RESEARCH ARTICLE

Perceived School Climate and Chinese

Adolescents Suicidal Ideation and Suicide
Attempts: The Mediating Role of Sleep
Quality
DONGPING LI, PhDa ZHENZHOU BAO, MSb XIAN LI, MSc YANHUI WANG, MSd

ABSTRACT
BACKGROUND: School factors play important roles in adolescent suicide. However, little is known about how school climate
is associated with adolescent suicide. This study examined the relationship between perceived school climate and adolescent
suicidal ideation and suicide attempts, and whether these relations were explained by adolescent sleep quality.
METHODS: A total of 1529 Chinese adolescents (mean age = 14.74 years; 52% boys) participated in the study. They provided
self-report data on control variables, perceived school climate, sleep quality, suicidal ideation, and suicide attempts.
RESULTS: After controlling for sex, age, family structure, socioeconomic status, and parent-adolescent attachment, we found
that perceived school climate negatively predicted adolescent suicidal ideation (odds ratio [OR] = 0.66, p < .001) and suicide
attempts (OR = 0.72, p < .001). Moreover, perceived school climate positively predicated adolescent sleep quality ( = 0.13,
p < .001), which in turn, negatively predicted adolescent suicidal ideation (OR = 0.75, p < .001) and suicide attempts
(OR = 0.76, p < .001).
CONCLUSION: These ndings, although cross-sectional, indicate that perceived school climate plays an important role in
adolescent suicidality. Moreover, the relation between perceived school climate and adolescent suicidality was largely mediated
by adolescent sleep quality.

Keywords: suicidal ideation; suicide attempt; perceived school climate; sleep quality; adolescents.
Citation: Li D, Bao Z, Li X, Wang Y. Perceived school climate and Chinese adolescents suicidal ideation and suicide attempts:
the mediating role of sleep quality. J Sch Health. 2016; 86: 75-83.

Received on October 25, 2014

Accepted on September 23, 2015

research.2 This approach, grounded in ecological the-

A dolescent suicide is a serious public health
problem worldwide.1 It is one of the leading
causes of death in young people aged 10 to 24 years.1
Suicidal behavior can be divided into 3 stages: suicidal
ideation, suicide attempts, and completed suicide. Both
suicidal ideation and suicide attempts are predictive of
future completed suicide. Therefore, the examination
of suicidal ideation and suicide attempts (hereafter
referred to as suicidality) may help identify those
at risk for suicide completion and facilitate early
prevention and intervention.
The social and ecological approach is a com-
pelling theoretical framework for adolescent suicidality
ory of human development,3 posits that adolescent
suicidality is developed and maintained within social
contexts, so social and ecological risk factors of ado-
lescent suicidality should be identified for intervention
and prevention.2 For adolescents, school is one of
the most important contexts for their development.4
Research has shown that various aspects of school
dysfunction are important risk factors for adolescent
suicidality.5,6 However, the role of school climate (a
central aspect of the school environment) in ado-
lescent suicidality has been underappreciated in the
literature.7

a
Lecturer, (lidongping83@126.com), School of Psychology, Central China Normal University, China.
b
Doctoral Candidate, (19534306@qq.com), School of Psychology, South China Normal University China.
c
Doctoral Candidate, (stellalixian@hotmail.com), Department of Educational and Counseling Psychology, University at Albany, SUNY, Albany, NY.
d
Lecturer, (yanhui_09@qq.com), School of Education Science, Jiaying University, China.
Address correspondence to: Dongping Li, Lecturer, (lidongping83@126.com), School of Psychology, Central China Normal University, No. 152, Luoyu Road, Hongshan District,
Wuhan, 430079 China.

