Disciplinary behaviour management strategies  in schools and their impact on student psychosocial outcomes: A systematic review

adolescent, school discipline, behaviour management, mental health, wellbeing, systematic review ALL Metrics - Views Downloads How to cite this article Ijaz S, Nobles J, Mamluk L et al. Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.13563.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Systematic Review Revised Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved] Sharea Ijaz https://orcid.org/0000-0001-5727-1790 1, James Nobles2, Loubaba Mamluk1, [...] Sarah Dawson1, Bonnie Curran3, Rachael Pryor3,4, Sabi Redwood1, Jelena Savović https://orcid.org/0000-0002-2861-0578 1Sharea Ijaz https://orcid.org/0000-0001-5727-1790 1, James Nobles2, [...] Loubaba Mamluk1, Sarah Dawson1, Bonnie Curran3, Rachael Pryor3,4, Sabi Redwood1, Jelena Savović https://orcid.org/0000-0002-2861-0578 1 PUBLISHED 01 Jul 2024 Author details Author details 1 Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK 2 School of health, Leeds Beckett University, Leeds, England, LS1 3HE, UK 3 Public Health, Bristol City Council, Bristol, England, BS1 5TR, UK 4 University of the West of England, Bristol, England, BS16 1QY, UK 2 School of health, Leeds Beckett University, Leeds, England, LS1 3HE, UK 3 Public Health, Bristol City Council, Bristol, England, BS1 5TR, UK 4 University of the West of England, Bristol, England, BS16 1QY, UK Sharea Ijaz Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation James Nobles Roles: Conceptualization, Data Curation, Investigation, Project Administration, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Investigation, Project Administration, Validation, Writing – Review & Editing Loubaba Mamluk Roles: Conceptualization, Investigation, Validation, Writing – Review & Editing Roles: Conceptualization, Investigation, Validation, Writing – Review & Editing Sarah Dawson Roles: Conceptualization, Investigation, Methodology, Software, Writing – Review & Editing Roles: Conceptualization, Investigation, Methodology, Software, Writing – Review & Editing Bonnie Curran Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Rachael Pryor Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Sabi Redwood Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Jelena Savović Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Disciplinary behaviour management strategies are implemented in schools to manage pupil behaviour. There is limited evidence of their intended impact on behaviour but there is growing concern around the potential negative impacts on pupil wellbeing. We carried out a systematic review to examine the impact of these strategies on psychosocial outcomes in pupils (PROSPERO Registration: CRD42021285427). We searched multiple sources and double-screened titles, abstracts, and full texts. Data extraction and risk of bias assessment were done by one reviewer and checked by another. Results were narratively synthesised. We included 14 studies, from 5375 citations, assessing temporary suspension (n=10), verbal reprimand (n=2), and mixed strategies (n=2). Depression was the most common outcome (n=7), followed by academic grades (n=4) and behaviour in class (n=4). All except one study were at high risk of bias. We found a recurring pattern in the evidence of disciplinary strategies associated with poor mental wellbeing and behaviour in pupils. The effect on academic attainment was unclear. Disciplinary behaviour management strategies may have negative impact on pupil mental wellbeing and class behaviour. These important consequences should be assessed in better designed studies before these strategies are implemented. How does school discipline affect pupil mental health and wellbeing? A systematic review In England, a variety of approaches are used in schools to manage pupils’ behaviour. There isn’t much evidence about their impact on behaviour, but there’s growing concern they might negatively affect pupils’ wellbeing. We systematically reviewed the published research to understand the impact of these behaviour management strategies on pupils’ wellbeing. We searched multiple sources and two people looked at titles, abstracts and full papers. One reviewer extracted the data and assessed the studies for risk of bias, while another checked this work. Results from all studies were combined together in text and tables. We included 14 studies from the 5,375 papers that we looked at. Included studies explored at a range of strategies, including temporary suspension (10 studies), verbal reprimand or being told off (2 studies), and a combination of strategies (2 studies). Seven studies looked at whether these strategies led to depression, four looked at the impact on exam grades and four on behaviour in class. All except one study were at high risk of bias, meaning we can’t fully trust their findings. Many of the studies showed these disciplinary strategies were linked to poor mental wellbeing and behaviour in pupils. The effect on exam results wasn’t clear. It appears pupil mental wellbeing and class behaviour was made worse by these strategies. These are important impacts and should be researched in high quality studies before these strategies are used further. adolescent, school discipline, behaviour management, mental health, wellbeing, systematic review Corresponding Author(s) Sharea Ijaz ([email protected]) Grant information: This research was funded by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) (NIHR200181). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Ijaz S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ijaz S, Nobles J, Mamluk L et al. Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.13563.2) First published: 25 Mar 2024, 4:13 (https://doi.org/10.3310/nihropenres.13563.1) Latest published: 01 Jul 2024, 4:13 (https://doi.org/10.3310/nihropenres.13563.2) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We have updated the text of our original submission in response to peer review. We added information in the background about the review's focus on secondary schools. We elaborated further in the methods why any meta-analyses were not conducted. We have provided more specific reasons for the exclusion of studies in the PRISMA diagram. We have included further reflection on link between punitive disciplinary strategies and poor academic outcomes, and the potential value of alternative approaches in discussion. We have added further reflections on our search for grey literature in the limitation section. See our detailed response to the reviews for specific locations of these updates. We have updated the text of our original submission in response to peer review. We added information in the background about the review's focus on secondary schools. We elaborated further in the methods why any meta-analyses were not conducted. We have provided more specific reasons for the exclusion of studies in the PRISMA diagram. We have included further reflection on link between punitive disciplinary strategies and poor academic outcomes, and the potential value of alternative approaches in discussion. We have added further reflections on our search for grey literature in the limitation section. See our detailed response to the reviews for specific locations of these updates. We added information in the background about the review's focus on secondary schools. We elaborated further in the methods why any meta-analyses were not conducted. We have provided more specific reasons for the exclusion of studies in the PRISMA diagram. We have included further reflection on link between punitive disciplinary strategies and poor academic outcomes, and the potential value of alternative approaches in discussion. We have added further reflections on our search for grey literature in the limitation section. See our detailed response to the reviews for specific locations of these updates. See the authors' detailed response to the review by Nicholas A Gage See the authors' detailed response to the review by Erica Gadsby Disciplinary behaviour management strategies are implemented in schools to help manage pupil behaviour. There are several approaches towards behaviour management. There are punitive strategies which align with the theory of assertive discipline1, which set out clear