Caroline Helwick

October 23, 2012

NEW ORLEANS — Children diagnosed with mental health disorders are at least 3 times more likely to be labelled as bullies as those without such diagnoses, new research shows.

A nationwide survey found that 20% of US high school students reported being bullied on school property and that 16% reported being cyberbullied in the past 12 months.

"The presence of a mental health disorder diagnosis, regardless of the type, is strongly associated with being a bully," said principal investigator Frances G. Turcotte-Benedict, MD, a fellow in pediatric emergency medicine at Hasbro Children's Hospital in Providence, Rhode Island.

The findings of the study were presented here at the 2012 American Academy of Pediatrics (AAP) National Conference and Exhibition.

Although it is well established that victims of bullying are at increased risk for mental health disorders and suicide, less is known about the mental health status of those who do the bullying, Dr. Turcotte-Benedict pointed out.

"Victims are at increased risk for depression, anxiety, and psychosomatic complaints, while we believe that bullies are at increased risk for substance abuse, academic problems, and violence," she said.

"We wanted to identify the prevalence of bullying among children with mental health disorders and to determine if the diagnosis of a mental health disorder should be considered a risk factor for bullying behavior," she said. "Our hypothesis was that children with a mental health illness would be more likely to bully other children."

Need for Psychological Support

Dr. Turcotte-Benedict and colleagues reviewed data on 63,997 children, aged 6 to 17 years, provided by their parents or guardians in the 2007 National Survey of Children's Health. Bivariate analyses and logistic regression were performed to assess the association between mental health status and being identified as a bully.

The survey showed that 15.2% of US children were identified as bullies by their own parent or guardian and that 16.6% had been diagnosed with at least 1 mental health disorder. Children with mental health disorders were most likely to be white, non-Hispanic males.

Significant differences were observed in mental health status according to age, neighborhood safety, parent-child communication, type of school, and bullying status. The logistic regression analysis controlled for these.

Overall, children with mental health disorders were 3 times more likely to bully other children. Of 10,616 children with a mental health diagnosis, 2503 (29.8%) demonstrated bullying behavior. Of 53,445 without a mental health diagnosis, 4986 (12.4%) were considered bullies.

A subanalysis of the type of mental health disorder, adjusted for age, sex, race, ethnicity, neighborhood safety, and parent-child communication, found the following odds ratios for children who engage in bullying behavior vs children without these mental health diagnoses:

  • Depression: odds ratio (OR), 3.31 (95% confidence interval [CI], 2.70 - 4.07)

  • Anxiety: OR, 2.89 (95% CI, 2.41 - 3.46)

  • Attention-deficit/hyperactivity disorder: OR, 2.82 (95% CI, 2.43 - 3.28)

  • Oppositional defiant disorder: OR, 6.02 (95% CI, 5.03 - 7.21)

When questioned as to the finding of bullying among children who are depressed, Dr. Turcotte-Benedict pointed out that depression in adolescence is often associated with impulsivity, which can fuel bullying behavior.

"These findings highlight the importance of providing psychological support not only to victims of bullying but to bullies as well," Dr. Turcotte-Benedict said. "In order to create successful antibullying prevention and intervention programs, we need more research to understand the relationship more thoroughly, and especially the risk profile of childhood bullies."

Worry About the Bully

Session moderator Benjamin Hoffman, associate professor of pediatrics at Oregon Health and Sciences University in Portland, said the findings fit his gestalt of the issue.

"This study confirms what most of us have long suspected. In a bully relationship, it's the bully I worry about most," he told Medscape Medical News.

"We worry about the short-term effects on the victim, and we understand there may be long-term ramifications, but the factors that underlie the bully's motivation to bully are important," he said.

"This study highlights that we have a lot more to learn about what gets the bully 'to bully.' I am sure the issues around mental health disorders will be the tip of the iceberg, and we will find issues of poverty, education, exposure to domestic violence, and so forth to also be factors. While the findings do not surprise me, it is important to have the science to back up this up. This will help us identify kids at risk before they develop bullying behaviors, so we can protect both the bully and the victim."

Dr. Turcotte-Benedict and Dr. Hoffman have disclosed no relevant financial relationships.

The American Academy of Pediatrics (AAP) National Conference and Exhibition. Presented October 22, 2012.