Journal of School Health February 2016, Vol. 86, No. 2 2016, American School Health Association 75
 School climate refers to the quality and charac-
ter of school life; [it] is based on patterns of peoples
experiences of school life and reflects norms, goals,
values, interpersonal relationships, teaching and learn-
ing practices, and organizational structures.8(p182) As
Morin, Maano, Marsh, Nagengast, and Janosz note:
Because individuals choose and modify their envi-
ronments, it is unlikely that all students will be
exposed to similar school experiences or share sim-
ilar perceptions of their schools.9(p1972) Therefore,
a growing body of research treats school climate as
the psychological environments of the school and
use each students unique perception of the school
life to measure school climate.9-12 This approach
well coordinates with the ecological theory which
suggests that (subjective) perceptions of school cli-
mate are better predictors of students development
than the (objective) aggregated school characteristics.3
Previous studies have well documented the associa-
tions between perceived school climate and adolescent
suicidality.7,13-16 For example, Espelage et al found
that positive perceptions of school climate, includ-
ing student-teacher relationships, fairness of disci-
pline policies, and attitude and affect toward school,
protected sexual minority students from developing
suicidality.13,15
Although we know much from the previous
research, a number of areas require clarification and
expansion. First, the conceptualization of key variables
in most previous research were problematic or invalid
(measurement issue). For example, the majority of
existing studies did not distinguish students personal
school experiences (the referent is the individual
student) from students perceptions of school climate
(the referent is the school).7,13-16 Specifically, they
used items referring to students personal experiences
(eg, My teachers care about me) to measure more
general perceptions of school climate (eg, teachers
help students with problems). As Morin et al noted,
although these two facets of school life are interrelated,
they represent different constructs and thus should
be distinguished.9 Moreover, some studies used items
related to self-harm (eg, thinking about physically
harming yourself over the past 12 months) and
depression (eg, During the past 30 days, have you
felt depressed or very sad?) to assess adolescent
suicidality.13-15 This approach makes it difficult to
disentangle the impact of perceived school climate on
adolescent suicidality from the impact on adolescent
depression or self-injury.
Second, most prior studies have used inappropriate
data analytic strategies in their analysis (data analysis
issue). This is reflected in two aspects. On the one
hand, they did not attend to the nested nature
of the data (ie, students nesting within schools).
The nonindependence of observations violates the
assumption of traditional regression analysis and
76 Journal of School Health February 2016, Vol. 86, No. 2
may produce biased standard errors of parameter
estimates. On the other hand, they did not use
appropriate centering method to obtain the student-
level effects of school climate net of the school-level
effects. That is, the impact of perceived school climate
(student-level construct) on adolescent suicidality
found in these studies was contaminated by the
impact of global school climate (school-level construct)
on adolescent suicidality. These questionable data
analyses are mainly because that the small number
of schools in these studies (as the case in this study)
makes it infeasible to perform multilevel data analysis.
However, multilevel analysis is not the only method
that can be used in this situation. The fixed effects
approach to clustering is a great alternative that can be
used to account for the nested nature of the data and
obtain proper standard errors of parameter estimates.17
In addition, the group-mean-centering method (ie,
subtracting the school means from individual ratings)
can be used to obtain the individual-level effects of
perceived school climate on adolescent suicidality
net of the school-level effects.18 This approach is
particularly useful when the study included multiple
schools but not big enough to conduct multilevel
analysis.18 For example, in a study of the impact of
perceived school climate on adolescent self-esteem
trajectory, Morin et al used the group-mean-centering
approach to obtain proper student-level effects when
the school number (N = 5) was not enough to conduct
multilevel analysis.9
Third, most of previous research has been conducted
in Western countries such as the United States;
thus, we know little about whether the relationship
between perceived school climate and adolescent
suicidality applicable to other countries such as China
(generalizability issue). This research question is of
great importance because school contexts vary across
different countries and cultures.19 For example, some
cross-cultural studies have found that Chinese students
perceived higher levels of teacher support, student-
student support, opportunities for autonomy in the
classroom, and fairness of school rules than students
in the United States.10,20 Thus, it is important to
investigate the relationship between perceived school
climate and adolescent suicidality in these countries
such as China.
Last, there is a paucity of research examining
the mediation mechanism through which perceived
school climate was associated with adolescent sui-
cidality. According to the context-process-outcomes
model, the link between perceived school psycho-
logical environment (perceived school climate) and
adolescent development (suicidality) might not be
a direct one; rather, it is important individual vari-
ables (process) that mediate the relationship between
school environment and adolescent development.21
In this study, we contend that sleep quality may
2016, American School Health Association
be an important mediator underlying the relation-
ship between perceived school climate and adolescent
suicidality. On the one hand, there are theoretical justi-
fications to expect that perceived school climate may be
associated with adolescent sleep quality. When schools
have more positive climate (eg, the environment is
safe and orderly, the interpersonal relationships are
positive and nurturing), students are more likely to
develop emotional bond and affect with their school
and are less likely to show anxiety and hypervigi-
lance for school violence or peer victimization.22,23 All
these psychosocial emotional benefits will transform
into physical well-being, contribute to a better sleep
quality.24-27 On the other hand, adolescent sleep plays
a critical role in their suicidality.28-31 For example, in
a nationally representative sample of American ado-
lescents, Wong and Brower found that sleep problems
at a previous wave significantly predicted suicidality at
a subsequent wave, even after controlling for depres-
sion, substance use, and demographic variables.31 To
our knowledge, no studies to date have examined
whether sleep quality would mediate the relation
between perceived school climate and adolescent
suicidality.
In summary, relying on more precise measurement
and rigorous statistical analyses, this study aimed
to examine the relationship between perceived
school climate and Chinese adolescents suicidality.
Our study also investigated the mediating role of
sleep quality in the relation between perceived
school climate and adolescent suicidality. Based on
the previous literature review, we propose the
following hypotheses: First, there would be significant
negative association between positive perceptions of
school climate and adolescent suicidality. Second,
the relations between perceived school climate and
adolescent suicidality would be mediated by sleep
quality, such that more positive perceptions of school
climate would be associated with higher sleep quality,
which in turn would be associated with decreased
adolescent suicidality. Note that we use the term
mediate only in the statistical sense, as this cross-
sectional data do not allow one to draw any causal
conclusions.
METHODS
Participants
A total of 1529 7th to 11th graders from 7 middle
schools in central China participated in this study.
Fifty-two percent of them were boys. The mean
age of the participants was 14.74 years (SD = 1.48).
Reflecting the demographics of this area, 45.1% of
