'Striking' Impact of Bullying on Teens' Mental, Physical Health

Deborah Brauser

February 19, 2014

Long-term and current bullying can have serious consequences for adolescents' physical and mental health, new research suggests.

A survey of more than 4000 children when they were in 5th, 7th, and 10th grades showed that those who were bullied both in the past and in the present had significantly worse self-worth and greater depressive symptoms over time than those who had present-only, past-only, or no experiences with bullying.

In addition, more than 44% of the current and past bullying victims "were at the lowest decile of psychosocial health," report the investigators.

"The findings didn't really surprise us, but some of the results were very striking," lead author Laura M. Bogart, PhD, associate professor of pediatrics at Harvard Medical School in Boston, Massachusetts, and a social psychologist at Boston Children's Hospital, told Medscape Medical News.

"We know from previous research that bullying is related to poor mental and physical health. But we found really large effects," she added.

Dr. Bogart noted that clinicians should talk with their patients about bullying even before they are affected.

"The sooner we stop a child from being bullied, the less likely bullying is to have a lasting, damaging effect on his or her health down the road," she said in a release.

The study was published online February 17 in Pediatrics.

Many Kids Bullied

According to the researchers, past studies have shown that peer victimization affects from 10% to more than 25% of middle school students in the United States.

As reported at the time by Medscape Medical News, a study published last month suggested that bully victimization and/or perpetration during childhood increases the risk of developing psychotic symptoms in early adulthood.

"It strengthens the evidence base that reducing bullying in childhood could substantially reduce mental health problems," said lead author Dieter Wolke, PhD, from the University of Warwick in Coventry, United Kingdom, at the time.

"The benefit to society would be huge, but of course the greatest benefit would be to the individual," he added.

For the current study, the investigators sought to examine the effects of just bully victimization on both physical and psychological health. They note that many past studies examining these issues have been cross-sectional in nature, with few having used a longitudinal design that examined effects over time.

Dr. Laura Bogart

So they evaluated data from 4297 children (44% Latino, 29% black, 22% white, 4% other) who originally participated in the Healthy Passages longitudinal study as 5th graders in 118 public schools in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas.

The children and their parents completed in-home computerized interviews in English or Spanish at baseline, and again when the children were in 7th grade and in 10th grade. Bullying was assessed with the Peer Experience Questionnaire.

"The kids were asked if they had experienced different kinds of peer victimization and bullying, including physical forms as well as social forms such as nasty things being said about you," reported Dr. Bogart.

The Pediatric Quality of Life Inventory's Psychosocial Subscale and Physical Health Subscale were also administered, as were the Diagnostic Interview Schedule for Children Predictive Scales (to measure depression symptoms) and the Self-Perception Profile's self-worth subscale.

Low Self-worth, Depression

Results showed that 30.2% of all participants had experienced frequent bullying during at least 1 of the survey periods.

The "lowest decile of psychosocial health" was found in 44.6% of the 10th-grade participants who had been bullied in the past and the present vs 30.7% of those bullied in the present but not the past (P = .005), 12.1% who had been bullied in the past only (P < .001), and 6.5% who had never been bullied (P < .001).

The lowest decile of physical health scores, for activities such as walking or participating in sports, was in 22.2% of the 10th graders bullied both in the past and present vs 11.9% of those bullied in the past only (P < .01) and 8% of those never bullied (P < .001). There was no significant difference between the past and present bullied group and the present only group (25.5%).

Many of the present only group and the past and present group showed significant depression symptoms by the 10th grade, but the scores and effect sizes were worse for those in the latter group.

In fact, 30.4% of this group were in the worst symptom scores category vs 18.5% of those currently being bullied, 12.7% of those bullied in the past only, and 7.8% of those never bullied (all, P < .001).

Finally, the lowest self-worth scores were found in 28.8% of those bullied in the past and present vs 20.4% of those bullied in the present only (not significantly different), 12.3% of those bullied in the past only (P < .001), and 7.8% of those never bullied (P < .001).

Early Intervention

"In one of the few longitudinal studies on this topic, we demonstrated that bullying…is associated with poorer health across a broad variety of measures from elementary school through middle school and into high school," write the investigators.

"No research before the present analysis has examined the effects of different types of bullying histories on mental and physical health, including whether previous…experiences exacerbate the effects of ongoing bullying."

They note that clinicians should therefore carefully monitor their young patients to make sure they recognize bullying when it first starts. Intervening early could "reverse the downward health trajectory experienced by youth who are repeated targets," they write.

However, Dr. Bogart added that more research is needed to develop better interventions.

"There's no such thing as a 1-size-fits-all approach when it comes to addressing bullying," she said.

"But by providing teachers, parents, and clinicians with evidence-based best practices, they would be better equipped to assist those at the front lines helping children cope with this serious problem and lessen the damage."

She added that if clinicians notice that a child is in a risk group for bullying, such as having health issues or disabilities or being obese, they should question the patient and discuss signs of peer victimization with the parent or caretaker.

"If a pediatrician or other doctor starts a conversation early, that child will know it's acceptable to bring the topic up in the future," said Dr. Bogart.

"And if a child has been bullied, talk with them about what happened and refer them to mental health counseling if the child is showing some of these adverse psychological signs. This should help to stymie these effects of bullying before they get too severe and continue over time," she concluded.

The study authors have reported no relevant financial relationships.

Pediatrics. Published online February 17, 2014. Abstract

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