The role of schools in children and young people’s self-harm and suicide: systematic review and meta-ethnography of qualitative research

Abstract

Background: Evidence reports that schools influence children and young people's health behaviours across a range of outcomes. However there remains limited understanding of the mechanisms through which institutional features may structure self-harm and suicide. This paper reports on a systematic review and meta-ethnography of qualitative research exploring how schools influence self-harm and suicide in students. Methods: Systematic searches were conducted of nineteen databases from inception to June 2015. English language, primary research studies, utilising any qualitative research design to report on the influence of primary or secondary educational settings (or international equivalents) on children and young people's self-harm and suicide were included. Two reviewers independently appraised studies against the inclusion criteria, assessed quality, and abstracted data. Data synthesis was conducted in adherence with Noblit and Hare's meta-ethnographic approach. Of 6744 unique articles identified, six articles reporting on five studies were included in the meta-ethnography. Results: Five meta-themes emerged from the studies. First, self-harm is often rendered invisible within educational settings, meaning it is not prioritised within the curriculum despite students' expressed need. Second, where self-harm transgresses institutional rules it may be treated as 'bad behaviour', meaning adequate support is denied. Third, schools' informal management strategy of escalating incidents of self-harm to external 'experts' serves to contribute to non-help seeking behaviour amongst students who desire confidential support from teachers. Fourth, anxiety and stress associated with school performance may escalate self-harm and suicide. Fifth, bullying within the school context can contribute to self-harm, whilst some young people may engage in these practices as initiation into a social group.

Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses

“…This approach was developed by Noblit and Hare 156 and has proved to be a useful method to interpret findings across multiple qualitative studies in health research. [157][158][159] Metaethnography aims to create new interpretations through a process of reciprocal translation and refutation across studies. Translation involves establishing a common language of interpretation between or among the included studies and refutation involves the explanation of contradictory findings.…”

Adolescent self‐harm prevention and intervention in secondary schools: a survey of staff in England and Wales

“…This is because, in alignment with the complex systems perspective, intervention can be seen as an attempt to disrupt existing system dynamics, where entrenched structures and resources may work to support or reject the introduction of a new approach (Fletcher et al., ; Keshavarz, Nutbeam, Rowling, & Khavarpour, ; Moore & Evans, ). A recent systematic review and meta‐ethnography of international qualitative evidence on the role of schools in adolescent self‐harm and suicide found that it is often not prioritised (Evans & Hurrell, ). There is a culture of fear amongst staff (Best, ; Dowling & Doyle, ), with many school professionals feeling ill equipped to manage behaviours (Berger, Hasking, & Reupert, 2014a, 2014b; De Riggi et al., ).…”

A small-scale study investigating staff and student perceptions of the barriers to a preventative approach for adolescent self-harm in secondary schools in Wales—a grounded theory model of stigma

“…34 35 This is why the initial grounded theory model is useful, revealing the specific characteristics of public stigma 36 surrounding adolescent self-harm within the two secondary school contexts. To date this is a limited research area, 37 which the current study contributes to. Furthermore, the negative consequences of public stigma, which include social exclusion and health inequalities, 38 are likely to be severe at times for the adolescent self-harm population group.…”

“…Exploration of the school-based contextual influences, including their risk and protective factors upon self-harm, is warranted. 39 The grounded theory model reveals adolescent self-harm as a powerful stigma marker, 40 which levers differentiation and the resulting negative behaviours within the school context; another term for this is discrimination. Unpacking this point through the social and medical model perspectives embedded within the UK's 2010 Equality Act, 41 adolescent self-harm can be a fluctuating condition that may substantially impair ability at times, and is therefore a protected characteristic under the Act.…”