their fathers and 54.7% of their mothers had less than
a high school education; 45.3% of their fathers and
47.1% of their mothers had an unskilled or semi-
skilled occupation.
Journal of School Health February 2016, Vol. 86, No. 2
Measures
Perceived school climate. The 25-item school cli-
mate questionnaire is revised from previous school
climate measures.10,22 This questionnaire assesses 5
aspects of school climate: teacher support (eg, Teach-
ers help students solve problems), student-student
support (eg, students care about one another),
teaching atmosphere (eg, teachers effectively moti-
vate students to learn), learning atmosphere (eg,
students invest and engage in their school), and
school safety (eg, Bullying is an issue of the campus
[reverse scored]). Adolescents indicated how true each
item was of their school on a 6-point scale ranging
from 1 (not at all true) to 6 (always true). Responses
across all the items were averaged, with higher sores
representing better school climate. Evidence for valid-
ity includes confirmatory factor analysis of a 5-factor
model, 2 (df = 265) = 1632.85, comparative fit index
(CFI) = .98, non-normed fit index (NNFI) = .98, root
mean square error of approximation (RMSEA) = .06,
and significant associations with theoretically rel-
evant constructs such as school connectedness
(r = .58, p < .001), delinquency (r = .23, p < .001),
and depression (r = .35, p < .001). For this study,
this scale demonstrated good reliability ( = .92).
Sleep quality. Adolescents sleep quality was
assessed using Meijer and van den Wittenboers Sleep
Quality Scale.32 This self-report scale consists of 6 items
which measure sleep latency, awakenings at night,
sleep latency after awakenings, troubled sleep, per-
ception of sleep quality, and feeling rested after sleep.
Adolescents indicated how true each item (eg, I sleep
well at night) was of them on a 6-point scale ranging
from 1 (not at all true) to 6 (always true). Responses
across all the items were averaged, with higher sores
representing higher sleep quality. This scale has been
found to have good reliability in previous research.33
For this study, this scale demonstrated good reliability
( = .81).
Suicidal ideation and suicide attempts. Adoles-
cents suicidal ideation and suicide attempts were
assessed with 2 items, which were adapted from the
Youth Self-Report.34 The 2 items were I thought
about killing myself and I deliberately tried to kill
myself. Participants were asked to answer each ques-
tion on a 3-point scale: 0 = never, 1 = sometimes, and
2 = often during the past 6 months. Adolescents who
scored 1 or 2 on the first question were considered
to have suicidal ideation, and those who scored 1
or 2 on the second questions were considered to
have attempted suicide. Although only 2 items were
used, this kind of measure has been widely used and
can provide valuable information about adolescent
suicidality.35-38
Control variables. Given that previous studies have
shown that adolescents sex, age, family structure,
family socioeconomic status, and parent-adolescent
2016, American School Health Association 77
attachment are related to adolescent suicidality, we
included these variables as control variables.6,7,39
More detailed information about the measures of
family socioeconomic status and parent-adolescent
attachment can be found in previous research.40
Procedure
This study was approved by the research ethics
committee of the corresponding authors institution.
Because the protocol was judged to pose no risk and the
data were collected and processed anonymously, oral
consent was recommended and obtained from school
administrators and participants before data collection.
The survey was conducted in classrooms. Trained
data collectors (undergraduate students) administered
the questionnaires using scripts and a manual of
procedures so as to standardize the data collection
process.
Analysis Plan
We first presented descriptive statistics for our
variables of interest and control variables, followed
by bivariate associations among these variables.
Second, we conducted logistic regression analysis to
reveal the direct association between perceived school
climate and adolescent suicidal ideation and suicide
attempts after controlling for demographic and family
factors. Third, we followed the procedure proposed
by Hayes to establish the mediation effect of sleep
quality.41 In all these analyses, we used the CLUSTER
command in PROCESS to account for students nesting
within schools.41 In addition, to obtain student-
level effects net of school-level effects, we group-
mean centered the perceived school climate variable
prior to analyses.9 Finally, we conducted structural
equation modeling analysis to graphically present the
mediational paths between perceived school climate
and adolescent suicidality.
RESULTS
Preliminary Analyses
Table 1 presents descriptive statistics (means and
standard deviations) and the correlation matrix for all
study variables. In the total sample, 17.5% (N = 268)
of the adolescents had thought about suicide in the
past 6 months, and 7.3% (N = 112) of the adolescents
had attempted suicide in the previous 6 months. These
rates are consistent with the national data of China and
those of other country such as the United States.42,43
Pearson correlation analyses showed that perceived
school climate was negatively associated with both
suicidal ideation and suicide attempts. Besides, sleep
quality was negatively associated with both suicidal
ideation and suicide attempts. Finally, as expected,
perceived school climate was positively associated with
adolescent sleep quality.
78 Journal of School Health February 2016, Vol. 86, No. 2
Testing for Direct Associations
The first aim of this study was to explore
the unique relationship between perceived school
climate and adolescent suicidal ideation and suicide
attempts. We hypothesized that perceived school
climate would uniquely associate with suicidal ideation
and suicide attempts. The results of logistic regression
analyses (Equation 1 of Tables 2 and 3) supported
our hypothesis. Specifically, after controlling for
covariates (adolescent sex, age, family structure,
family socioeconomic status, and parent-adolescent
attachment), perceived school climate negatively
predicted both suicidal ideation (OR = 0.66, p < .001)
and suicidal attempts (OR = 0.72, p < .001). That is to
say, adolescents who had more positive perceptions of
school climate were less likely to have suicidality, so
Hypothesis 1 was supported.
Testing for Mediated (Indirect) Associations
To examine whether sleep quality mediated the
link between perceived school climate and suicidal
ideation and suicide attempts, we followed the
two-step procedure to establish this mediation.41
In the first step, after controlling for demographic
variables, multiple regression analyses (Equation 2
of Tables 2 and 3) revealed that perceived school
climate positively predicted sleep quality ( = 0.13,
p < .001). In the second step, logistic regression
analyses (see Equation 3 of Tables 2 and 3) indicated
that after controlling for demographic and family
risk factors, sleep quality negatively predicted suicidal
ideation (OR = 0.73, p < .001), and suicide attempts
(OR = 0.74, p < .001). The results of the bootstrap
method indicated that sleep quality mediated the link
between perceived school climate and suicidal ideation
(ab = 0.06, p < .001) and the link between perceived
school climate and suicide attempts (ab = 0.06,
p < .001).
To illustrate the mediational paths between per-
ceived school climate and adolescent suicidality fur-
ther, we conducted structural equation modeling by
using the weighted least squares method in Mplus
7.44 This method was suitable to deal with cate-
gorical dependent variables. In addition, we used
the TYPE = COMPLEX option in conjunction with
the CLUSTER option in Mplus to take into account
students nesting within schools.44 The model demon-
strated sufficient fit to the data, 2 (df = 121) = 157.91,
CFI = .95, NNFI = .93, RMSEA = .01. As Figure 1
shows, positive perceptions of school climate were
associated with higher levels of sleep quality, which
in turn mitigated adolescent suicidal ideation and
suicide attempts. Perceived school climate also had
a residual direct association with adolescent sui-
cidal ideation. Taken together, Hypothesis 2 was
supported.
2016, American School Health Association
Table 1. Univariate and Bivariate Statistics for All Study Variables

