. Wasserman D, Cheng Q, Jiang GX (2005) Global suicide rates among young people aged 15–19. World Psychiatry 4(2):114–120

    PubMed Central  PubMed  Google Scholar 

  2. Bursztein C, Apter A (2009) Adolescent suicide. Curr Opin Psychiatry 22(1):1–6

    PubMed  Article  Google Scholar 

  3. Cash SJ, Bridge JA (2009) Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr 21(5):613–619

    PubMed Central  PubMed  Article  Google Scholar 

  4. Evans E, Hawton K, Rodham K (2004) Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. Clin Psychol Rev 24(8):957–979

    PubMed  Article  Google Scholar 

  5. Amitai M, Apter A (2012) Social aspects of suicidal behavior and prevention in early life: a review. Int J Environ Res Public Health 9(3):985–994

    PubMed  Article  Google Scholar 

  6. 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

    PubMed Central  PubMed  Article  Google Scholar 

  7. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, Currie C (2012) Adolescence and the social determinants of health. Lancet 379(9826):1641–1652

    PubMed  Article  Google Scholar 

  8. Li J, Shang L, Wang T, Siegrist J (2010) Measuring effort–reward imbalance in school settings: a novel approach and its association with self-rated health. J Epidemiol 20(2):111–118

    CAS  PubMed  Article  Google Scholar 

  9. Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41

    CAS  PubMed  Article  Google Scholar 

  10. Stansfeld S, Candy B (2006) Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health 32(6):443–462

    PubMed  Article  Google Scholar 

  11. Backé EM, Seidler A, Latza U, Rossnagel K, Schumann B (2012) The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Arch Occup Environ Health 85(1):67–79

    PubMed Central  PubMed  Article  Google Scholar 

  12. Mann JJ, Waternaux C, Haas GL, Malone KM (1999) Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 156(2):181–189

    CAS  PubMed  Google Scholar 

  13. Mann JJ (2013) The serotonergic system in mood disorders and suicidal behaviour. Philos Trans R Soc Lond B Biol Sci 368(1615):20120537

    PubMed  Article  Google Scholar 

  14. Hen M, Goroshit M (2012) Academic procrastination, emotional intelligence, academic self-efficacy, and GPA: a comparison between students with and without learning disabilities. J Learn Disabil. doi:10.1177/0022219412439325

    PubMed  Google Scholar 

  15. Geisthardt C, Munsch J (1996) Coping with school stress: a comparison of adolescents with and without learning disabilities. J Learn Disabil 29(3):287–296

    CAS  PubMed  Article  Google Scholar 

  16. Blum RW, Kelly A, Ireland M (2001) Health-risk behaviors and protective factors among adolescents with mobility impairments and learning and emotional disabilities. J Adolesc Health 28(6):481–490

    CAS  PubMed  Article  Google Scholar 

  17. Hurtig T, Taanila A, Moilanen I, Nordström T, Ebeling H (2012) Suicidal and self-harm behaviour associated with adolescent attention deficit hyperactivity disorder-a study in the Northern Finland Birth Cohort 1986. Nord J Psychiatry 66(5):320–328

    PubMed  Article  Google Scholar 

  18. O’Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM (1996) Beyond the tower of babel: a nomenclature for suicidology. Suicide Life Threat Behav 26(3):237–252

    PubMed  Google Scholar 

  19. Baca-Garcia E, Perez-Rodriguez MM, Oquendo MA, Keyes KM, Hasin DS, Grant BF, Blanco C (2011) Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior. J Affect Disord 134(1–3):327–332

    PubMed Central  PubMed  Article  Google Scholar 

  20. Crystal DS, Chen C, Fuligni AJ, Stevenson HW, Hsu CC, Ko HJ, Kitamura S, Kimura S (1994) Psychological maladjustment and academic achievement: a cross-cultural study of Japanese, Chinese, and American high school students. Child Dev 65(3):738–753

    CAS  PubMed  Article  Google Scholar 

  21. United Nations Educational, Scientific and Cultural Organization (2011) International Standard Classification of Education. IOP Publishing PhysicsWeb. http://www.uis.unesco.org/Education/Documents/UNESCO_GC_36C-19_ISCED_EN.pdf. Accessed 15 May 2013

  22. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R (2004) The measurement of effort–reward imbalance at work: European comparisons. Soc Sci Med 58(8):1483–1499

    PubMed  Article  Google Scholar 

  23. Zullig KJ, Pun S, Patton JM, Ubbes VA (2006) Reliability of the 2005 middle school Youth Risk Behavior Survey. J Adolesc Health 39(6):856–860

    PubMed  Article  Google Scholar 

  24. Swahn MH, Bossarte RM, Choquet M, Hassler C, Falissard B, Chau N (2012) Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health 57(1):95–105

    PubMed  Article  Google Scholar 

  25. Wang RH, Lai HJ, Hsu HY, Hsu MT (2011) Risk and protective factors for suicidal ideation among Taiwanese adolescents. Nurs Res 60(6):413–421

    PubMed  Article  Google Scholar 

  26. Evans E, Hawton K, Rodham K, Deeks J (2005) The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide Life Threat Behav 35(3):239–250

