School Dropout and Suicide: Common Risk Factors and Prevention Strategies
As you have read in chapter 6 of the textbook, a variety of factors contribute to high school dropout. While the dropout problem is not often discussed along with the issues of youth mental health and suicide, there are connections in terms of the risk and protective factors for both problems. For this discussion, please read textbook chapters 6 and 10 and this article from the Journal of Adolescent Health- Revisiting the Link Between Depression Symptoms and High School Dropout: Timing of Exposure Matters and then discuss the following points in a post of approximately 250 words:
· What are some of the common risk and protective factors for school dropout and youth suicide? Cite specific facts from the reading and/or other sources.
· Of the four types of dropout types described in chapter 6, which ones would be most at risk for mental health problems and suicide? Explain your reasoning.
· Describe a strategy that a school might implement to prevent both dropouts and suicide among students. Explain why you believe this strategy is likely to be effective.
The book is At-Risk Youth 6th edition from J. Jeffries McWhirter. Please use the pages provided to answer the questions. Also, there is an article that you have to read. Please provide a reference sheet in APA style when citing use APA style. I provided chapters 6 and 10 below this page.
Chapter 10
Revisiting the Link Between Depression Symptoms and High School Dropout: Timing of Exposure Matters
Original article
Revisiting the Link Between Depression Symptoms and High
School Dropout: Timing of Exposure Matters
Véronique Dupéré, Ph.D. a,*, Eric Dion, Ph.D. b, Frédéric Nault-Brière, Ph.D. a,
Isabelle Archambault, Ph.D. a, Tama Leventhal, Ph.D. c, and Alain Lesage, MD d
a
School of Educational Psychology (École de psychoéducation), Université de Montréal, Montreal, Quebec, Canada
Department of Special Education, Université du Québec à Montréal, Montréal, Quebec, Canada
c
Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, Massachusetts
d
Department of Psychiatry, Université de Montréal, Montréal, Quebec, Canada
Article history: Received June 15, 2017; Accepted September 15, 2017
Keywords: Depression symptoms; High school dropout; Late adolescence
A B S T R A C T
Purpose: Recent reviews concluded that past depression symptoms are not independently asso-
ciated with high school dropout, a conclusion that could induce schools with high dropout rates
and limited resources to consider depression screening, prevention, and treatment as low-
priority. Even if past symptoms are not associated with dropout, however, it is possible that recent
symptoms are. The goal of this study was to examine this hypothesis.
Methods: In 12 disadvantaged high schools in Montreal (Canada), all students at least 14 years
of age were first screened between 2012 and 2015 (Nscreened = 6,773). Students who dropped out
of school afterward (according to school records) were then invited for interviews about their mental
health in the past year. Also interviewed were matched controls with similar risk profiles but who
emained in school, along with average not at-risk schoolmates (Ninterviewed = 545). Interviews were
conducted by trained graduate students.
Results: Almost one dropout out of four had clinically significant depressive symptoms in the 3
months before leaving school. Adolescents with recent symptoms had an odd of dropping out more
than twice as high as their peers without such symptoms (adjusted odds ratio = 2.17; 95% confi-
dence interval = 1.14–4.12). In line with previous findings, adolescents who had recovered from
earlier symptoms were not particularly at risk.
Conclusions: These findings suggest that to improve disadvantaged youths’ educational out-
comes, investments in comprehensive mental health services are needed in schools struggling with
high dropout rates, the very places where adolescents with unmet mental health needs tend to
concentrate.
© 2017 Society for Adolescent Health and Medicine. All rights reserved.
IMPLICATIONS AND
CONTRIBUTIONS
Recent reviews concluded
that past symptoms of
depression are not inde-
pendently associated with
high school dropout.
Results of the present study
find that recent symptoms
are, thus underscoring the
potential of school-based
mental health programs to
hit two targets with one
shot, by improving adoles-
cent mental health and
educational/vocational
outcomes.
Adolescents should be a priority target for screening, preven-
tion, and treatment of mental health problems [1,2]. First,
adolescence is a critical developmental period during which many
common mental health problems emerge [3]. For instance, among
15–16 years old, about one out of six adolescents experience majo
depression [4]. Second, untreated mental health problems during
Conflicts of Interest: The authors have no conflicts of interest to disclose.