Variables 1 2 3 4 5 6 7 8 9
1. Sex
2. Age .04
3. Family structure .02 .05
4. SES .01 .06* .00
5. Parent-adolescent attachment .02 .04 .09** .07**
6. School climate .00 .09** .04 .00 .39***
7. Sleep quality .04 .08** .00 .01 .23*** .21***
8. Suicidal ideation .06* .12*** .08** .00 .31*** .20*** .19***
9. Suicide attempt .07** .12*** .05* .03 .28*** .15** .15*** .54***
Mean 0.52 14.74 0.89 0.00 3.46 0.00 4.52 0.18 0.07
Standard deviation 0.50 1.48 0.31 1.00 0.85 0.76 1.15 0.38 0.26
*p < .05.
**p < .01.
***p < .001.
SES, socioeconomic status.
N = 1529. Sex was dummy coded such that 1 = boys and 0 = girls. Family structure was dummy coded such that 1 = intact family and 0 = nonintact family.

Table 2. Testing the Unique and Mediated Associations Between School Climate and Suicidal Ideation

Equation 1: Suicidal ideation Equation 2: Sleep quality Equation 3: Suicidal ideation

Predictors B SE OR B SE B SE OR
Sex 0.30 0.15 .74* 0.05 0.06 0.02 0.31 0.15 .74*
Age 0.17 0.08 .85*** 0.02 0.03 .03** 0.17 0.08 .84***
Family structure 0.33 0.21 0.72 0.06 0.09 0.02 0.36 0.21 0.70
SES 0.02 0.09 1.02 0.04 0.03 0.03 0.00 0.09 1.00
Parent-adolescent attachment 0.85 0.09 .43*** 0.27 0.04 .20*** 0.78 0.09 .46***
School climate 0.42 0.10 .66*** 0.20 0.04 .13*** 0.36 0.10 .70***
Sleep quality 0.32 0.06 .73***
Nagelkerkes R2 .202 .119 .226
*p < .05.
**p < .01.
***p < .001.
OR, odds ratio; SES, socioeconomic status.
Each column is a regression model that predicts the criterion at the top of the column. Equations 1 and 3 are logistic, and Equation 2 is linear. N = 1529. Sex was dummy coded
such that 1 = boys and 0 = girls. Family structure was dummy coded such that 1 = intact family and 0 = nonintact family.