rules that reward good behaviour and punish poor behaviour. Punitive approaches will typically directly respond to poor behaviour, whereby punishing a pupil is anticipated to reduce the likelihood of repeated disruptive behaviour. However, if a pupil misbehaves again or dependent on the misbehaviour itself, increasingly severe forms of punishment are then used. Punitive approaches include strategies such as verbal reprimanding (e.g., being shouted at in class), detentions, isolation rooms, in- and out-of-school suspensions, and expulsion (permanent exclusion). These punitive approaches are commonplace in the western world2,3, and are more common in secondary schools in UK4,5. Conversely, there are alternative approaches that aim to understand why pupils act as they do, in the context of poor behaviour, and then work with the child to reduce the likelihood of these behaviours recurring. These include restorative approaches6, trauma informed approaches7, collaborative problem solving8, positive behavioural intervention and support (PBIS)9, or attachment-based strategies10. These strategies support pro-social behaviour between pupils, and collaborative interaction between pupils and teachers11. The evidence base in support of these alternative approaches has developed in recent years12–14. There is limited evidence regarding the intended impact of punitive approaches on behaviour and academic outcomes for affected pupils and their peers15–18. There is also a growing concern for the potential negative implications that punitive approaches may have on wellbeing outcomes later in life19,20. This is important given that young people’s mental health has declined in recent years in the UK, partly due to disruptions in school and home routines following COVID-19 and the pandemic response strategies21. This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities. This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people22. To examine whether the use of disciplinary behaviour management strategies (interventions) in secondary schools leads to adverse psychosocial outcomes for pupils Secondary objectives were: To explore whether adverse effects differ between children of different socio-demographic backgrounds To determine whether there is evidence of effectiveness for these disciplinary behaviour management strategies in improving behaviour and academic outcomes This review was registered with the international Prospective Register of Systematic Reviews (PROSPERO) in October 2021. Registration number CRD4202128542723. Public Involvement We held three involvement sessions with young people aged between 11 and 16 years old to develop the broad research questions. The first session involved the Young People’s Advisory Group (YPAG; a local public involvement group for young people interested in research) raising concerns about the effect of disciplinary behaviour management strategies on pupil wellbeing. A second workshop was conducted with funding from Create to Collaborate24 to explore these concerns with a broader group of young people affiliated with a mental health charity. In this workshop, young people suggested that some school discipline practices affect their wellbeing negatively. We then ran a third workshop to refine the review questions and search terms with the input from YPAG. Eligibility criteria We included randomised and non-randomised study designs (including longitudinal and cross-sectional surveys). We excluded solely qualitative studies as this review’s scope was limited to effects of interventions. Based on our public involvement work with young people, we were interested in zero-tolerance, punishment-based, or punitive disciplinary strategies that include verbal reprimanding, behaviour monitoring and reporting, isolation, detentions (either during- or after- school hours), and suspension (inclusive of temporary- or fixed- term exclusion). We did not include studies which only focused on permanent exclusion or expulsions from schools. We limited our inclusions to the UK and other high-income countries in The Organisation for Economic Co-operation and Development (OECD). This meant that approaches such as corporal punishment, and physical- or chemical- restraint were not included given that they are not implemented in a UK (or similar) context. We included studies of children and young people from the general population, aged 11–16 years, attending a main-stream school. We excluded studies focused on pupils in specialist schools, such as secure centres for children (similar to a juvenile correction facility in the USA), special behavioural units, and Special Educational Needs and Disability (SEND) schools. Our primary outcomes were any measures of mental health and wellbeing. We included academic and social outcomes as secondary outcomes. Search strategy We developed search strategies with an information specialist (SD) and searched seven online databases from inception to October 15th, 2021: MEDLINE; Embase; PsycINFO; British Education Index; Australian Education Index; Education Resources Information Centre (ERIC); Web of Science Social Science Citation Index (SSCI). See Extended data for search strategies25. We also sent a standardised email through the Children and Young People’s Mental Health Coalition26 to their 237 member organisations to help identify grey literature. Study selection Titles and abstracts identified through electronic database- and web- searching were independently screened for relevance in duplicate (JN, SI, & LM) using Rayyan27. Full texts were then retrieved for all relevant references and assessed against the inclusion criteria, in duplicate. Reasons for exclusion were documented (see table S1 in supplementary file) at this stage. Any discrepancies between reviewers at either stage were resolved through discussion or via a third reviewer (JS). Data extraction and risk of bias assessment Data extraction was undertaken by one reviewer (JN) using a standardised form in Microsoft Excel. To minimise bias and errors, a second reviewer (SI) checked the data extracted from all included papers. We extracted information on the following: a) study design, b) sample size and characteristics, c) the behaviour management strategy being studied, d) control / comparator [where available], e) context and setting, and f) information about, and results pertaining to, the primary and secondary outcomes. We assessed risk of bias in included studies using Cochrane Effective Practice and Organisation of Care (EPOC) group’s criteria for nonrandomised studies28. We considered a study to be at an overall low risk of bias when all items were scored at low risk, at an overall moderate risk of bias when more than half the items were at low risk of bias, and all others were rated high risk of bias. Synthesis We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations. Electronic searches resulted in 5357 citations. We found no additional studies through contacts with experts and third sector organisations. Fifty papers were included for full text assessment. After full text screening, 14 studies29–42 out of these 50 were included in narrative synthesis. See Figure 1 for detail of the process. Ten studies were from USA, followed by two from Australia and the UK respectively, and one from Poland. We found no randomised trials. Studies were either surveys or uncontrolled before and after designs. Sample sizes across studies varied widely, ranging from 23 pupils to 33 572 pupils (median = 1811 pupils). Studies typically included more females than males. Most studies (n=9)29,30,32,33,35,37–40 included high school pupils. White pupils were included less often (mean 36%, median 30% across studies) than non-white pupils. Five studies31,35,39,41,42 focused on deprived populations, reported as majority (>50%) children being on free school meals and/or low earning. Temporary suspension from school was most frequently studied (n=11)29,31,33–35,37,39–43, followed by verbal reprimanding or punishment (n=2)36,38 and various mixed (multiple combined) strategies (n=2)30,32. We present result for these categories separately below. The most common studied outcome was depression (n=7)30–32,34,35,37,40 using various scales: PHQ-9 (Patient health Questionnaire); CESD (Center for Epidemiological Studies Depression); SDQ (Strengths and Difficulties Questionnaire); California Healthy Kids Survey (WestEd) (Depression subscale); and Add Health survey. Two studies assessed internalising symptoms (i.e., problems of withdrawal, somatic complaints, and anxiety/depression)44, one using Teacher observation of classroom adaptation checklist (TOCAC)31 and Youth Self Report (YSR) in the other41. One study assessed externalising symptoms (i.e., problems of aggression, impulsivity, and inattention)44 on adapted Behavior Assessment System for Children: second edition (BASC 2) scale29. Anxiety was assessed in one study36 using a Polish version of State-Trait Anxiety Inventory for Children. General mental wellbeing was assessed in three studies33,38,39, one using the Warwick and Edinburgh Mental Wellbeing Scale33, and two using author developed scales38,39. Five studies30,35,36,39,42 assessed impact of disciplinary strategies on educational attainment. See Table 1 for details of included studies. | Author (Year) Country | Study design | Disciplinary intervention | Setting, sample and demographics | Outcomes reported | Findings | |---|---|---|---|---|---| | Suspension Strategies | ||||| | Bottiani et al. (2017)29 USA | Cross-sectional survey | Out-of-school suspension | Setting: High school Sample size: 19 726 pupils Age: 15.9 years Sex: 50% female Ethnicity: 64% White American Deprivation: 37.5% of schools provided FSM | Externalising symptoms; social belonging, perceived equity | Higher Black-to-White suspension gaps (higher suspension for Black students) led to higher levels of adjustment problems (externalising symptoms) in black pupils (γ=0.77, p<.001) at one year post suspension | | Cohen et al. (2020)31 USA | Prospective follow up | In-school and out-of-school suspension | Setting: Middle school Sample size: 788 pupils Age: N/R Sex: 50% female Ethnicity: 74% African American Deprivation: 75% FSM | Student-reported depression, and emotional dysregulation; behaviour; concentration in class | Neither in school nor out of school suspension frequency affected self-reported depression on PhQ-9: In school suspension effect: b=0.015; SE 0.103, standardized beta weight (95% CI) = 0.007 (−0.086, 0.100) out of school suspension effect: b=0.211 SE 0.186, standardized beta weight (95% CI) = 0.043 (−0.032, 0.118) The frequency of in- and out-of-school suspension predicted greater disruptive behaviour (b = 0.119, p ≤ .001)) more concentration problems (b=0.118, 0.028), p ≤ .001). Suspension not our outcome | | Fazel et al. (2021)33 UK | Cross-sectional survey | Out-of-school suspension | Setting: High school Sample size: 1648 pupils Age: N/R Sex: 60% female Ethnicity: N/R Deprivation: N/R | Mental wellbeing; accessing mental health services | No significant difference in wellbeing scores between those who were suspended (n=93) or not (n=1555). 25.8% of those suspended accessed mental health services compared to 14% who were not suspended. Suspended pupils more likely to be male, identify as “aggressive and violent”, and have been recently bullied compared to non-suspended pupils. | | Ford et al. (2018)34 UK | Longitudinal survey | Out-of-school suspension | Setting: N/A Sample size: 5326 pupils Age: N/R Sex: N/R Ethnicity: N/R Deprivation: N/R | Depressive symptoms; psychopathology | At baseline, suspended pupils have 13.7 (95%CI: 10.8-17.4) times greater odds of having a psychiatric disorder compared to non-suspended. At follow up, odds were 5.5 times greater (95%CI: 3.6-8.4). Suspended pupils, have poorer scores on the Strengths and Difficulties Questionnaire at follow up compared to non-suspended (OR: 6.8, 95%CI: 5.9-7.7) and higher odds of a new psychiatric disorder (OR: 7.1, 95%CI: 5.1-9.9). Not our outcome- the effect of these covariates (subgroups should be on our outcomes not on exposure) | | Gase et al. (2017)35 USA | Cross-sectional survey | Out-of-school suspension | Setting: High school Sample size: 33 572 pupils Age: N/R Sex: 50.2% female Ethnicity: 75% Hispanic Deprivation: 70% of schools provided FSM | Depressive symptoms or suicidal ideation; educational attainment; health behaviour | Suspension rates not associated with depressive symptoms or suicidal ideation (OR: 0.39, 95% CI: 0.15-1.04) Suspension rate was significantly associated with marijuana use (adjusted odds ratio 6.41, 95% CI 1.64, 25.07) but not tobacco use or alcohol use. No significant effect on grade point average in multilinear regression: −0.04 (−0.60, 0.53), and after controlling for age, sex, ethnicity and SES: 0.02 (−0.57, 0.62). | | Quin (2019)37 Australia | Cross-sectional survey | Out-of-school suspension | Setting: High school Sample size: 304 pupils Age: 14.7 years Sex: 45.4% female Ethnicity: 44% Asian, 24% English Australian Deprivation: 28.9% received Education Maintenance Allowance | Depressive symptoms; school belonging; behaviour | 39% of suspended students had a borderline score on the Strengths and Difficulties Questionnaire compared to 19% of non-suspended students (p<0.001). Statistically significant relationship between the total difficulties scores and suspension: χ2(1) = 12.35, p < .001 | | Rose et al. (2017)39 USA | Cross-sectional survey | Out-of-school suspension | Setting: High school Sample size: 1170 pupils Age: 15.0 years Sex: 52% female Ethnicity: 69.2% African American Deprivation: 54.8% of families earned less than $32 000 | Mental wellbeing (poor, content or positive); educational attainment | Suspended pupils had 2.1 times greater odds of being in poor mental health group rather than positive mental health group (p≤0.05). Similarly, they had 1.9 times greater odds of being held back a grade (p≤0.05). Findings on relationship between grades and suspension not reported. No statistically significant effect of ethnicity when comparing the positive mental health group to the others. But males had higher odds (OR=1.865) of being in the troubled group, and pupils from higher-income families had lower odds of being in vulnerable group (OR=0.721) | | Rushton et al. (2002)40 USA | Longitudinal survey | Out-of-school suspension | Setting: High school Sample size: 13 568 pupils Age: 15.6 years Sex: 49.7% female Ethnicity: 68% White American Deprivation: 11.5% received public assistance | Depressive symptoms | Suspended pupils had 1.9 (95%CI: 1.3-2.7) times greater odds of having depressive symptoms compared to non-suspended pupils. Results adjusted for race, grade in school, socio-economic status, maternal educational status, and single-parent household. | | Smokowski et al. (2014)41 USA | Longitudinal survey | Out-of-school suspension | Setting: Middle school Sample size: 4229 pupils Age: 12.8 years Sex: 52% female Ethnicity: 28.4% American Indian, 26.7% White American, 23.3% African American Deprivation: 85.8% FSM | Internalising symptoms; Self-esteem | For every out-of-school suspension a pupil receives, their odds of internalised symptomology increased by 5% (p≤0.05). No association between out-of-school suspension and self-esteem. | | Stanley et al. (2006)42 USA | Cross-sectional survey | Out-of-school suspension | Setting: Middle school Sample size: 23 pupils Age: N/R Sex: 35% female Ethnicity: 69% Hispanic Deprivation: 73% FSM | Adjustment problems,); Student academic resources (composite score of academic performance, academic habits, parent participation, social skills) Behavioural problems | Suspension was significantly associated with greater adjustment problems scores ranging from 56 to 70 when normal scores are below 50 Suspension was also associated with significantly lower t scores on academic resources ranging from 26 to 36 which are below the norm (50 and above) | | Verbal reprimand strategies | ||||| | Piekarska (2000)36 Poland | Prospective cross-sectional survey | Verbal punishment induced school stress from teachers, inclusive of: 1) Threats 2) Mockery 3) Humiliation 4) Insulting 5) Verbal attack 6) Written or oral tests | Setting: Primary school in Poland (includes grade 1-8) Sample size: 271 pupils Age: 13-14 years Sex: N/R Ethnicity: N/R Deprivation: N/R | Anxiety; Educational attainment | School stress due to poor performance on sudden written and oral tests, reported by 77% and 53% of pupils respectively. Significant association between school stress and anxiety (r = 0.30, p<0.001). Significant association between