Monday, 25 February 2013

Childhood bullying led to range of psychiatric disorders in adulthood

Copeland WE. JAMA Psychiatry. 2013;doi:10.1001/jamapsychiatry.2013.504.

  • February 20, 2013
Both bullies and bullying victims during childhood and adolescence were at an increased risk, sometimes dramatically, for psychiatric disorders in young adulthood, according to recent study results.
“For clinicians working with children, this means that asking, ‘How are you getting on with your peers?’ should be part of every assessment, just as it is to ask, ‘How are you getting along with you parents?’ For those working with adults, this means asking about whether bullying was an issue growing up. If a clinician wants to understand why a client is struggling emotionally, then they need to take bullying and assessment of bullying seriously.”
William E. Copeland, PhD
William E. Copeland

Copeland and colleagues examined the prevalence of psychiatric disorders among 1,420 young adults aged 19 to 26 years who had been victims of bullying and/or bullied peers during childhood and adolescence. Participants were assessed for bullying when they were aged 9 to 16 years, and were classified as bullies only, victims only, or bullies and victims — referred to as “bullies/victims.” Psychiatric disorders in young adulthood, which ranged from antisocial behavior to suicidality, were assessed via structured interviews and based on DSM-IV diagnostic criteria.
Results indicated that victims of bullying were more likely to have bullied others (OR=2.9; 95% CI, 2.0-4.1). Copeland and colleagues found that both victims and bullies/victims had elevated rates of young adult psychiatric disorders, and both groups also had elevated rates of childhood psychiatric disorders and family hardships. Therefore, the researchers controlled for childhood factors, finding that victims still had a higher prevalence of agoraphobia (OR=4.6; 95% CI, 1.7-12.5), generalized anxiety (OR=2.7; 95% CI, 1.1-6.3) and panic disorder (OR=3.1; 95% CI, 1.5-6.5).
Compared with those who were not involved in bullying, bullies/victims were more likely in young adulthood to have depression (OR=4.8; 95% CI, 1.2-19.4) and panic disorder (OR=14.5; 95% CI, 5.7-36.6); female bullies/victims were more likely to have agoraphobia (OR=26.7; 95% CI, 4.3-52.5); and male bullies/victims were more likely to exhibit suicidal behavior (OR=18.5; 95% CI, 6.2-55.1). Bullies were at an increased risk for antisocial personality disorder only (OR=4.1; 95% CI, 1.1-15.8).
According to Copeland and colleagues, there may be a number of reasons peer victimization may lead to emotional disorders and suicidality, including changes to physiological or cognitive responses to stress and threatening situations, or even gene–environment interaction. However, effective preventive strategies are needed to mitigate those long-term effects of bullying and to create safer environments for children and adolescents.
“Bullying can be easily assessed and monitored by health professionals and school personnel, and effective interventions that reduce victimization are available,” they wrote. “Such interventions are likely to reduce human suffering and long-term health costs and provide a safer environment for children to grow up in.”
Disclosure: Copeland reports no relevant financial disclosures.

Robert J. Hilt, MD, FAAP
Robert J. Hilt
  • Although bullying is increasingly viewed as a childhood experience with long-term negative consequences, research supporting this association has been slow to develop. The article by Copeland et al is a significant addition to our knowledge base about bullying consequences due to its prospective, population-based design and breadth of data available to control for confounding variables. Essentially, this new analysis of the Great Smoky Mountain dataset shows that being both a victim and perpetrator of bullying is strongly associated with multiple adult mental health disorders, and being a victim of bullying without also being a perpetrator was significantly but less strongly associated with adult mental health disorders. Being a bully without also being a victim was strongly associated with antisocial personality disorder as an adult but not other mental health disorders. The importance of this study was that after controlling for other confounding variables, including childhood psychiatric disorders and family hardships, the observed negative outcomes of bullying remained.
    • Robert J. Hilt, MD
    • Psychiatric Annals Editorial Board member
      Seattle Children’s Hospital

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