DISCUSSION maladjustment.45 In this study, negative school cli-

Rest on the social and ecological framework of
adolescent suicidality, this study examined the relation
between perceived school climate and adolescent
suicidality, as well as the mediation role of adolescent
sleep quality in this relation. We discuss each of our
research questions in the following sections.
First, consistent with our hypothesis, after con-
trolling for covariates, perceived school climate was
negatively related to adolescent suicidality. This result
is of particular significance, because perceived school
climate has a unique role in adolescent suicidality
above and beyond important individual and family
risk factors. Our finding and those of others high-
light the importance of perceived school climate in
adolescent suicidality.7,13-16 The stage-environment fit
theory proposes that adolescents have optimal devel-
opment when school contexts satisfy their develop-
mental needs. On the contrary, the mismatch between
students developmental needs and the opportuni-
ties offered by school environment may lead to
mate implies unsafe school environments, limited
opportunities to establish and maintain close relation-
ships with teachers and students, few teachers who
dedicate in teaching, and few students who are inter-
ested and engaged in learning. All these factors may
thwart the satisfaction of adolescents basic psycholog-
ical needs such as safety, relatedness, and competence,
and thus lead to unbearable psychological pain such as
fear, social isolation, worthlessness, and hopelessness,
which are significant risk factors for suicidality.46,47
Thus, negative perceptions of school climate are impor-
tant risk factors for adolescent suicidality.
More importantly, our study constructively expands
previous research regarding the direct links between
perceived school climate and adolescent suicidality.
First, we clarify the conceptualization of key con-
cepts. The measure of perceived school climate was
not confounded with students personal school expe-
riences and the measure of suicidality was not con-
founded with self-injury or depression. Second, we

Journal of School Health February 2016, Vol. 86, No. 2 2016, American School Health Association 79
Table 3. Testing the Unique and Mediated Associations Between School Climate and Suicide Attempt

Equation 1: Suicide attempt Equation 2: Sleep quality Equation 3: Suicide attempt

Predictors B SE OR B SE B SE OR
Sex 0.47 0.22 .63* 0.05 0.06 0.02 0.49 0.22 .61*
Age 0.28 0.11 .76*** 0.02 0.03 .03** 0.28 0.11 .76*
Family structure 0.17 0.30 0.84 0.06 0.09 0.02 0.23 0.30 0.80
SES 0.06 0.14 0.94 0.04 0.03 0.03 0.09 0.14 0.91
Parent-adolescent attachment 1.09 0.13 .34*** 0.27 0.04 .20*** 1.01 0.14 .36***
School climate 0.33 0.14 .72* 0.20 0.04 .13*** 0.26 0.14 0.77
Sleep quality 0.31 0.09 .74***
Nagelkerkes R2 .223 .119 .240
*p < .05.
**p < .01.
***p < .001.
OR, odds ratio; SES, socioeconomic status.
Each column is a regression model that predicts the criterion at the top of the column. Equations 1 and 3 are logistic, and Equation 2 is linear. N = 1529. Sex was dummy coded
such that 1 = boys and 0 = girls. Family structure was dummy coded such that 1 = intact family and 0 = nonintact family.

Figure 1. Structural Equation Model Predicting Adolescent Suicidality Standardized Coefcients Are Presented. All the Parameter
Estimates in This Figure Were Signicant (ps < .001). Adolescents Sex, Age, Family Structure, Socioeconomic Status, and Parent-
Adolescent Attachment Were Included in the Equations as Statistical Controls but Are Not Presented for Reasons of Simplicity.

PSC1 Suicidal
Ideation
.80 .13***
PSC2
.80
Perceived .19***
Sleep
PSC3 .78 School
.14*** Quality .78***
Climate
.79
PSC4 .20***
.35 .66 .75 .54 .54 .73 .66
PSC5
Suicide
SQ1 SQ2 SQ3 SQ4 SQ5 SQ6
Attempts

used the CLUSTER command to account for stu-
dents nesting with schools. This practice departs from
previous research which simply ignored the noninde-
pendence of observations. We also incorporated group-
mean centering approach to obtain student-level effect
of perceived school climate.9 These methodological
improvements (including measurement and data anal-
ysis) provide greater accuracy in quantifying and
interpreting the relationship between perceived school
climate and adolescent suicidality, and should also
be considered in future studies. Third, this study
also extends previous research by utilizing a non-
Western adolescent sample. Despite mean differences
in perceived school climate in Eastern and Western
samples,7,10 the beneficial role of perceived school cli-
mate in Western samples can be generalized to Chinese
adolescents.13-16 The cultural similarities between our
finding and those found in other countries are in line
with the universalistic (vs relativistic) perspective of
school climate which proposes that positive school cli-
mate satisfies fundamental and universal needs (safety,
relatedness, competence) of adolescents in all cultures,
and thus has salutary effect on adolescent suicidality
across different cultures.10
Second, this study was also designed to identify the
mediating processes or mechanisms through which
perceived school climate is associated with adolescent
suicidality. We focused on a specific biological
indexsleep qualitythat has been empirically
linked to adolescent suicidality and has theoretical
link with perceived school climate. We found that
the relationship between perceived school climate
and adolescent suicidality was indeed statistically
mediated (explained) by adolescent sleep quality.
In the past, the impact of perceived school climate
on adolescent suicidality has been emphasized by
school psychologists; whereas, the role of sleep quality
in adolescent suicidality has been focused on by
psychiatrists. These 2 research areas have developed
largely independently of each other, neglecting any
possible linkage between perceived school climate and
sleep quality. To our knowledge, this is the first
study that integrated research from both fields to
understand the development of adolescent suicidality.

