Full Brunt of Childhood Bullying May Not Be Realized Until Adulthood

Caroline Cassels

February 20, 2013

Long considered a routine, albeit unpleasant, childhood rite of passage, new research shows that the negative impact of bullying extends well beyond youth, significantly increasing the risk for poor psychiatric outcomes in adulthood.

Results of a large, prospective, longitudinal study of bullied children show that victims of bullying are at much higher risk for anxiety disorders, depression, and suicidal behavior as adults. Bullies themselves are at risk for antisocial personality disorder.

"We were surprised at how profoundly bullying affects a person's long-term functioning," lead investigator William E. Copeland, PhD, Duke University Medical Center, Durham, North Carolina, said in a release.

"This psychological damage doesn't just go away because a person grew up and is no longer bullied. This is something that stays with them. If we can address this now, we can prevent a whole host of problems down the road," he added.

The study was published online February 20 in JAMA Psychiatry.

Long-term Impact

Previous research examining the impact of bullying on physical and mental health has largely consisted of short-term studies that followed children only for a few months or a few years into adolescence.

The investigators note that one Finnish study investigating the involvement of children in bullying at 8 years of age and adult outcomes reported mixed results and concluded that boys had few lasting problems, whereas girls suffered more long-term psychological harm. However, Dr. Copeland and colleagues note that this study was limited by data that did not fully capture psychiatric records.

In the current study, investigators examined the long-term effects of bullying involvement, either as victims, bullies, or both, on self-reported psychiatric outcomes in young adulthood, including suicidality.

The researchers analyzed data from the Great Smoky Mountain Study, which included data on 1420 children aged 9, 11, and 13 years from 11 counties in western North Carolina. All participants were categorized as bullies only, victims only, bullies and victims (bullies/victims), or neither.

Enrolled in the study in 1993, the children and their parents or caregivers were interviewed annually until the children turned 16 and then periodically thereafter.

Psychiatric outcomes, which included depression, anxiety, antisocial personality disorder, substance use disorders, and suicidality, were assessed at age 19, 21, and 24 to 26 years, using structured diagnostic interviews.

After controlling for childhood psychiatric disorders and family hardships, the investigators found that victims of bullying had higher levels of anxiety disorders, including generalized anxiety (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.1 - 6.3; P < .001), panic disorder (OR, 3.1; 95% CI, 1.5 - 6.5; P < .01), and agoraphobia (OR, 4.6; 95% CI, 1.7 - 12.5; P < .01).

Those who had been both bullies and victims as children were at increased risk for depression in young adulthood (OR, 4.8; 95% CI, 1.2 - 19.4; P < .05), panic disorder (OR, 14.5; 95% CI, 5.7 - 36.6); P < .001), agoraphobia (females only; OR, 26.7; 95% CI, 4.3 - 52.5; P < .001), and suicidality (males only; OR, 18.5; 95% CI, 6.2 - 55.1; P < .001).

Bullies were at risk for antisocial personality disorder only (OR, 4.1; 95% CI, 1.1 - 15.8; P < .04).

Serious Consequences

"Bullying is potentially a problem for bullies as well as for victims. Bullying, which we tend to think of as a normal and not terribly important part of childhood, turns out to have the potential for very serious consequences for children, adolescents, and adults," senior author E. Jane Costello, PhD, said in a statement.

The investigators conclude by urging health professionals and school personnel to screen for bullying and to act when necessary.

They add that there are effective interventions available that reduce victimization.

"Such interventions are likely to reduce human suffering and long-term health costs and provide a safer environment for children to grow up in," the authors write.

JAMA Psychiatry. Published online February 20, 2013. Abstract