SAN FRANCISCO — Children in the United States who experience both school bullying and cyberbullying are at alarming risk for suicidal behavior, new research shows.
A nationwide study conducted by investigators at the University of Arkansas, in Little Rock, showed that the combination of both types of bullying was associated with a 4-fold higher incidence of all suicide risk factors, including suicidal thoughts, plans, and attempts, compared with those who experienced no bullying. Cyberbullying alone was associated with a 3-fold increased risk for suicidal behaviors.
"We need to increase awareness that it is a very serious thing and not just a rite of passage — it is a real issue that is impacting teens all across the nation," principal investigator Kristi Kindrick, MD, told Medscape Medical News.
The findings were presented here at the American Psychiatric Association's 2013 Annual Meeting.
According to investigators, suicide is the third leading cause of death in teens, behind accidents and homicide. The estimated lifetime prevalence of suicide ideation, plans, and attempts among youth aged 13 to 17 years is 12.1%, 4.0%, and 4.1%, respectively, and is similar to rates in adults.
"Suicidality rates in kids are approaching that of adults. Kids think about suicide, and they act on it at alarming rates, and this something that we think just shouldn't be happening. One in 18 kids may actually think about suicide, and about 1 in 25 may attempt it. So if you think of a small classroom of 25 kids, 1 of them will end up attempting suicide," said Dr. Kendrick.
Bullying statistics in teens show that approximately 1 in 5 high school students report being bullied on school property, and 1 in 6 report being bullied electronically.
Although school bullying is similar in girls and boys — 22% vs 18%, respectively — cyberbullying is twice as common in girls (22% vs 11%).
"Cyberbullying is happening twice as commonly in girls as opposed to boys, so the movie Mean Girls kind of lives up to its reputation here," said Dr. Kindrick.
The other "alarming" statistic, she said, is that almost 6% of high school students reported missing school because of concerns for their own safety.
Although there have been several studies linking cyberbullying to mental health problems, none have addressed the extent to which it directly influences suicidality, including plans, attempts, and attempts requiring treatment.
The investigators hypothesized that teens who were victims of school bullying, cyberbullying, or both would be at higher risk for depression and suicidality than their counterparts who did not experience bullying.
For the study, the investigators used data from the 2011 Youth Risk Behavior Survey, a school-based, nationally representative biannual survey conducted by the Centers for Disease Control and Prevention to assess risk behaviors in high school. The 2011 survey is the first such survey in which questions about bullying and cyberbullying were included.
The sample consisted of 15,425 high school students between the ages of 13 and 17 years. Given the overlap between school bullying and cyberbullying, the investigators created a combined variable, so that there were 4 categories:
School bullying only
Both school and cyberbullying
Outcome variables included 4 questions addressing the continuum of suicidality.
The findings showed positive reports of depressive symptoms in victims of both types of bullying (adjusted odds ratio [AOR], 5.4; 95% Confidence Interval [CI], 4.5 - 6.5) as well as in those who reported being victims of school bullying only (AOR, 2.4; 95% CI, 2.1 - 2.8) and cyberbullying only (AOR, 3.4; 95% CI, 2.8 - 4.1).
There was also a positive association between suicide attempt in victims of both types of bullying (AOR, 5.6; 95% CI, 4.4 - 7.0) as well as in those reporting being a victim of only school bullying (AOR, 2.3; 95% CI, 1.8 - 2.9) or only cyberbullying (AOR, 3.5l 95% CI, 2.6 - 4.7).
"We found that kids who are victims of both types of bullying have higher incidence of all suicide risk factors. We also find that victims of cyberbullying alone have a higher incidence of all suicide risk factors when compared to the group reporting being victim of only school bullying," said Dr. Kindrick.
She added that currently, there are no formal screening tools for bullying. But, given the potentially devastating consequences, parents, educators, and clinicians need to be alert to potential warning signs and screen for all types of bullying and intervene when necessary.
Warning signs can include overt social withdrawal, anxiety, and depression, but it is important to be aware that sometimes somatic symptoms in kids, such as gastrointestinal or headache complaints, may be masking underlying depression and/or anxiety, which can indicate bullying.
Finally, she said, clinicians need to take the time to ask their young patients about school and their close relationships as well as social media use. Adolescents, she noted, are often more forthcoming with a healthcare professional than they are with their parents.
Ask and Ask Again
Commenting on the study, Jeffrey Borenstein, MD, APA chair of the Council on Communications and president and CEO of Brain and Behavior Research, said the findings underscore the importance of screening for bullying in young people.
"Certainly for psychiatrists and other mental health professionals, parents, teachers, and pediatricians, the issue of bullying should be in the back of our minds when we are dealing with youngsters. You have to ask, and sometimes you have to ask in more than one way [about this issue]."
Dr. Borenstein added that children need to understand that bullying of any type is unacceptable and that children who are victims need strong support to get through it, and he warned against the danger of isolation.
"Children need to know they are not alone because it is when they are isolated that they are at real risk of suicide," Dr. Borenstein told Medscape Medical News.
Dr. Kindrick and Dr. Borenstein report no relevant financial relationships.
The American Psychiatric Association's 2013 Annual Meeting. Abstract NR7-18. Presented May 20, 2013.
Medscape Medical News © 2013 WebMD, LLC
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Cite this: Cyberbullying Packs a Potentially Deadly Punch in Teens - Medscape - May 21, 2013.