* Address co
espondence to: Véronique Dupéré, Ph.D., School of Educational
Psychology (École de psychoéducation), Université de Montréal, C.P. 6128, succ.
Centre-ville, Montreal, QC, H3C 3J7, Canada.
E-mail address: XXXXXXXXXX (V. Dupéré).
1054-139X/© 2017 Society for Adolescent Health and Medicine. All rights reserved.
https:
doi.org/10.1016/j.jadohealth XXXXXXXXXX
Journal of Adolescent Health XXXXXXXXXX–211
www.jahonline.org
http:
crossmark.crossref.org/dialog/?doi=10.1016/j.jadohealth XXXXXXXXXX&domain=pdf
mailto: XXXXXXXXXX
http:
www.jahonline.org
adolescence can lead to poor health and social outcomes through-
out adulthood [5]. Third, compulsory schooling ends after high
school; thus adolescence represent a final opportunity to reach,
via school-based programs, virtually every individual in a given
cohort [2].
In practice, however, implementing mental-health pro-
grams in high schools is a challenge, especially in disadvantaged
contexts where these programs are most needed [5–7]. A main
a
ier is the fact that “achieving health outcomes is not the core
usiness of schools” [6]. Rather, high schools’ first mandate is to
ing as many students as possible to graduation. If mental health
programs do not clearly contribute to this primary goal, school
personnel under pressure to improve substandard graduation rates
may hesitate to channel scarce resources toward such pro-
grams [2,8]. As such, health workers need to reconcile thei
priorities with those of educational workers and decision makers
to achieve better collaboration and, ultimately, better out-
comes [9].
A key way to promote such collaboration is to demonstrate
that mental health problems are strongly associated with high
school dropout, and that mental health prevention programs have
the potential to improve graduation rates [2]. Such strong asso-
ciations exist for one class of mental health problems,
externalizing behaviors, most notably attention-deficit
hyperactivity disorders (ADHD) and conduct disorders (CD)
[10,11]. Evaluation studies show that school-based programs re-
ducing these problems also prevent dropout [10]. From school
personnel’s viewpoint, these programs hit two high-value targets
with one shot: they reduce troublesome behaviors that are very
disruptive for classroom functioning and improve graduation rates.
In contrast, the link between high school dropout and inter-
nalizing problems, first and foremost depression, is much less
clear. Logically, depressed adolescents should be at risk of aban-
doning school, as a core symptom of depression is of a lack of
energy and interest to ca
y out daily activities like attending
school. This potential risk, however, is often overlooked because
depression symptoms are not overtly visible and often go un-
noticed by teachers [12]. Even when manifest, they are often seen
as less urgent because unlike externalizing behaviors, they typ-
ically do not interfere with classroom activities [13]. Such
perceptions are reinforced by recent reviews concluding that de-
pressive symptoms are not linked with dropout once accounting
for externalizing problems [11,14,15].
Rather, this null finding may reflect suboptimal timing of de-
pression assessments in existing studies. Depression tends to be
episodic: Most adolescents who experience an episode of de-
pression at some point recover within a few months, and
subsequently remain free of clinically significant symptoms fo
extended periods [16–18]. Such episodic mental health prob-
lems are more subject to unde
eporting than stable problems
like ADHD or CD, especially when measured retrospectively years
after the fact [19]. Unde
eporting could have influenced the
esults of studies linking depression and dropout, as most are ret-
ospective and based on information obtained years or even
decades after participants were out of high school [11].
Another timing problem shared by all existing studies, in-
cluding the few prospective ones, is their focus on depressive
symptoms present during childhood or early- to mid-adolescence,
that is, many years before dropout becomes legally possible (i.e.,
at age 16 or 17 in most jurisdictions). With this time frame, it is
not surprising that depression symptoms were only weakly as-
sociated with dropout, if at all. Theoretically, it is clear why a 17-
year-old struggling with depression may be at risk of acting on
his or her legal prerogative to drop out, but it is unclear why a
classmate who had a bout with depression some years before and
is fully recovered (with no relapse) should be particularly at risk.
