The role of schools in children and young people's self-harm and suicide: systematic review and meta-ethnography of qualitative research.
The role of schools in children and young people's self-harm and suicide: systematic review and meta-ethnography of qualitative research.
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DOI：
10.1186/s12889-016-3065-2
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发表时间：
2016-05-14
影响因子：
4.5
通讯作者：
Hurrell C
中科院分区：
文献类型：
--
作者：
Evans R;Hurrell C
有证据表明，学校会在一系列结果中影响儿童和青少年的健康行为。然而，对于制度特征可能构成自残和自杀的机制的了解仍然有限。本文报告了对定性研究的系统回顾和元人种学研究，探讨学校如何影响学生的自残和自杀。从成立到 2015 年 6 月，我们对 19 个数据库进行了系统检索。其中包括英语、初级研究、利用任何定性研究设计来报告中小学教育环境（或国际同等教育环境）对儿童和青少年自残和自杀的影响。两名评审员根据纳入标准独立评估研究，评估质量并提取数据。数据合成是按照 Noblit 和 Hare 的元民族志方法进行的。在确定的 6744 篇独特文章中，元民族志中包含了 6 篇报告五项研究的文章。研究中出现了五个元主题。首先，自残在教育环境中常常被忽视，这意味着尽管学生表达了需要，但在课程中它并未被优先考虑。其次，如果自残违反了制度规则，它可能会被视为“不良行为”，这意味着得不到足够的支持。第三，学校将自残事件升级给外部“专家”的非正式管理策略，导致了那些希望得到老师保密支持的学生不寻求帮助的行为。第四，与学校表现相关的焦虑和压力可能会加剧自残和自杀。第五，学校环境中的欺凌可能导致自残，而一些年轻人可能会在加入社会群体时参与这些行为。学校可能会影响儿童和青少年的自残，尽管其对自杀影响的证据仍然有限。预防和干预需要承认并适应这些制度层面的因素。本综述中包含的研究由于缺乏概念丰富性而受到限制，限制了解释性综合的过程。进一步的定性研究应侧重于不断发展对制度特征与学生自残和自杀之间关系的理论和实证洞察。
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. 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. 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. Schools may influence children and young people’s self-harm, although evidence of their impact on suicide remains limited. Prevention and intervention needs to acknowledge and accommodate these institutional-level factors. Studies included in this review are limited by their lack of conceptual richness, restricting the process of interpretative synthesis. Further qualitative research should focus on the continued development of theoretical and empirical insight into the relationship between institutional features and students’ self-harm and suicide.