Adolescent Perceptions of School Before and After Psychiatric Hospitalization: Predicting Suicidal Ideation

Impact and Implications Findings from the present study identified the importance of fostering student-teacher relationships and preventing bullying experiences for students returning to school following psychiatric hospitalization for a suicide-related crisis. Whole-school approaches promoting positive relationships for all youth, as well as targeted approaches for youth recovering from a suicide-related crisis, may play a protective role against severity and intensity of suicidal ideation in the early period following hospitalization. During the immediate period following psychiatric hospitalization, adolescents are at increased risk for suicide attempts and rehospitalization. Because most adolescents return to school during this time, school-related experiences are important considerations during the transition from inpatient hospitalization. This study sought to understand how adolescent perceptions of school may change following hospitalization, and how these changes may predict recovery from a suicide-related crisis. Participants included 155 adolescents (M (age) = 15.2 years; 68.6% female, 65.4% White; 14.7% Hispanic/Latinx; grades 7-12) hospitalized for a suicide-related crisis assessed 3 weeks and 6 months following discharge. Results from Latent Change Score models indicated a worsening of perceptions of teacher relationships (mean change (Delta) = 1.52), connectedness to learning (Delta = 1.55), parent involvement (Delta = 1.82), and academic satisfaction (Delta = 1.34), as well as higher frequency of perceived bullying victimization (Delta = 0.71) following hospitalization. Poorer perceptions of teacher relationships and higher frequency of perceived bullying victimization during hospitalization (beta = 0.31 and 0.34), as well as worsening changes of teacher relationships and increased frequency of perceived bullying victimization following hospitalization (beta = 0.48 and 0.41) were associated with higher levels of suicidal ideation severity 3 weeks following discharge. Poorer and worsening perceptions of teacher relationships were associated with higher levels of suicidal ideation intensity at 3 weeks (beta = 0.37 and 0.54). Poorer perceptions of connectedness to learning during hospitalization emerged as a significant predictor of higher levels of suicidal ideation intensity 6 months following hospitalization (beta = 0.20). Results reinforce the importance of fostering positive adult relationships and preventing bullying both prior to and immediately following psychiatric hospitalization.