school stress and educational attainment - grade point average (r = -0.29, p<0.001). | | Roache et al. (2011)38 Australia | Prospective cross-sectional survey | Verbal punishments, inclusive of yelling in anger and embarrassing students deliberately Compared to techniques using combination of rewards and punishments | Setting: High school Sample size: 1975 pupils Age: N/R Sex: N/R Ethnicity: N/R Deprivation: N/R | General wellbeing; School connectedness; Misbehaviour; Attitude and interest in subjects | No relationships reported between punishment-based or aggression-based classroom management and pupil wellbeing. Significant relationships between aggressive classroom management techniques and pupil misbehaviour (r=0.48, p≤0.05), being distracted from work (r=0.72, p≤0.05), and pupil interest in the subject (r=-0.58, p≤0.05). | | Mixed strategies | ||||| | Chen et al. (2021)30 USA | Prospective follow up | Total punishment, inclusive of: 1) Corporal punishment 2) In-school and out-of-school suspension 3) Expulsion 4) Referral to law enforcement 5) School-related arrests | Setting: High school Sample size: 261 pupils Age: 11.2 years Sex: 34.9% female Ethnicity: 100% African American Deprivation: 42.3% lived in relative poverty | Depressive symptoms; academic orientation; Educational attainment | Attending a school that disproportionately punished Black students predicted more depressive symptoms at age 27 years β= 0.11 (95% CI: 0.04, 0.18). Significant positive interaction between academic orientation and disproportionate school punishment β=0.12 (95% CI: 0.01, 0.24). Disproportionate school punishment did not affect educational achievement at age 27 β=0.785 (95%CI: 1.466, 3.035) however, A positive main effect of academic orientation on adult educational attainment qualified by a significant interaction with disproportionate school punishment β= 0.11 (95% CI: 0.00, 0.23). | | Eyllon et al. (2022)32 USA | Longitudinal survey | Severity of school disciplinary policies: 1) Lenient policies 2) In-school suspension 3) Out-of-school suspension 4) Expulsion Assessed on a 7-point Likert scale to produce a mean score per school | Setting: High school Sample size: 8878 pupils Age: 15.7 years Sex: 54% female Ethnicity: 59% White American Deprivation: 23% received public assistance | Depressive symptoms | Significant association between mean disciplinary policy severity and depressive symptoms. A one-unit increase in mean discipline policy severity was associated with a 1.03 unit increase in depressive symptoms among non-excluded students (95% CI: 0.15, 1.91). Controlling for ethnicity did not modify the results. | Studies were mostly at high risk of bias across all domains (see Figure 2). Only one study31 was considered at an overall moderate risk of bias. None were considered at a low risk of bias. For most studies there is risk of bias due to confounding. For cross-sectional studies and surveys the risk of reverse causality is a key problem, i.e., we can’t be sure whether poor mental health was the cause of 'bad behaviour' and thus the reprimand or suspension, rather than the consequence. • Depression i. School Suspension Strategies Five studies31,34,35,37,40 reported on depression due to suspension. Odds of greater total difficulties (SDQ) were found to be significantly higher for those who were suspended in two studies34,37. Rushton et al.40 also found that being suspended from school was associated with increased odds of depressive symptomology. Two studies31,35 found self-reported depressive symptoms were not related to suspension. ii. Verbal reprimand strategies None of the two studies assessing verbal punishment strategies reported on depression. iii. Mixed strategies Two studies30,32 reported depression assessing two slightly different strategies that included suspensions and some other forms of punishments together. Both found that punishment-based policies led to more depressive symptoms, but at different time points. Chen et al.30 found that Black pupils attending a school that disproportionately punished Black students had greater depressive symptoms as an adult ten years later (β= 0.11,95% CI: 0.04, 0.18), compared to their White peers. Eyllon et al.32 found strict (vs lenient) policies to increase depression in pupils so that each unit increase in school’s policy being strict led to a 1.03 unit rise in pupil depression scores on average (95% CI: 0.15, 1.91). Impact on population subgroups The two studies reporting data on ethnicity were not in agreement. While Chen et al.30 found Black pupils to be disproportionately affected by disciplinary punishments and the consequent depression in later age, Eyllon et al.32 found no link between ethnicity and higher depression due to strict school policies within one year. • Anxiety No suspension or mixed strategy studies reported this outcome. A single study set in Poland36 found that higher school stress brought on by verbal reprimand strategies led to higher anxiety in pupils (R = 0.30, p <.001). • Psychiatric disorder A single study34 found children who had been suspended from school had higher odds of diagnosis of a new psychiatric disorder (OR 7.09; 95%CI 5.07 to 9.91; p < 0.001) compared to those not suspended. No studies of verbal reprimand or mixed strategies reported this outcome. • General mental wellbeing One study33 assessing the effect of suspension found a non-significant (p=0.15) lower wellbeing (on Warwick Edinburgh Mental Wellbeing Scale) and significantly (p=0.003) greater use of mental health services for suspended children compared to pupils who have never been suspended. Another found children who were suspended were twice as likely to have poor mental health39. A single study38 assessing link between verbal disciplinary strategies and pupil mental wellbeing (on author developed scale) reported no outcome data. No study on mixed strategies reported this outcome. • Internalising symptoms One study on suspension41 found that each additional suspension per school led to increase in internalising scores by 0.05%, while another31 found that suspensions were not associated with internalising problems. No verbal reprimand or mixed strategy studies reported this outcome. • Externalising symptoms A single study found that in schools which suspended proportionally more Black pupils than White pupils, Black pupils overall showed higher externalising symptoms29. No verbal reprimand or mixed strategy studies reported this outcome. i. School Suspension Strategies Three studies31,37,42 found suspension was associated with poorer (more disruptive, less pro-social) behaviour. Two studies found suspensions were associated with lower perception of social belonging at school29,37. School-level Black–White suspension gaps (i.e., excess risk of out-of-school suspension among Black students relative to White students,) were associated with Black students’ perceptions of less school equity in a single study29. A single study35 found suspensions led to greater marijuana use but had no association with tobacco or alcohol use. A single study41 found no association between out-of-school suspension and self-esteem. ii. Verbal reprimand strategies A single study (Roache) found that aggressive verbal punishments from teachers led to increased disruptive behaviour in the classroom (r=0.48, p<0.05), being more distracted from class work (r=0.72, p<0.05), and reduced pupil interest in the subject being taught (r=-0.58, p<0.05). No studies in this category reported social outcomes. iii. Mixed strategies No studies of mixed strategies reported social outcomes. Of the three studies assessing educational outcomes, one comprehensively reported data and35 found no link between suspension and grade scores. This effect remained non-significant (although direction was opposite) after adjusting for demographic factors including ethnicity. One study39 did not report data on the effect of suspension on grades, and the other42 said they found lower scores on a composite of academic performance habits and skills but did not report data to support this finding. Piekarska et al.36 found that verbal punishments from teachers caused school stress which negatively impacted academic performance as grade point average. While Chen et al. (2021) reported no direct effect of greater punishment on