80 Journal of School Health February 2016, Vol. 86, No. 2 2016, American School Health Association
Our integrated (mediation) model suggests that
perceived school climate is beneficial to adolescent
sleep functioning, which in turn lessen adolescent
suicidality. Thus, the integration can offer greater
predictive power and conceptual fruitfulness than each
of the 2 areas alone can do.
In addition to the overall mediation results, each
of the individual links in our mediation model is
noteworthy. For the first stage of the mediation process
(ie, perceived school climate sleep quality), our
findings support the premise that positive perceptions
of school climate are associated with better sleep
quality. In a school with positive climate, students
are more likely to be connected to their school
and satisfy with their school life, and are less
likely to experience anxiety and hypervigilance for
school violence or peer victimization, thus they
are more likely to have better sleep. For the
second stage of our mediation model (ie, sleep
quality suicidality), we found that sleep quality
was negatively associated with adolescent suicidality.
This finding is congruent with previous research
that shows that sleep problems are important risk
factors for adolescent suicidality.28,29,31 Researchers
have proposed several mechanisms to explain this
association. For example, sleep disturbances may
impair individuals emotional regulation,48 impulse
control,49 and problem-solving ability,50 which in
turn, increase their risk for suicidality.
Limitations
First, this study was cross-sectional in design; thus,
no conclusions can be drawn regarding causality.
Future studies may benefit from longitudinal or exper-
imental investigations to better establish the direction
of relationships posited in our study. Second, all data
were based on self-reported measures that are poten-
tially subject to several forms of bias. Although there
are good theoretical reasonsadolescents may be the
best informants of perceived school climate, suicidal
ideation, suicide attempts because of the internal, per-
sonal, and covert nature of these constructs, future
studies should use multiple methods to collect data.
For example, sleep quality could also be measured
by polysomnograph to reduce response bias. Third,
our findings were based on a general population
sample of Chinese adolescents which may not be
generalized to clinical samples. Fourth, although the
overall sample size was relatively large in this study,
there were not enough participants with suicidality
in subgroups, given the low base rate of suicidality
in the general population. We followed the sugges-
tion of Lagakos51 and Sun et al52 and did not conduct
subgroup analyses. However, future research should
use larger sample sizes to investigate this important
issue.
Journal of School Health February 2016, Vol. 86, No. 2
Conclusions
In summary, although further replication and
expansion are needed, findings from this study
advance the literature by uncovering the association
between perceived school climate and adolescent
suicidality as well as the underlying mechanisms of
these associations. We find that positive perceptions
of school climate are protective factors for adolescent
suicidality. Moreover, adolescent sleep quality may
be an important biological mechanism underlying
the relations between perceived school climate and
adolescent suicidality. These findings demonstrate
the importance of incorporating the school factors
and sleep function into understanding of adolescent
suicidality.
IMPLICATIONS FOR SCHOOL HEALTH
First, our findings suggest that positive perceptions
of school climate may play a significant role in the
prevention of adolescent suicidality. Recent research
has found that perceived school climate is malleable.53
The malleability of perceived school climate will
set the stage for exploring context and strategy of
intervention. For example, students can be trained
to pick and modify their own micro environments
(eg, choosing the people who they interact with) in
order to be exposed to positive school environment
and have positive school perceptions. Second, the
results suggest that sleep quality may be a promising
target in prevention and intervention programs of
adolescent suicidality. Intervention programs aimed at
promoting sleep quality may help reduce adolescent
suicidality.54 Overall, multimodal programs that target
both perceptions of school climate and sleep quality
may have better success in decreasing adolescent
suicidality.
Human Subjects Approval Statement
The protocol used for the study described in this
article was approved by the Institutional Review Board
