Effects of Childhood Bullying Persist Well Into Adulthood

Pam Harrison

April 22, 2014

Children who are bullied, especially those who are frequently bullied, continue to be at risk for a wide range of poor mental and physical health outcomes in adulthood, new research shows.

Led by Louise Arseneault, PhD, King's College, London, investigators found that frequent bullying in children, assessed at the ages of 7 and 11 years, was associated with an increased risk for depression and anxiety disorders at age 45 years.

Frequent childhood bullying was also associated with an increased risk for suicidality in midlife. Children who were occasionally bullied were also at increased risk for depression almost 40 years after victimization.

"It is normal for children to be upset and distressed if they are bullied," Dr. Arseneault told Medscape Medical News.

"But showing that the impact of bullying persists when the bullying has stopped even beyond early adulthood is evidence that being bullied could be considered alongside other forms of abuse, like physical maltreatment. [The fact that] the effect of childhood bullying persists up until people enter midlife in itself makes bullying a form of abuse that we want to eradicate."

The study was published online April 18 in the American Journal of Psychiatry.

Depression, Anxiety

Data were collected from the 1958 British Birth Cohort study, which included virtually all births that took place during 1 week in England, Scotland, and Wales.

This particular study involved more than 7700 cohort participants.

Bullying victimization was assessed on the basis of parental reports of bullying when children were 7 years of age and again when they were 11.

Psychological distress was measured at the ages of 23 and 50 using a 9-item version of the Malaise Inventory, a widely used measure of low mood with demonstrated validity in this sample.

Consistent with contemporary findings, the authors found that 28% of the birth cohort had been exposed to occasional bullying and that 15% had been frequently bullied.

Results showed that childhood bullying was associated with a significantly greater risk for psychological distress at 23 and 50 years of age.

Depression, any anxiety disorder, and suicidality were also significantly more prevalent at the age of 45 in children who had been frequently bulled.

Children who had been occasionally bullied were significantly more likely to have depression at the age of 45 as well, although not anxiety disorders or suicidality.

Adverse effects of childhood bullying on adult health outcomes were independent of IQ, social class, and other childhood confounders.

Table. Association Between Occasional and Frequent Bullying With Health Outcomes in Adulthood, Controlling for Confounders*

Adverse Outcomes in Adulthood Occasional Bullying Frequently Bullying
Psychological distress (age 23) 1.38 1.57
Psychological distress (age 50) 1.33 1.37
Depression (age 45) 1.56 1.65
Any anxiety disorder (age 45) 1.05 1.42
Suicidality (age 45) 1.23 1.66

*Numbers in bold are statistically significant.


Socioeconomic Impact

The longitudinal associations between bullying and adverse adult outcomes in this birth cohort were similar in magnitude to the effects of being placed in foster care.

Bullying effects were also comparable to being exposed to multiple adversities within the family. The long-term effects of these forms of childhood adversity have been extensively documented, the authors note.

The study is the first to show that being bullied in childhood influences not only victims' mental health but also social and economic status in midadulthood as well as cognitive functioning.

In contrast, victimization in childhood was not associated with an increased risk for dependence on alcohol as an adult.

"There could be several pathways explaining the persistence of harmful outcomes of being bullied in childhood," Dr. Arseneault told Medscape Medical News.

For example, in another cohort of UK children, Dr. Arseneault and colleagues found that children who had been bullied in the past did not show a typical increase in cortisol that normally occurs when individuals are under stress.

This maladaptive reaction to stress may undermine the victims' ability to cope well with stress throughout adulthood and may place them at risk for ongoing poorer health as they age.

Another possibility may be that victims of bullying continue to be victims of other forms of abuse over the years.

Victimization effects may then be cumulative and lead to poorer health outcomes, Dr. Arseneault suggested, although this hypothesis has not yet been tested.

"Our findings suggest that intervention efforts should aim to minimize poor health outcomes in young victims of bullying," the investigators conclude. "Not only may this stop children's suffering, it may also help prevent problems persisting to adolescence and adult life."

"Striking" Confirmatory Data

Commenting on the study for Medscape Medical News, William Copeland, PhD, Duke University School of Medicine, Durham, North Carolina, said that he might have been surprised at how persistent the ill effects of bullying are had he and his colleagues not found a "very similar profile" of adverse psychological outcomes years after the bullying experience among their own cohort of victims.

In his study ( JAMA Psychiatry. 2013;70:419-26), Dr. Copeland and colleagues found that victims of bullying continued to have significantly higher prevalence rates of agoraphobia, generalized anxiety disorder, and panic disorder in young adulthood.

Both bullies and their victims were at increased risk for depression in young adulthood, as well as panic disorder.

Rates of agoraphobia in women and suicidality in men were also significantly higher among both bullies and victims in the study by Dr. Copeland and coworkers, and antisocial personality disorder was also significantly more prevalent among bullies at the same assessment point.

"What's striking to me is how similar the profiles were from the British birth cohort to what we saw in our US cohort, and the British study followed up its victims for 2 more decades than we did," Dr. Copeland said. "It's very impressive how consistent these results are across these 2 studies."

He also thought it was "incredible" that the persistent effects of childhood bullying are similar to those associated with the most negative experiences that can occur in childhood, including being placed outside of the home.

Both studies suggest that it is possible that early childhood adversities and negative social experiences can become "biologically embedded" over time.

"The idea that these experiences can change a person's trajectory of health and functioning over time and may even contribute to age-related diseases such as cardiovascular disease is really significant," Dr. Copeland observed. "And we want to learn more about this, especially because so many children today are exposed to bullying, not only inside the school but electronically wherever they are."

Dr. Copeland and colleagues have been studying the effect of bullying on markers of inflammation, notably, C-reactive protein, controlling for inflammation prior to the bullying experience.

The authors and Dr. Copeland report no relevant financial relationships.

Am J Psychiatry. Published online April 18, 2014. Full article


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