long-term educational attainment, they did find that for children who were not academically oriented, greater punishment was associated with lower educational attainment. This study included only Black American pupils. Our review illustrates that evidence on the impact of disciplinary strategies in schools is scarce and of low quality. Although at high risk of bias, five out of seven studies assessing depressive symptomatology found it to be associated with exposure to disciplinary strategies. All three studies on general mental wellbeing found it to be associated with exposure to disciplinary strategies. Single studies on anxiety, psychiatric disorder diagnosis, and externalising symptoms also found that disciplinary strategies were associated with these issues. Internalising symptoms, and a similar link with externalising symptoms, were only seen in one of the two studies to be associated with a disciplinary approach. Similar effect was seen with social outcomes where, overall, disciplinary strategies were associated with poor social behaviour (n=4), lower school belonging (n=2), and greater marijuana use (n=1), but had no association with tobacco use or self-esteem (n=1). Evidence of the impact on educational attainment was limited and it was not clear how they were related to disciplinary strategies. A recent qualitative synthesis has found some evidence of a link between punitive disciplinary strategies and poor academic outcomes45. While there are reviews on suspensions and exclusions as outcomes2,46, we did not find any that examine the mental health or wellbeing impact of these strategies. We found one systematic review reporting that pupils experiencing exclusionary discipline were more likely to have subsequent contact with the justice system47. To our knowledge, our systematic review is the first to question the impact of these strategies on mental wellbeing of school children. Considering the increasing levels of mental health problems in young people in the UK48 it is important to assess these strategies for their potential impact on these outcomes which are important to pupils, their families and society. Most of the evidence available was on suspensions. Suspensions have been rising in recent years in the UK, with the main reason for suspensions being disruptive behaviour49. Our review shows that suspensions can potentially increase disruptive behaviour, thus creating a vicious cycle of increase in both. Although not the main focus of our review, we did see across three studies that children of Black, Asian, and Minority Ethnicities (BAME) origin were often at higher risk of disciplinary actions from teachers. This is in line with recent findings from both USA50 and the UK49, indicating that the interaction of race and adverse childhood experiences predispose students of colour to be subject to school discipline. Future research should explore these links, and schools should consider these potential equality risks when implementing disciplinary strategies. Governments place importance on the safeguarding of all pupils’ wellbeing in their expectations from teachers51,52. Our review suggests that currently approved strategies can negatively impact student wellbeing, which can make it hard for teachers to fulfil these expectations. This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behaviours in schools53,54 that are less likely to negatively impact pupil wellbeing. We followed PRISMA standards when reporting the review and searched comprehensively using relevant scientific databases and grey literature sources. We were inclusive in our criteria for studies to allow us to examine the full range of effects of these commonly used strategies. Considering how widespread their use is, the empirical evidence on these strategies is limited for wellbeing, behaviour or academic outcomes. We found no studies from grey literature. Some of the databases we searched would have contained certain types of grey literature (e.g. conference abstracts, theses and dissertations). However, had we searched repositories of grey literature (e.g. OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc. It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources. Included studies were at high risk of bias in most domains. This is a major limitation of our findings. There is a need for better quality research to address these questions. We searched for, and included studies that reported at least one primary (mental wellbeing) outcome. Our restriction to primary outcome reporting has likely overlooked evidence on educational and behavioural outcomes reported in studies without a focus on general mental wellbeing. Thus, our findings on these outcomes are likely not to be comprehensive, although they may be indicative of the general trend. This review included studies conducted only in mainstream schools and therefore the findings do not extend to other settings. However, when screening the literature, there were studies that focused on specialist schools or exclusively including pupils with additional learning needs (e.g., attention deficit hyperactivity disorder) and these should be assessed in a separate review. We included all author definitions for strategies (e.g., suspension or temporary exclusion could be anything from a few hours to several days, and may or may not include supervised confinement to a room or location in school) to not miss any relevant evidence. There is however a lack of clear definitions and descriptions for any of the disciplinary strategies. Thus, there is a need to clearly define these interventions and their proposed impact before research on these can give clear conclusion on their relative impacts. For example, UK defines suspensions as any fixed time exclusion between one school period (length of a lesson varies from 30 minutes to 120 minutes) and 45 school days49. This definition may be different from those used in other nations. This would invariably also be reflected in studies from different countries. We would anticipate that the effect of a 45-minute isolation may be different from that of a week-long or month-long suspension. A differential or dose response effect may only be elicited if the definitions used in each study are clear. Existing evidence indicates that disciplinary behaviour strategies might lead to poorer mental wellbeing and behaviours for pupils. There is some evidence to suggest these strategies may also inadvertently increase inequalities. However, the limitations of quality and size of the evidence precludes clear conclusions. This means schools, and decision makers within educational systems, need to be cautious when adopting and advocating these strategies until better evidence on these is available. It would also be advantageous for schools to share data on disciplinary strategies and pupil health outcomes with research teams to facilitate a deeper level of exploration. There is a need to assess wellbeing, social and academic effects of these disciplinary strategies (and other strategies) ideally in robustly designed trials comparing school clusters with different strategies in place. These trials (natural experiments) should be complemented with qualitative exploration of pupil perceptions of these strategies and their outcomes in various contexts. There are county-wide surveys and school-based surveys in the UK that routinely measure the health and wellbeing of pupils. These data could be compared to respective school level suspension rates and other disciplinary strategies (e.g., isolation/isolation rooms). As these wellbeing surveys are repeated annually, we should also be able to see trends of wellbeing over time, as well as the potential impacts of changing national or regional disciplinary policies on these outcomes at school level. Follow up data should also be gathered beyond the school period (into adulthood) as disciplinary strategies may have long term consequences30,47. Disciplinary strategies aimed at improving behaviour at school may have negative effects on the pupil mental wellbeing as well as school behaviour. These are important consequences and should be assessed in better designed studies before these strategies can be recommended. The underlying data for this article consists of bibliographic references, which are included in the References section. Open Science Framework: Behaviour management in schools review https://doi.org/10.17605/OSF.IO/AJHGR25 This project contains the following extended data: PRISMA checklist and flowchart for ‘Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review’. https://doi.org/10.17605/OSF.IO/AJHGR25 We want to thank members of Young People’s Advisory Group and Off The Record who helped us develop and refine the review question and acknowledge the Create to Collaborate funding for workshops that helped in the development of project. We also want to thank Professor Esther Crawley for her support and guidance in setting up the project. Faculty Opinions recommendedReferences - 1. 