Bullying an Overlooked Risk Factor for Suicidal Behavior

Daniel M. Keller, PhD

April 01, 2015

VIENNA — Bullying among children and adolescents is common but is often overlooked as an important contributor to suicidal ideation and suicide attempts.

Speaking here at the European Psychiatric Association (EPA) 23rd Congress, Nazanin Alavi, MD, a fourth-year resident at Queen's University, in Kingston, Canada, said recent research shows that 10% to 30% of youth are repeatedly involved in bullying at school "either as victims, bullies, or both bully and victims."

To understand the relationship between bullying and suicidal behavior and the prevalence of different kinds of bullying in patients with mental health problems, Dr Alavi reviewed the charts of all patients younger than 18 years who visited her hospital's emergency department (ED) with suicidal ideation or behavior during the period 2012-2013.

ED Setting

Of the target patient population seen in the ED during the study period, 44% reported being bullied. Of these, 47% were currently being bullied, 21% had been bullied in the past, and 32% and been bullied in the past and were being bullied currently.

Among bullied patients (past or current), 75% had suicidal ideation, a prevalence rate twice that of patients with no history of bullying. Most (63%) of the bullied patients were female.

With regard to forms of bullying, the greatest number of patients (n = 54) experienced verbal bullying only, followed by cyberbullying only (n = 39), bullying of no specific form (n = 36), and then combinations of verbal/physical, cyber/verbal, and cyber/verbal/physical bullying. Interestingly, the least prevalent form of bullying was physical only.

Only cyberbullying resulted in a significantly elevated rate of suicidal ideation (fourfold) compared with other forms of bullying. Dr Alavi postulated that the preponderance of verbal aggression and the low number of patients reporting physical aggression may be the result of a "zero tolerance" policy in the schools for physical aggression.

She also proposed that the high rate of suicidal ideation among adolescents who were cyberbullied may the result of the lower likelihood of these individuals to report instances of cyberbullying and to seek help compared with teens who were bullied through more "traditional" means.

Therefore, cyberbullied individuals would have a lower level of social support, increasing their risk for suicidal ideation.

Furthermore, unlike forms of bullying that require physical presence, teens experiencing cyberbullying are at risk any time and any place. They can receive email, Twitter messages, and Facebook messages no matter where they are or when, "with the possibility of widespread dissemination of demeaning or threatening material to a large audience of peers," Dr Alavi said.

She recommended that when health professionals perform a psychiatric and suicide risk assessment of youth, the extent and type of bullying should be an integral part of the workup.

Not Surprising

Session moderator Peter Pregelj, MD, PhD, president of the Slovenia Psychiatric Association and associate professor at the University of Ljubljana, told Medscape Medical News that it is important to have the kind of information that Dr Alavi's study generated. He said that other studies have shown that social inclusion/exclusion and the stress that arises from it are significant factors in suicidal behavior.

He said it is not surprising to find that bullying is linked to suicidal behavior, given its strong influence on self-esteem.

As a result, Dr Pregelj said that it is important to investigate these relationships, because a large proportion of adolescents' communication is via social media. He said that unfortunately, it is difficult to guard against this form of bullying. It is not that the Internet is a riskier form of communication but that it is a more ubiquitous medium.

Dr Pregelj agreed with Dr Alavi's recommendation to ask about and to evaluate bullying, because it is not usually self-reported, especially when the bullying occurs on the Internet.

There was no commercial funding for the study. Dr Alavi and Dr Pregelj have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 23rd Congress. Abstract 0209. Presented March 30, 2015.

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