Young et al. BMC Public Health 2011, 11:874 http://www.biomedcentral.com/1471-2458/11/874 R E S E A R C H A R T I C L E Open Access Do schools differ in suicide risk? The influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils Robert Young*, Helen Sweeting and Anne Ellaway Abstract Background: Rates of suicide and poor mental health are high in environments (neighbourhoods and institutions) where individuals have only weak social ties, feel socially disconnected and experience anomie - a mismatch between individual and community norms and values. Young people spend much of their time within the school environment, but the influence of school context (school connectedness, ethos and contextual factors such as school size or denomination) on suicide-risk is understudied. Our aim is to explore if school context is associated with rates of attempted suicide and suicide-risk at age 15 and self-harm at age 19, adjusting for confounders. Methods: A longitudinal school-based survey of 1698 young people surveyed when aged 11, (primary school), 15 (secondary school) and in early adulthood (age 19). Participants provided data about attempted suicide and suicide-risk at age 15 and deliberate self-harm at 19. In addition, data were collected about mental health at age 11, social background (gender, religion, etc.), and at age 15, perception of local area (e.g. neighbourhood cohesion, safety/civility and facilities), school connectedness (school engagement, involvement, etc.) and school context (size, denomination, etc.). A dummy variable was created indicating a religious ‘mismatch’, where pupils held a different faith from their school denomination. Data were analysed using multilevel logistic regression. Results: After adjustment for confounders, pupils attempted suicide, suicide-risk and self-harm were all more likely among pupils with low school engagement (15-18% increase in odds for each SD change in engagement). While holding Catholic religious beliefs was protective, attending a Catholic school was a risk factor for suicidal behaviours. This pattern was explained by religious ‘mismatch’: pupils of a different religion from their school were approximately 2-4 times more likely to attempt suicide, be a suicide-risk or self-harm. Conclusions: With several caveats, we found support for the importance of school context for suicidality and self- harm. School policies promoting school connectedness are uncontroversial. Devising a policy to reduce risks to pupils holding a different faith from that of their school may be more problematic. Background An act of suicide is influenced by both individual risk (e. g. pre-existing mental health problems or stress) and the social and environmental context in which an individual is embedded (e.g. a supportive environment and prevail- ing moral norms against suicide) [1]. During the ‘teen years’ the incidence of suicide attempts, suicide ideation * Correspondence: robert@sphsu.mrc.ac.uk MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK and self-harm peak [2] and suicide is a leading cause of death [1]. This is probably attributable to the increased individual risk factors associated with this transitional life-stage, such as pubertal changes, increased stress, depression and impulsiveness, although background fac- tors such as family situation or socioeconomic circum- stances are all important predictors [1]. During this period there are two major sources of environmental or contextual influence; school and neighbourhood. Given the amount of time young people spend in each [3], © 2011 Young et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.