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PubMed Abstract | Publisher Full Text | Free Full Text Author details Author details 1 Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK 2 School of health, Leeds Beckett University, Leeds, England, LS1 3HE, UK 3 Public Health, Bristol City Council, Bristol, England, BS1 5TR, UK 4 University of the West of England, Bristol, England, BS16 1QY, UK 2 School of health, Leeds Beckett University, Leeds, England, LS1 3HE, UK 3 Public Health, Bristol City Council, Bristol, England, BS1 5TR, UK 4 University of the West of England, Bristol, England, BS16 1QY, UK Sharea Ijaz Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation James Nobles Roles: Conceptualization, Data Curation, Investigation, Project Administration, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Investigation, Project Administration, Validation, Writing – Review & Editing Loubaba Mamluk Roles: Conceptualization, Investigation, Validation, Writing – Review & Editing Roles: Conceptualization, Investigation, Validation, Writing – Review & Editing Sarah Dawson Roles: Conceptualization, Investigation, Methodology, Software, Writing – Review & Editing Roles: Conceptualization, Investigation, Methodology, Software, Writing – Review & Editing Bonnie Curran Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Rachael Pryor Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Roles: Conceptualization, Resources, Validation, Writing – Review & Editing Sabi Redwood Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Jelena Savović Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research was funded by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) (NIHR200181). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) Copyright © 2024 Ijaz S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Ijaz S, Nobles J, Mamluk L et al. Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.13563.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 01 Jul 2024 Revised Views 0 How to cite this report: Gage NA. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14788.r32270) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v2#referee-response-32270 https://openresearch.nihr.ac.uk/articles/4-13/v2#referee-response-32270 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 15 Jul 2024 Approved VIEWS 0 The authors have ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close The authors have addressed my concerns. Competing Interests: No competing interests were disclosed. Reviewer Expertise: systematic review, meta-analysis, and quantitate methods CITE HOW TO CITE THIS REPORT Gage NA. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14788.r32270) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v2#referee-response-32270 https://openresearch.nihr.ac.uk/articles/4-13/v2#referee-response-32270 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Version 1 VERSION 1 PUBLISHED 25 Mar 2024 Views 0 How to cite this report: Gadsby E. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14722.r31420) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31420 https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31420 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 29 Apr 2024 Approved VIEWS 0 This is a systematic review of disciplinary behaviour management strategies and their impact on student psychosocial outcomes. This is an area that is under-researched and of significant importance given the state of young people's mental health in the UK. ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close ... Continue reading This is a systematic review of disciplinary behaviour management strategies and their impact on student psychosocial outcomes. This is an area that is under-researched and of significant importance given the state of young people's mental health in the UK. The authors present a sound rationale, responding to the limited evidence on the intended impact, and concerns regarding unintended impact. Researchers singled out psychosocial outcomes as a focus and conducted a systematic review to examine the impact of behaviour management on these outcomes. The question, in lay English was: How does school discipline affect pupil mental health and wellbeing? The introduction provided a good explanation of punitive approaches to school discipline, and alternative approaches (e.g. trauma informed, restorative, collaborative problem solving, etc.). The concern, that disciplinary strategies in school could be negatively impacting pupils' mental health, was raised in by young people within a consultation meeting in Bristol.

The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. The review had two secondary objectives: to assess whether the potential negative effects differed between different SES groups, and to see whether there was any evidence of the strategies positively impacting behaviour or academic outcomes. The focus are disciplinary measures of most concern was guided by young people - punitive measures, stopping short of permanent exclusion or expulsion. The review was limited to UK and OECD countries - justification that this does not include corporal punishment or other forms of restraint, which is reasonable. The population was young people aged 11 to 16, and the context mainstream school (not specialist schools). Primary outcomes - any measures of mental health and wellbeing. Secondary outcomes - academic and social outcomes. The search involved an information specialist and is well described. Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria?

Evidence on the effects of school disciplinary strategies is scarce and of low quality. There are caveats associated with the low quality evidence, but findings suggest a link between punitive disciplinary strategies and pupil mental health and wellbeing, and also social outcomes (social behaviour). Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. The authors present a sound rationale, responding to the limited evidence on the intended impact, and concerns regarding unintended impact. Researchers singled out psychosocial outcomes as a focus and conducted a systematic review to examine the impact of behaviour management on these outcomes. The question, in lay English was: How does school discipline affect pupil mental health and wellbeing? The introduction provided a good explanation of punitive approaches to school discipline, and alternative approaches (e.g. trauma informed, restorative, collaborative problem solving, etc.). The concern, that disciplinary strategies in school could be negatively impacting pupils' mental health, was raised in by young people within a consultation meeting in Bristol.

The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. The review had two secondary objectives: to assess whether the potential negative effects differed between different SES groups, and to see whether there was any evidence of the strategies positively impacting behaviour or academic outcomes. The focus are disciplinary measures of most concern was guided by young people - punitive measures, stopping short of permanent exclusion or expulsion. The review was limited to UK and OECD countries - justification that this does not include corporal punishment or other forms of restraint, which is reasonable. The population was young people aged 11 to 16, and the context mainstream school (not specialist schools). Primary outcomes - any measures of mental health and wellbeing. Secondary outcomes - academic and social outcomes. The search involved an information specialist and is well described. Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria?