Empirically, some studies not explicitly addressing the link
etween depression and dropout still provide suggestive evi-
dence that timing matters and that late adolescence is a key
period. Among adolescents, the prevalence of depression peaks
around 17 years old [20]. Moreover, it is around that age that ado-
lescents are most likely to engage, when under pressure, in risk
ehaviors like dropping out that confer short-term relief at the
potential cost of lasting negative consequences [21]. In addi-
tion, a recent meta-analysis of studies examining the link between
depression and academic grades, an outcome related to dropout,
found effect sizes that were almost three times larger when de-
pression symptoms were measured in late rather than early
adolescence [22]. Finally, exposure to severely stressful (and
depressogenic) life events in late adolescence is associated with
a three-fold increase in the risk of dropping out shortly follow-
ing exposure [23].
The goal of this study was to examine whether the presence
of clinically significant depression symptoms during late ado-
lescence would be associated with high school dropout, afte
accounting for externalizing ADHD and CD symptoms, as well as
for other important family and school-related background
characteristics.
Methods
Sample
The project was approved by appropriate Institutional Review
Boards at the University and School Board levels. The recruit-
ment procedure is described in detail elsewhere [23]. Broadly,
12 francophone public high schools with high dropout rates
(M = 36%, a rate more than twice the provincial average) in and
around the city of Montreal, Canada, participated between 2012
and 2015. In each school, students were administered, early in
the school year, a short screening questionnaire that measured
their initial risk for dropout, as well as basic sociodemograph-
ics (see Measures). All students at least 14 years of age were
invited to participate, and the vast majority (97%) provided written
consent and participated (Nscreened = 6,773).
In a second phase, a selected subset of students was invited
to participate in face-to-face interviews during which they were
asked about their experiences in the last 12-month period, notably
in terms of mental health (Ninterviewed = 545). For the interviews,
a participation rate of 70% was obtained, a comparatively high
ate, given the ove
epresentation of socioeconomically disad-
vantaged, academically vulnerable adolescents [24]. The interviews
were conducted by trained graduate students in clinical
educational psychology and related disciplines.
The interviewed participants fell into three categories. First,
all students who dropped out of school in the year following the
initial screening were invited. School staff informed the re-
search team as soon as a student dropped out, and meetings were
quickly a
anged for those who consented to be interviewed.
Second, following a matched case-control logic, after each com-
pleted interview with a recent dropout, a second interview was
conducted with a persevering student from the same school, the
same program, the same sex, and with a similar individual risk
for dropout according to a risk index administered during the
206 V. Dupéré et al. / Journal of Adolescent Health XXXXXXXXXX–211
screening phase (see Measures). To the extent possible, matched
students were also similar to dropouts in terms of family back-
ground. Third, schoolmates with scores on the risk index that were
close to their school’s average were invited to participate to form
a second, not at-risk or “average” comparison group.
Measures
Descriptive statistics for each measure are presented in Table 1.
Separate estimates are shown for the three groups of participants.
Background. During the screening phase, participants com-
pleted a
ief questionnaire booklet. They reported on thei
sociodemographic background, including their sex, age, visible mi-
nority (i.e., non-white) and immigrant status (i.e., at least one
parent born outside Canada), as well as their family structure and
their parents’ employment status and level of education.
The booklet also included two self-reported measures assess-
ing students’ initial individual risk profile. First, a validated risk
index captured participants’ general propensity for dropout
ased on seven questions about grade retention, appreciation
of school, importance of grades, academic aspirations, percep-
tions of grades, and language art and math grades [25]. In the
cu
ent sample, this index showed good predictive validity
(with an area under the receiver operating characteristic
curve = .81), and predicted dropout more accurately than ad-
ministrative data about failure, truancy, and disciplinary
suspensions [26]. Second, students reported on enrollment in
special education either because of learning or conduct
emotional problems, another key marker of risk. These measures
indirectly tapped relevant externalizing symptoms [27], but
additional steps were taken during the interviews to assess
ADHD and CD symptoms more directly, as described in the
next section.
Mental health symptoms. To maximize participation in this high-