The Intersection of Bullying and Mental Illness

Sarah Payne MD

Bullying is a pervasive problem that affects many children and youth, especially with its extension into the cyberworld in recent years. Increasing numbers of studies have been published documenting the impact of bullying on mental health – the effects of which can persist into adulthood. Peer victimization can increase the risk of developing depression, anxiety, and suicidal ideation and this can be independent of other genetic or environmental stressors. The following three abstracts elucidate the psychiatric manifestations of peer victimization seen in long-term follow-up of large cohorts of children in the UK and the USA. These  three papers demonstrate the importance of evaluating for peer victimization in psychiatric assessments, intervening wherever possible, and providing support to patient and families.

Psychiatric outcomes of bullying victimization: a study of discordant monozygotic twins

1. L. Silberg, W. Copeland, J. Linker, A. A. Moore, R. Roberson-Nay, and T. P. York

Psychological Medicine July 2016, Volume 46 (9): p.1875-1883.

ABSTRACT

Bullying victimization in childhood is associated with a broad array of serious mental health disturbances, including anxiety, depression, and suicidal ideation and behavior. The key goal of this study was to evaluate whether bullying victimization is a true environmental risk factor for psychiatric disturbance using data from 145 bully-discordant monozygotic (MZ) juvenile twin pairs from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and their follow-up into young adulthood.

Environmental correlations between being bullied and the different psychiatric traits were estimated by fitting structural equation models to the full sample of MZ and DZ twins ( N = 2824). Environmental associations were further explored using the longitudinal data on the bullying-discordant MZ twins. Being bullied was associated with a wide range of psychiatric disorders in both children and young adults. The analysis of data on the MZ-discordant twins supports a genuine environmental impact of bullying victimization on childhood social anxiety [odds ratio (OR) 1.7], separation anxiety (OR 1.9), and young adult suicidal ideation (OR 1.3). There was a shared genetic influence on social anxiety and bullying victimization, consistent with social anxiety being both an antecedent and consequence of being bullied.

Bullying victimization in childhood is a significant environmental trauma and should be included in any mental health assessment of children and young adults.

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Adult mental health consequences of peer bullying and maltreatment in childhood: Two cohorts in two countries

S.T. Lereya, W.E. Copeland, E.J. Costello, and D. Wolke

Lancet Psychiatry June 2015, Volume 2(6): p. 524-531. doi: 10.1016/S2215-0366(15)00165-0.

ABSTRACT

The adult mental health consequences of childhood maltreatment are well documented. Maltreatment by peers (i.e., bullying) has also been shown to have long-term adverse effects. We aimed to determine whether these effects are just due to being exposed to both maltreatment and bullying or whether bullying has a unique effect. We used data from the Avon Longitudinal Study of Parents and Children in the UK (ALSPAC) and the Great Smoky Mountains Study in the USA (GSMS) longitudinal studies. The primary outcome variable was overall mental health problem (any anxiety, depression, or self-harm or suicidality). 4026 children from the ALSPAC cohort and 1420 children from the GSMS cohort provided information about bullying victimisation, maltreatment, and overall mental health problems.

Compared with children who were not maltreated or bullied, children who were only maltreated were at increased risk for depression in young adulthood in models adjusted for sex and family hardships according to the GSMS cohort (odds ratio [OR] 4·1, 95% CI 1·5-11·7). According to the ALSPAC cohort, those who were only being maltreated were not at increased risk for any mental health problem compared with children who were not maltreated or bullied. By contrast, those who were both maltreated and bullied were at increased risk for overall mental health problems, anxiety, and depression according to both cohorts and self-harm according to the ALSPAC cohort compared with neutral children. Children who were bullied by peers only were more likely than children who were maltreated only to have mental health problems in both cohorts (ALSPAC OR 1·6, 95% CI 1·1-2·2; p=0·005; GSMS 3·8, 1·8-7·9, p<0·0001), with differences in anxiety (GSMS OR 4·9; 95% CI 2·0-12·0), depression (ALSPAC 1·7, 1·1-2·7), and self-harm (ALSPAC 1·7, 1·1-2·6) between the two cohorts.

Being bullied by peers in childhood had generally worse long-term adverse effects on young adults’ mental health. These effects were not explained by poly-victimisation. The findings have important implications for public health planning and service development for dealing with peer bullying.

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Peer victimization during adolescence and risk for anxiety disorders in adulthood: A prospective cohort study

L.A. Stapinski, L. Bowes, D. Wolke, R.M. Pearson, L. Mahedy, K.S. Button, G. Lewis, and R. Araya

Depression and Anxiety July 2014, Volume 31(7): p. 574-582. See comment in PubMed Commons belowdoi: 10.1002/da.22270. Epub 2014 Apr 30.

ABSTRACT

Peer victimization is ubiquitous across schools and cultures, and has been suggested as one developmental pathway to anxiety disorders. The purpose of this cohort study was to examine the association between peer victimization during adolescence and subsequent anxiety diagnoses in adulthood. A secondary aim was to investigate whether victimization increases risk for severe anxiety presentations involving diagnostic comorbidity. The sample comprised 6,208 adolescents from the Avon Longitudinal Study of Parents and Children who were interviewed about experiences of peer victimization at age 13. Maternal report of her child’s victimization was also assessed. Anxiety disorders at age 18 were assessed with the Clinical Interview Schedule-Revised. Multivariable logistic regression was used to examine the association between victimization and anxiety diagnoses adjusted for potentially confounding individual and family factors. Sensitivity analyses explored whether the association was independent of diagnostic comorbidity with depression.

Frequently victimized adolescents were two to three times more likely to develop an anxiety disorder than nonvictimized adolescents (OR = 2.49, 95% CI: 1.62-3.85). The association remained after adjustment for potentially confounding individual and family factors, and was not attributable to diagnostic overlap with depression. Frequently victimized adolescents were also more likely to develop multiple internalizing diagnoses in adulthood. Interventions to reduce peer victimization and provide support for victims may be an effective strategy for reducing the burden associated with these disorders.