at the School of Psychology, Central China Normal
University.
REFERENCES
1. Hawton K, Saunders KE, OConnor RC. Self-harm and suicide
in adolescents. Lancet. 2012;379(9834):2373-2382.
2. Heilbron N, Franklin JC, Guerry JD, Prinstein MJ. Social and
ecological approaches to understanding suicidal behaviors and
nonsuicidal self-injury. In: Nock MK, ed. The Oxford Handbook of
Suicide and Self-injury. New York, NY: Oxford University Press;
2014:206-234.
3. Bronfenbrenner U. The Ecology of Human Development. Cam-
bridge, MA: Harvard University Press; 1979.
4. Eccles JS, Roeser RW. An ecological view of schools and
development. In: Meece JL, Eccles JS, eds. Handbook of Research
on Schools, Schooling, and Human Development. New York, NY:
Routledge; 2010:6-21.
2016, American School Health Association 81
 5. Klomek AB, Marrocco F, Kleinman M, Schonfeld IS, Gould MS.
Bullying, depression, and suicidality in adolescents. J Am Acad
Child Adolesc Psychiatry. 2007;46(1):40-49.
6. Shang L, Li J, Li Y, Wang T, Siegrist J. Stressful psychosocial
school environment and suicidal ideation in Chinese adoles-
cents. Soc Psychiatry Psychiatr Epidemiol. 2014;49(2):205-210.
7. Yang X, Wang Y, Li D, Zhao L, Bao Z, Zhou Z. School climate
and adolescents suicidal ideation and suicide attempts: the
mediating role of self-esteem. Psychol Dev Educ. 2013;29(5):
541-551.
8. Cohen J, McCabe L, Michelli NM, Pickeral T. School climate:
research, policy, practice, and teacher education. Teach Coll Rec.
2009;111(1):180-213.
9. Morin AJ, Maano C, Marsh HW, Nagengast B, Janosz M.
School life and adolescents self-esteem trajectories. Child Dev.
2013;84(6):1967-1988.
10. Jia Y, Way N, Ling G, et al. The influence of student perceptions
of school climate on socioemotional and academic adjustment:
a comparison of Chinese and American adolescents. Child Dev.
2009;80(5):1514-1530.
11. Wang MT, Dishion TJ. The trajectories of adolescents
perceptions of school climate, deviant peer affiliation, and
behavioral problems during the middle school years. J Res
Adolesc. 2013;22(1):40-53.
12. Way N, Reddy R, Rhodes J. Students perceptions of school
climate during the middle school years: associations with
trajectories of psychological and behavioral adjustment. Am
J Community Psychol. 2007;40(3-4):194-213.
13. Birkett M, Espelage DL, Koenig B. LGB and questioning students
in schools: the moderating effects of homophobic bullying
and school climate on negative outcomes. J Youth Adolesc.
2009;38(7):989-1000.
14. Carter M, McGee R, Taylor B, Williams S. Health outcomes
in adolescence: associations with family, friends and school
engagement. J Adolesc. 2007;30(1):51-62.
15. Espelage DL, Aragon SR, Birkett M, Koenig BW. Homophobic
teasing, psychological outcomes, and sexual orientation among
high school students: what influence do parents and schools
have? School Psychol Rev. 2008;37(2):202-216.
16. Perkins DF, Hartless G. An ecological risk-factor examination
of suicide ideation and behavior of adolescents. J Adolesc Res.
2002;17(1):3-26.
17. Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple
Regression/Correlation Analysis for the Behavioral Sciences. 3rd ed.
Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 2003.
18. Enders CK, Tofighi D. Centering predictor variables in cross-
sectional multilevel models: a new look at an old issue. Psychol
Methods. 2007;12(2):121-138.
19. Goldston DB, Molock SD, Whitbeck LB, Murakami JL,
Zayas LH, Hall GCN. Cultural considerations in adolescent
suicide prevention and psychosocial treatment. Am Psychol.
2008;63(1):14-31.
20. Yang C, Bear GG, Chen FF, Zhang W, Blank JC, Huang X.
Students perceptions of school climate in the US and China.
Sch Psychol Q. 2013;28(1):7-24.
21. Roeser RW, Midgley C, Urdan TC. Perceptions of the school
psychological environment and early adolescents psychological
and behavioral functioning in school: the mediating role of goals
and belonging. J Educ Psychol. 1996;88(3):408-422.
22. Bao Z, Zhang W, Li D, Li D, Wang Y. School climate
and academic achievement among adolescents: a moderated
mediation model. Psychol Dev Educ. 2013;29(1):61-70.
23. Peterson RL, Skiba R. Creating school climates that prevent
school violence. Clearing House. 2001;74(3):155-163.
24. Lepore SJ, Kliewer W. Violence exposure, sleep disturbance,
and poor academic performance in middle school. J Abnorm
Child Psychol. 2013;41(8):1179-1189.
25. Maume DJ. Social ties and adolescent sleep disruption. J Health
Soc Behav. 2013;54(4):498-515.
82 Journal of School Health February 2016, Vol. 86, No. 2
26. Mesquita G, Reimao R. Stress and sleep quality in high school
Brazilian adolescents. An Acad Bras Cienc. 2010;82(2):545-551.