Evidence on the effects of school disciplinary strategies is scarce and of low quality. There are caveats associated with the low quality evidence, but findings suggest a link between punitive disciplinary strategies and pupil mental health and wellbeing, and also social outcomes (social behaviour). Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. - Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes - Are sufficient details of the methods and analysis provided to allow replication by others? Yes - Is the statistical analysis and its interpretation appropriate? Not applicable - Are the conclusions drawn adequately supported by the results presented in the review? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health services and public health research focusing on social determinants of health CITE HOW TO CITE THIS REPORT Gadsby E. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14722.r31420) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31420 https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31420 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 01 Jul 2024Sharea Ijaz, Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK01 Jul 2024Author ResponseThank you for your generous comments on and appreciation of our work. We have listed the queries in your review below and have responded to each. - The review - The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. - Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. We have added the below text to acknowledge the limitation of our grey search: We found no studies from grey literature. Some of the databases we searched would have contained certain types of grey literature (e.g. conference abstracts, theses and dissertations). However, had we searched repositories of grey literature (e.g. OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc. It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.- In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? - The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria? - Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). You are correct that this was a secondary outcome and not a focus of our review. In addition, the included study evidence was of very limited size and quality, so we did not expand on this. Within our search we found two reviews on educational attainment outcome although they did not study our interventions of interest:- Craggs H, Kelly C. Adolescents' experiences of school belonging: A qualitative meta-synthesis. Journal of Youth Studies. 2018;21(10):1411-25. https://www.tandfonline.com/doi/full/10.1080/13676261.2018.1477125 - Lee A, Gage NA. Updating and expanding systematic reviews and meta-analyses on the effects of school-wide positive behavior interventions and supports. Psychology in the Schools. 2020;57(5):783-804. https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.22336 Duarte CD, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci. 2023 Jan;1519(1):129-152. doi: 10.1111/nyas.14922. PMID: 36385456; https://pubmed.ncbi.nlm.nih.gov/36385456/ We have now added a sentence to expand on the evidence in reference to this review. - I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behavior's in schools[52, 53] that are less likely to negatively impact pupil wellbeing.Thank you for your generous comments on and appreciation of our work. We have listed the queries in your review below and have responded to each.Competing Interests: No competing interests were disclosed. Close- The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. - Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. We have added the below text to acknowledge the limitation of our grey search: We found no studies from grey literature. Some of the databases we searched would have contained certain types of grey literature (e.g. conference abstracts, theses and dissertations). However, had we searched repositories of grey literature (e.g. OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc. It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.- In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? - The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria? - Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). You are correct that this was a secondary outcome and not a focus of our review. In addition, the included study evidence was of very limited size and quality, so we did not expand on this. Within our search we found two reviews on educational attainment outcome although they did not study our interventions of interest:- Craggs H, Kelly C. Adolescents' experiences of school belonging: A qualitative meta-synthesis. Journal of Youth Studies. 2018;21(10):1411-25. https://www.tandfonline.com/doi/full/10.1080/13676261.2018.1477125 - Lee A, Gage NA. Updating and expanding systematic reviews and meta-analyses on the effects of school-wide positive behavior interventions and supports. Psychology in the Schools. 2020;57(5):783-804. https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.22336 Duarte CD, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci. 2023 Jan;1519(1):129-152. doi: 10.1111/nyas.14922. PMID: 36385456; https://pubmed.ncbi.nlm.nih.gov/36385456/ We have now added a sentence to expand on the evidence in reference to this review. - I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behavior's in schools[52, 53] that are less likely to negatively impact pupil wellbeing. COMMENTS ON THIS REPORT - Author Response 01 Jul 2024Sharea Ijaz, Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK01 Jul 2024Author ResponseThank you for your generous comments on and appreciation of our work. We have listed the queries in your review below and have responded to each. - The review - The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. - Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. We have added the below text to acknowledge the limitation of our grey search: We found no studies from grey literature. Some of the databases we searched would have contained certain types of grey literature (e.g. conference abstracts, theses and dissertations). However, had we searched repositories of grey literature (e.g. OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc. It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.- In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? - The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria? - Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). You are correct that this was a secondary outcome and not a focus of our review. In addition, the included study evidence was of very limited size and quality, so we did not expand on this. Within our search we found two reviews on educational attainment outcome although they did not study our interventions of interest:- Craggs H, Kelly C. Adolescents' experiences of school belonging: A qualitative meta-synthesis. Journal of Youth Studies. 2018;21(10):1411-25. https://www.tandfonline.com/doi/full/10.1080/13676261.2018.1477125 - Lee A, Gage NA. Updating and expanding systematic reviews and meta-analyses on the effects of school-wide positive behavior interventions and supports. Psychology in the Schools. 2020;57(5):783-804. https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.22336 Duarte CD, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci. 2023 Jan;1519(1):129-152. doi: 10.1111/nyas.14922. PMID: 36385456; https://pubmed.ncbi.nlm.nih.gov/36385456/ We have now added a sentence to expand on the evidence in reference to this review. - I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behavior's in schools[52, 53] that are less likely to negatively impact pupil wellbeing.Thank you for your generous comments on and appreciation of our work. We have listed the queries in your review below and have responded to each.Competing Interests: No competing interests were disclosed. Close- The review was developed with input from young people - this involvement is described briefly in the public involvement section. It would be good to know whether this involvement was evaluated at all. - Grey literature was sought through targeted emails (via a network) - given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy? The process and conduct of the systematic review was as according to best practice. A narrative synthesis of the findings was the only thing possible, given the quality and type of data. We have added the below text to acknowledge the limitation of our grey search: We found no studies from grey literature. Some of the databases we searched would have contained certain types of grey literature (e.g. conference abstracts, theses and dissertations). However, had we searched repositories of grey literature (e.g. OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc. It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.- In the description of included studies, the numbers don't add up. The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland. That makes 15. I counted 9 from USA in table 1. What was the 10th? - The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'. I'm wondering how this study fits the inclusion criteria? - Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess? - have other reviews looked at this?). You are correct that this was a secondary outcome and not a focus of our review. In addition, the included study evidence was of very limited size and quality, so we did not expand on this. Within our search we found two reviews on educational attainment outcome although they did not study our interventions of interest:- Craggs H, Kelly C. Adolescents' experiences of school belonging: A qualitative meta-synthesis. Journal of Youth Studies. 2018;21(10):1411-25. https://www.tandfonline.com/doi/full/10.1080/13676261.2018.1477125 - Lee A, Gage NA. Updating and expanding systematic reviews and meta-analyses on the effects of school-wide positive behavior interventions and supports. Psychology in the Schools. 2020;57(5):783-804. https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.22336 Duarte CD, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci. 2023 Jan;1519(1):129-152. doi: 10.1111/nyas.14922. PMID: 36385456; https://pubmed.ncbi.nlm.nih.gov/36385456/ We have now added a sentence to expand on the evidence in reference to this review. - I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all. The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing. This could have usefully been followed up with a short discussion of what this might include. There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behavior's in schools[52, 53] that are less likely to negatively impact pupil wellbeing. Views 0 How to cite this report: Gage NA. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14722.r31518) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31518 https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31518 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 25 Apr 2024 Approved with Reservations VIEWS 0 Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, the manuscript is clearly written and the OSF materials provide more detail about the review. That being said, I do have a few concerns. First, at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. Essentially, if the authors want to not provide a meta-analysis, a stronger rationale needs to be provided in the manuscript. Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. Essentially, if the authors want to not provide a meta-analysis, a stronger rationale needs to be provided in the manuscript. Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. - Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes - Are sufficient details of the methods and analysis provided to allow replication by others? Partly - Is the statistical analysis and its interpretation appropriate? Partly - Are the conclusions drawn adequately supported by the results presented in the review? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: more justification for only including secondary schools and not doing a meta-analysis are needed. CITE HOW TO CITE THIS REPORT Gage NA. Reviewer Report For: Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review [version 2; peer review: 2 approved]. NIHR Open Res 2024, 4:13 (https://doi.org/10.3310/nihropenres.14722.r31518) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31518 https://openresearch.nihr.ac.uk/articles/4-13/v1#referee-response-31518 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 01 Jul 2024Sharea Ijaz, Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK01 Jul 2024Author ResponseThank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited ... Continue reading Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, the manuscript is clearly written and the OSF materials provide more detail about the review. That being said, I do have a few concerns. Thank you for your feedback. We have made changes based on your comments and hope these are satisfactory- First, at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. End of para 1: These punitive approaches are commonplace in the western world [2, 3] and are more common in secondary schools in UK [4,5] Para 4: This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities. Para 5: This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people [22]. - Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. A meta-analysis was not conducted for the outcome of depression for suspensions as the 5 studies were very heterogeneous in not just populations (one study with 75% Black pupils, one study’s data from 1996), follow up times (no follow up in two studies, 1 year in two and 3 year in one study), outcome measures (dichotomous in 3 studies, continuous in 2) effect measures (odds ratios in 3 and regression coefficients in 2), comparisons (unspecified in three studies) but also study designs (one-time survey in two studies, repeated survey in two studies, and one controlled before-after study) and analyses (adjustment for confounders and numbers of analysed participants unclear in 3 studies). We found the same for mixed strategies for depression outcome where the two studies (Chen 2021; Eyllon 2022) were very heterogeneous in study sample, follow up, and effect size. We believe that pooling these disparate data from high risk of bias studies would not have changed our conclusions and recommendations but presented as a forest plot may give a false sense of validity to reader. We have now edited the text to explain our choice in our synthesis methods: We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.- Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. We had carried out screening of title/abstract and full texts in Rayyan and used these inbuilt labels in the platform to exclude and include studies. We have now revised the description in PRISMA to be more specific about the reasons.Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, the manuscript is clearly written and the OSF materials provide more detail about the review. That being said, I do have a few concerns.Competing Interests: No competing interests were disclosed. Close Thank you for your feedback. We have made changes based on your comments and hope these are satisfactory- First, at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. End of para 1: These punitive approaches are commonplace in the western world [2, 3] and are more common in secondary schools in UK [4,5] Para 4: This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities. Para 5: This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people [22]. - Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. A meta-analysis was not conducted for the outcome of depression for suspensions as the 5 studies were very heterogeneous in not just populations (one study with 75% Black pupils, one study’s data from 1996), follow up times (no follow up in two studies, 1 year in two and 3 year in one study), outcome measures (dichotomous in 3 studies, continuous in 2) effect measures (odds ratios in 3 and regression coefficients in 2), comparisons (unspecified in three studies) but also study designs (one-time survey in two studies, repeated survey in two studies, and one controlled before-after study) and analyses (adjustment for confounders and numbers of analysed participants unclear in 3 studies). We found the same for mixed strategies for depression outcome where the two studies (Chen 2021; Eyllon 2022) were very heterogeneous in study sample, follow up, and effect size. We believe that pooling these disparate data from high risk of bias studies would not have changed our conclusions and recommendations but presented as a forest plot may give a false sense of validity to reader. We have now edited the text to explain our choice in our synthesis methods: We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.- Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. We had carried out screening of title/abstract and full texts in Rayyan and used these inbuilt labels in the platform to exclude and include studies. We have now revised the description in PRISMA to be more specific about the reasons. COMMENTS ON THIS REPORT - Author Response 01 Jul 2024Sharea Ijaz, Population health sciences, NIHR ARC West, University of Bristol, Bristol, BS1 2NT, UK01 Jul 2024Author ResponseThank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited ... Continue reading Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, the manuscript is clearly written and the OSF materials provide more detail about the review. That being said, I do have a few concerns. Thank you for your feedback. We have made changes based on your comments and hope these are satisfactory- First, at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. End of para 1: These punitive approaches are commonplace in the western world [2, 3] and are more common in secondary schools in UK [4,5] Para 4: This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities. Para 5: This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people [22]. - Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. A meta-analysis was not conducted for the outcome of depression for suspensions as the 5 studies were very heterogeneous in not just populations (one study with 75% Black pupils, one study’s data from 1996), follow up times (no follow up in two studies, 1 year in two and 3 year in one study), outcome measures (dichotomous in 3 studies, continuous in 2) effect measures (odds ratios in 3 and regression coefficients in 2), comparisons (unspecified in three studies) but also study designs (one-time survey in two studies, repeated survey in two studies, and one controlled before-after study) and analyses (adjustment for confounders and numbers of analysed participants unclear in 3 studies). We found the same for mixed strategies for depression outcome where the two studies (Chen 2021; Eyllon 2022) were very heterogeneous in study sample, follow up, and effect size. We believe that pooling these disparate data from high risk of bias studies would not have changed our conclusions and recommendations but presented as a forest plot may give a false sense of validity to reader. We have now edited the text to explain our choice in our synthesis methods: We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.- Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. We had carried out screening of title/abstract and full texts in Rayyan and used these inbuilt labels in the platform to exclude and include studies. We have now revised the description in PRISMA to be more specific about the reasons.Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review. This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school. Overall, the manuscript is clearly written and the OSF materials provide more detail about the review. That being said, I do have a few concerns.Competing Interests: No competing interests were disclosed. Close Thank you for your feedback. We have made changes based on your comments and hope these are satisfactory- First, at the start of the methods section, the authors note that they focus on secondary schools. There is no mention of secondary schools in the introduction/literature review. Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools. End of para 1: These punitive approaches are commonplace in the western world [2, 3] and are more common in secondary schools in UK [4,5] Para 4: This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities. Para 5: This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people [22]. - Second, there is not enough information or justification for why a meta-analysis was not conducted. I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed. In fact, a quantitative synthesis would be very helpful to better understand the results. A meta-analysis was not conducted for the outcome of depression for suspensions as the 5 studies were very heterogeneous in not just populations (one study with 75% Black pupils, one study’s data from 1996), follow up times (no follow up in two studies, 1 year in two and 3 year in one study), outcome measures (dichotomous in 3 studies, continuous in 2) effect measures (odds ratios in 3 and regression coefficients in 2), comparisons (unspecified in three studies) but also study designs (one-time survey in two studies, repeated survey in two studies, and one controlled before-after study) and analyses (adjustment for confounders and numbers of analysed participants unclear in 3 studies). We found the same for mixed strategies for depression outcome where the two studies (Chen 2021; Eyllon 2022) were very heterogeneous in study sample, follow up, and effect size. We believe that pooling these disparate data from high risk of bias studies would not have changed our conclusions and recommendations but presented as a forest plot may give a false sense of validity to reader. We have now edited the text to explain our choice in our synthesis methods: We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.- Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity. Consider revising with clearer language and reasons. We had carried out screening of title/abstract and full texts in Rayyan and used these inbuilt labels in the platform to exclude and include studies. We have now revised the description in PRISMA to be more specific about the reasons. Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | || |---|---|---| | 1 | 2 | | | Version 2 (revision) 01 Jul 24 | read | | | Version 1 25 Mar 24 | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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