    PubMed  Article  Google Scholar 

  27. Juan W, Xiao-Juan D, Jia-Ji W, Xin-Wang W, Liang X (2010) The associations between health risk behaviors and suicidal ideation and attempts in an urban Chinese sample of adolescents. J Affect Disord 126(1–2):180–187

    PubMed  Article  Google Scholar 

  28. Langille DB, Asbridge M, Kisely S, Rasic D (2012) Suicidal behaviours in adolescents in Nova Scotia, Canada: protective associations with measures of social capital. Soc Psychiatry Psychiatr Epidemiol 47(10):1549–1555

    PubMed  Article  Google Scholar 

  29. Cheung YT, Wong PW, Lee AM, Lam TH, Fan YS, Yip PS (2013) Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-012-0640-4

    PubMed  Google Scholar 

  30. Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, Picket W, Richter M, Morgan A, Barnekow V (2008) Inequalities in young people’s health: international report from the HBSC 2006/06 survey. WHO policy series: health policy for children and adolescents Issue 5. WHO Regional Office for Europe, Copenhagen

  31. Li Y, Li Y, Cao J (2012) Factors associated with suicidal behaviors in mainland China: a meta-analysis. BMC Public Health 12:524

    PubMed Central  PubMed  Article  Google Scholar 

  32. Liu Y, Lu Z (2012) Chinese high school students’ academic stress and depressive symptoms: gender and school climate as moderators. Stress Health 28(4):340–346

    PubMed  Article  Google Scholar 

  33. Hesketh T, Ding QJ, Jenkins R (2002) Suicide ideation in Chinese adolescents. Soc Psychiatry Psychiatr Epidemiol 37(5):230–235

    CAS  PubMed  Article  Google Scholar 

  34. Liu X, Tein JY (2005) Life events, psychopathology, and suicidal behavior in Chinese adolescents. J Affect Disord 86(2–3):195–203

    PubMed  Article  Google Scholar 

  35. Cui S, Cheng Y, Xu Z, Chen D, Wang Y (2011) Peer relationships and suicide ideation and attempts among Chinese adolescents. Child Care Health Dev 37(5):692–702

    CAS  PubMed  Article  Google Scholar 

  36. Jablonska B, Lindberg L, Lindblad F, Rasmussen F, Ostberg V, Hjern A (2009) School performance and hospital admissions due to self-inflicted injury: a Swedish national cohort study. Int J Epidemiol 38(5):1334–1341

    PubMed  Article  Google Scholar 

  37. Gunnell D, Löfving S, Gustafsson JE, Allebeck P (2011) School performance and risk of suicide in early adulthood: follow-up of two national cohorts of Swedish schoolchildren. J Affect Disord 131(1–3):104–112

    CAS  PubMed  Article  Google Scholar 

  38. Wahrendorf M, von dem Knesebeck O, Siegrist J (2006) Social productivity and well-being of older people: baseline results from the SHARE study. Eur J Ageing 3(2):67–73

    Article  Google Scholar 

  39. Sperlich S, Arnhold-Kerri S, Siegrist J, Geyer S (2013) The mismatch between high effort and low reward in household and family work predicts impaired health among mothers. Eur J Public Health. doi:10.1093/eurpub/cks134

    PubMed  Google Scholar 

  40. Siegrist J (2005) Social reciprocity and health: new scientific evidence and policy implications. Psychoneuroendocrinology 30(10):1033–1038

    PubMed  Article  Google Scholar 

  41. Piko BF (2007) Self-perceived health among adolescents: the role of gender and psychosocial factors. Eur J Pediatr 166(7):701–708

    PubMed  Article  Google Scholar 

  42. Xu Z, Su H, Zou Y, Chen J, Wu J, Chang W (2011) Self-rated health of Chinese adolescents: distribution and its associated factors. Scand J Caring Sci 25(4):780–786

    PubMed  Article  Google Scholar 

  43. Eaton DK, Foti K, Brener ND, Crosby AE, Flores G, Kann L (2011) Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students? Arch Suicide Res 15(2):113–126

    PubMed  Article  Google Scholar 

  44. Eaton DK, Lowry R, Brener ND, Galuska DA, Crosby AE (2005) Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students. Arch Pediatr Adolesc Med 159(6):513–519

    PubMed  Article  Google Scholar 

  45. Robinson J, Cox G, Malone A, Williamson M, Baldwin G, Fletcher K, O’Brien M (2013) A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide- related behavior in young people. Crisis 34(3):164–182

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank all the students who participated in the questionnaire survey. We also gratefully acknowledge Qing Li and Kunrong Shang from the Panlong District Education Bureau, Kunming City, for their excellent organization in data collection. This research was partly supported by a Marie Curie International Incoming Fellowship within the 7th European Community Framework Programme (PIIF-GA-2008-220641).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jian Li.

Additional information

L. Shang and J. Li contributed equally.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shang, L., Li, J., Li, Y. et al. Stressful psychosocial school environment and suicidal ideation in Chinese adolescents. Soc Psychiatry Psychiatr Epidemiol 49, 205–210 (2014). https://doi.org/10.1007/s00127-013-0728-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0728-5

Keywords

  • Psychosocial school environment
  • Effort–reward imbalance
  • Suicidal ideation
  • Adolescents