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Have you ever been bullied? Or been a bully yourself?
Certainly, bullying has become an international problem with epidemiological studies of middle and high school students in the U.S. and elsewhere suggesting that a substantial minority of children are either bullied, engage in bullying, or both. The actual number may be harder to estimate since many bullying victims choose not to report what is happening. Studies using peer report or anonymous self-report tend to find 13 percent of children admit to have been victims while 17 percent admit to bullying. For children with issues such as ADHD, autism, learning problems, or other neuropsychiatric diagnoses, the likelihood of being a victim tends to be far higher with 40 percent reporting having been bullied at some point in their lives.
Of all the negative outcomes associated with bullying, suicide is definitely the cause for greatest concern. Along with being the third-leading cause of death among 10 to 19 year-olds in the United States alone, the risk of suicide is even higher in people with psychiatric disorders. One recent study looking at more than 130,000 middle and high school students showed a definite link between suicide ideation/attempts and bullying. The highest risk was for children who have been both bullies and victims (38 percent) with victims of bullying being the next highet risk category (29 percent). Even bulllies show an elevated suicide risk (22 percent compared to 11 percent for children with no history of being bullied).
Psychological factors linked to being a bullying victim include increased emotional problems such as anxiety and depression as well as acting-out behaviour (being disruptive at school or at home, frequent truancy, etc.). Children who are victimized may even become bullies themselves to take off some of the pressure. Not surprisingly, studies have shown that sleeping problems, including insomnia and nightmares, are often seen in children who are bullied. All of these factors have also associated with suicidal behaviour in children and adolescents, whether in the form of actual suicide attempts or verbal threats of suicide.
But does bullying cause suicidal behaviour in children or adolescents directly or are mental health factors such as depression more likely to lead to suicide? Different studies attempting to control for depression and other emotional issues have been mixed (although girls appear more prone to suicide than boys even when emotional problems have been taken into account). A new research study published in the journal Crisis provides a comprehensive test of the bullying-suicide link.
Conducted by a team of researchers at the Department of Psychiatry at Penn State's College of Medicine, the study looked at 1,291 children with psychiatric disorders and 658 general population children. All children ranged in age from six to eighteen and diagnoses ranged from ADHD to to anxiety disorder and depression. The control children were taken from a larger study on sleep disorders. According to lead researcher Susan Dickerson Mayes, the point of the research was to use a common methodology to compare bullies, victims, and non-victims in children with psychiatric problems as well as regular children living in the community.
The mothers of the children participating in the study filled out the 165-item Pediatric Behavior Scale which included items measuring different behavioural problems, including suicidal behaviour and bullying. The scale also measured problems such as conduct problems, emotional problems, substance abuse, and sleep problems. Maternal ratings were used since they tended to be the most sensitive measure of emotional and behavioural problems in children.
For the children in the control group, the percentage of children who admitted to bullying was seven percent, for children reporting being bullies and having a history of victimization, the percentage was seven percent, the percentage of victim-only children was twenty percent, while children with no history of bullying or victimization was sixty-five percent. These results were fairly similar to the percentages found in other research studiens looking at bullying behaviour. For children in the psychiatric sample, thirty-seven percent reported being victims and another twenty-two percent being bullies.
Not surprisingly, bullying behaviour, victimization, suicide ideation, and suicide attempts were all significantly higher in the psychiatric sample children than in the general population children. Suicide attempts were 7.2 times more likely in psychiatric sample children than in the control group children. Those control group children with a history of suicide attempts also scored significantly higher than other control children on maternal ratings for depression and also tended to be higher on scales measuring ADHD and anxiety.
Overall, children who were both bullies and victims of bullying were significantly higher in suicidal ideation and attempts than children with no bullying/victim history. This applied for all children, whether in the psychiatric group or the control group. For both bullies and victims however, the risk of suicide was far higher than for children with no history of bullying. As well, conduct problems such as acting out and truancy were significantly correlated with suicidal behaviour and ideation though other factors such as anxiety and sleep problems were not significant predictors of suicide by themselves. When conduct problems and depression were factored out, the relationship between bullying and suicidal behaviour was not as strong.
So, what do these results suggest? Though suicide prevention programs have focused on bullying victims, it appears that bullies are at risk for suicide as well. This is especially true for children with related psychological problems such as depression and conduct problems. The single most powerful predictor of suicidal behaviour in children is depression with the next highest predictor being conduct problems in children with psychiatric problems. While being a bullying victim can also be a predictor of suicide behaviour, the overall effect appears to be small (though bullying victims are also at increased risk of becoming bullies themselves).
Parents and teachers dealing with bullying in children must be alert to the dangers involved. Bullies, as well as their victims, need to be assessed concerning possible emotional problems that can increase the risk of suicide or other self-destructive behaviours. Children with psychiatric issues are particularly vulnerable to bullying and/or suicide and adults dealing with them need to be alert to these kinds of risk.
So how effective are bullying prevention programs? And can they prevent suicides? Unfortunately, the most successful programs are also the hardest to run since they usually involve intensive one-to-one counseling as well as frequent meetings with parents and teachers to provide effective supervision. Since many schools lack the resources or the trained counselors to carry out these programs, schools often resort to relying on punishment which is much less effective. Research has shown that detention, suspension, time spent in the principal's office, and parent meetings tend not to have any effect in curbing bullying, let alone protecting victims of bullying. As for suicide awareness programs, they also depend on intensive counseling and providing emotional support to help vulnerable students learn to cope with problems.
Childhood and adolescence can be difficult enough on their own and dealing with bullying, depression, and other problems can make extreme solutions such as suicide seem more acceptable. Helping vulnerable young people recognize that there are alternatives to suicide can save lives. It's up to all of us to provide them with those alternatives.
