Childhood Bullying: Serious Long-term Consequences

Pam Harrison

December 17, 2015

The largest study of its kind once again underscores just how harmful childhood bullying is, with victims much more likely to be diagnosed with a psychiatric disorder in adulthood, new research shows.

"Being a victim of bullying is frequently a traumatic experience for children, and we showed that being victimized — that is, being exposed to bullying — was independently associated with psychiatric disorders, and especially depression requiring treatment," Andre Sourander, MD, PhD, University of Turku, in Finland, told Medscape Medical News.

"So being frequently victimized in early school years is a risk factor for later depression, and the worst prognoses were with children who both frequently bullied and who were also exposed to bullying," he added.

The study was published online December 9 in JAMA Psychiatry.

Psychosis, Anxiety, Depression

The study was part of the multicenter Finnish Nationwide 1981 Birth Cohort Study, which included 60,007 Finnish children born from January 1 to December 1981 and who were still alive in 1989. The current study included 5034 individuals.

Children at the age of 8 years were asked whether they were victims of bullying or whether they bullied other children, and if so, how often.

Investigators then determined whether study participants required treatment of psychiatric disorders from the ages of 16 to 29 years. Follow-up was completed at the end of 2009.

Of 4540 participants who did not engage in bullying, 520 (11.5%) had received a psychiatric diagnosis at follow-up by the age of 29 years.

Among those who had engaged in frequent bullying, 33 of 166 (19.9%) had received a psychiatric diagnosis at follow-up, as had 58 of 251 (23.1%) of those who had been frequently exposed to bullying.

Of 77 participants who both frequently engaged in bullying and who were frequently exposed to it, 24 (31.2%) had received a psychiatric diagnosis by the time of follow-up, investigators add.

After adjusting for sex, family factors, and the presence of psychiatric symptoms at age 8 years, "we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying...and being a bully as well as being exposed to bullying," the investigators note.

For example, participants who were frequently exposed to bullying had almost a twofold increased risk of receiving a psychiatric diagnosis, including a diagnosis of psychosis, anxiety, and depression (hazard ratio [HR], 1.9) at follow-up compared with participants who did not frequently bully or who were not frequently exposed to bullying.

In comparison with the reference group, individuals who engaged in bullying and who were exposed to bullying had more than a twofold risk of receiving a psychiatric diagnosis by the time of follow-up (HR, 2.1).

Exposure to bullying was also specifically associated with almost a twofold risk of being diagnosed with depression at the age of 29 years (HR, 1.9).

Antibullying Campaigns Not Enough

"Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood," the investigators write.

"However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms."

Dr Sourander noted that the majority of this latter group were boys and that they often exhibited other psychiatric problems in childhood.

"This [bullying] behavior is thus a red flag," he observed. "There is something wrong, and these kids need to be assessed."

Dr Sourander also noted that bullying behavior is complex, but it is important that it be recognized.

In his view, antibullying campaigns are not enough: "We need integration of school-based interventions and mental health perspectives in the school health system," he said.

Investigators underscore the fact that patients, teachers, and pediatricians need to be educated about the association between bullying and psychiatric outcomes in order to screen children and to intervene if needed.

"Exposure to bullying is a form of abuse that should be addressed effectively even when other problems do not exist," Dr Sourander and colleagues conclude.

"Policy makers and healthcare professionals should be aware of the complex nature between bullying and psychiatric outcomes when they implement prevention and treatment interventions."

Crossing the Line

Jack Drescher, MD, clinical professor of psychiatry, New York Medical College, New York City, who works extensively with the LGBT community, members of which are frequently the targets of bullying, was asked by Medscape Medical News to comment on the study.

"I think there's a general belief that a certain amount of bullying toughens kids up, and there is a kind of admiration for rough and tumble play, a certain amount of which, done in a friendly environment, probably isn't necessarily harmful," Dr Drescher said.

"But that line can get crossed from friendly rough and tumble to serious intimidation quite easily, where people are afraid to go to school, they are afraid to trust anybody, and they won't even tell their parents or their teachers that they are being harassed by somebody, because they're frightened for their lives," he said.

This kind of experience can clearly lead to anxiety disorders in adults and can lead to adults being unable to trust anyone because no one stepped in to protect them as children, he added.

"Bullying usually takes place in secret. It doesn't happen directly in front of adults, so the only way to be aware of bullying is to look for the kinds of things in children who are being bullied, which are generally failing grades, social isolation, and school refusal," Dr Drescher said.

"The other thing we need to do is work with children in general to help them distinguish between what's normal fun vs what crosses the line. That is really where the kids could use some help, in determining how not to cross the line."

The study was supported by the Sigrid Juselius Foundation and the Finnish Academy. The authors and Dr Drescher have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online December 9, 2015. Abstract


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