27. Yen CF, Ko CH, Yen JY, Cheng CP. The multidimensional
correlates associated with short nocturnal sleep duration
and subjective insomnia among Taiwanese adolescents. Sleep.
2008;31(11):1515-1525.
28. Goldstein TR, Bridge JA, Brent DA. Sleep disturbance preceding
completed suicide in adolescents. J Consult Clin Psychol.
2008;76(1):84-91.
29. Lee YJ, Cho SJ, Cho IH, Kim SJ. Insufficient sleep and suicidality
in adolescents. Sleep. 2012;35(4):455-460.
30. Liu X, Buysse DJ. Sleep and youth suicidal behavior: a neglected
field. Curr Opin Psychiatry. 2005;19(3):288-293.
31. Wong MM, Brower KJ. The prospective relationship between
sleep problems and suicidal behavior in the National Longitu-
dinal Study of Adolescent Health. J Psychiatr Res. 2012;46(7):
953-959.
32. Meijer AM, van den Wittenboer GL. The joint contribution of
sleep, intelligence and motivation to school performance. Pers
Individ Dif . 2004;37(1):95-106.
33. Meijer AM, Reitz E, Dekovic M, Van Den Wittenboer GL, Stoel
RD. Longitudinal relations between sleep quality, time in bed
and adolescent problem behaviour. J Child Psychol Psychiatry.
2010;51(11):1278-1286.
34. Achenbach TM. Manual for the Youth Self-Report and 1991
Profile. Burlington, VT: Department of Psychiatry, University
of Vermont; 1991.
35. Hatzenbuehler ML, Birkett M, Van Wagenen A, Meyer IH.
Protective school climates and reduced risk for suicide ideation
in sexual minority youths. Am J Public Health. 2014;104(2):
279-286.
36. Herba CM, Ferdinand RF, Stijnen T, et al. Victimisation and
suicide ideation in the TRAILS study: specific vulnerabilities of
victims. J Child Psychol Psychiatry. 2008;49(8):867-876.
37. Kim YS, Koh YJ, Leventhal B. School bullying and suicidal
risk in Korean middle school students. Pediatrics. 2005;115(2):
357-363.
38. Martin G, Rotaries P, Pearce C, Allison S. Adolescent
suicide, depression and family dysfunction. Acta Psychiatr Scand.
1995;92(5):336-344.
39. Li D, Zhang W, Li X, Li N, Ye B. Gratitude and suicidal ideation
and suicide attempts among Chinese adolescents: direct,
mediated, and moderated effects. J Adolesc. 2012;35(1):55-66.
40. Li D, Li X, Wang Y, Zhao L, Bao Z, Wen F. School connectedness
and problematic internet use in adolescents: a moderated
mediation model of deviant peer affiliation and self-control.
J Abnorm Child Psychol. 2013;41(8):1231-1242.
41. Hayes AF. Introduction to Mediation, Moderation, and Conditional
Process Analysis: A Regression-Based Approach. New York, NY: The
Guilford Press; 2013.
42. Dong Y, Liu Y, Liu L, et al. Reported rate of suicide-related
behaviors among Chinese adolescents: a meta-analysis. Chin J
School Health. 2014;35(4):532-536.
43. Kann L, Kinchen S, Shanklin SL, et al. Youth risk behavior
surveillanceUnited States, 2013. MMWR Morb Mortal Wkly
Rep. 2014;63(4):1-168.
44. Muthen LK, Muthen BO. Mplus Users Guide. 7th ed. Los
Angeles, CA: Muthen & Muthen; 1998-2012.
45. Eccles JS, Midgley C, Wigfield A, et al. Development during
adolescence: the impact of stage-environment fit on young
adolescents experiences in schools and in families. Am Psychol.
1993;48(2):90-101.
46. Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F. Higher
psychological pain during a major depressive episode may be a
factor of vulnerability to suicidal ideation and act. J Affect Disord.
2010;120(1):226-230.
47. Bhatta MP, Shakya S, Jefferis E. Association of being bullied in
school with suicide ideation and planning among rural middle
school adolescents. J Sch Health. 2014;84(11):731-738.
2016, American School Health Association
48. Walker MP, van Der Helm E. Overnight therapy? The
role of sleep in emotional brain processing. Psychol Bull.
2009;135(5):731-748.
49. Abe T, Hagihara A, Nobutomo K. Sleep patterns and impulse
control among Japanese junior high school students. J Adolesc.
2010;33(5):633-641.
50. Wagner U, Gais S, Haider H, Verleger R, Born J. Sleep inspires
insight. Nature. 2004;427(6972):352-355.
51. Lagakos SW. The challenge of subgroup analysesreporting
without distorting. N Engl J Med. 2006;354(16):1667-1669.
Journal of School Health February 2016, Vol. 86, No. 2
52. Sun X, Briel M, Walter SD, Guyatt GH. Is a subgroup effect
believable? Updating criteria to evaluate the credibility of
subgroup analyses. BMJ. 2010;340(7751):850-854.
53. Mitchell MM, Bradshaw CP, Leaf PJ. Student and teacher
perceptions of school climate: a multilevel exploration
of patterns of discrepancy. J Sch Health. 2010;80(6):
271-279.
54. Pigeon WR, Caine ED. Insomnia and the risk for suicide: does
sleep medicine have interventions that can make a difference?
Sleep Med. 2010;11(9):816-817.
2016, American School Health Association 83