Thanks Ed. Yes, I've been following the Finland work. It raises interesting issues, which myself and others have been discussing (yet again). As these authors suggest, the strong implications are for screening, in order to address/prevent the development of psychiatric conditions in later (adult, e.g.) life. But their work does not get at causation, in either direction. That is, we still don't know whether for most children who bully or are bullied, psychiatric conditions are pre-existing or - even if the conditions 'pre-dated' the bullying (e.g., genetic predispositions, infancy or very early childhood/family problems - whether those conditions would have emerged in the absence of exposure to/involvement in bullying. In particular, we don't know whether, for children who were bullying or bullied at age, if they were in a setting (school, e.g.) in which bullying was effectively addressed (e.g., systematically), the bullying behavior or involvement noted at that age (8) would have continued. If, as we currently assume, the bullying would been addressed and diminished or ended going forward, would those children still have developed the psychiatric disorders in later life to the same extent or at all? Also, as a specific point, they (as this summary states) studied children at age 8. While bullying is definitely present at that age (and much earlier), the peak years for bullying incidents, as far as we know, are ages 12-14 (7th to 19th grades). So a population of those bullying/bullied at age 8 may not have the same characteristics as ones identified later.
There is an underlying conceptual issue, for which data is still very limited/lacking - is the bullying (bully or bullied, or mix) primarily caused by the pre-existing psychiatric condition or other individual tendency or vulnerability, or does bullying emerge primarily as consequence of being a child in a toxic environment, such as a school in which adults inadequately understand and address bullying. The current understanding is that the school environment, more than anything else, causes and sustains (most, perhaps not all) bullying. This work challenges that understanding to some extent, by showing such a clear/strong, early and lasting association with variables we think of as particularly individual. But their work does not address that specific issue enough to change the current prevailing view.
In terms of model peer support, in person or online, there are similar issues/challenges. I haven't seen (or can't recall having seen) any evidence that bullying or being bullied is significantly changed by involving those on either end of the equation in peer support groups, facilitated or otherwise. My reading of the social skills lit and similar is that doing such groupwork with those who bully tends to strengthen negative bonding and perhaps increase bullying behavior, while doing such work with those bullied tends to stigmatize those children as well as being ineffective. (That makes sense if bullying is primarily environmentally caused.)
Anyway, I appreciate your contact and the article note. Hope all is well.
- Stu
(908) 522-2581
www.njbullying.org
Bullying and Victimization in Childhood Linked to Psychiatric Disorders in Early Adulthood CME/CE
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Disclosures
Release Date: August 9, 2007;Valid for credit through August 9, 2008
Credits Available /Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)T for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses - 0.25 nursing contact hours (None of these credits is in the area of pharmacology)
August 9, 2007 - Bullying and victimization during early school years may identify boys at risk for psychiatric disorders in early adulthood, according to the results of a study reported in the August issue of Pediatrics.
"There have been no longitudinal cohort studies that examined the psychiatric outcomes in late adolescence or early adulthood of children who bully or are victimized in childhood," write Andre Sourander, MD, from Turku University in Finland, and colleagues. "Generally, our knowledge of the continuities and discontinuities of childhood problems to early adulthood was based on a limited number of study cohorts. However, information about the long-term effects of bullying has considerable public health significance that would justify universal or targeted preventive interventions and research directed at school bullying."
The goal of this study was to evaluate the relationships between bullying and victimization in boys aged 8 years and psychiatric diagnoses 10 to 15 years later. In 1989, the investigators collected data on 2540 boys who were born in 1981, by administering questionnaires about bullying and victimization to parents, teachers, and to the boys themselves. Military call-up examination and army registry data were used to determine the presence of psychiatric disorders when the participants reached 18 to 23 years of age.
Children who engaged in frequent bullying behavior but who were not victims of bullying were more likely to develop antisocial personality, substance abuse, and depressive and anxiety disorders than a reference group, based on univariate logistic regression analysis. Those who reported frequent victimization-only were more likely to develop anxiety disorder, whereas those who were often both bullies and victims were more likely to develop antisocial personality and anxiety disorder.
After adjustment for parental educational level and parent and teacher reports of emotional and behavioral symptoms on the Rutter scales, boys who reported frequent victimization-only were more likely to develop anxiety disorders; those who reported frequent bullying-only were more likely to develop antisocial personality disorder; and those who reported frequent bully-victimization were more likely to develop both anxiety and antisocial personality disorder. When used as primary screening for high-risk children, information about frequent bullying and victimization identified 28% of those who developed a psychiatric disorder within 10 to 15 years.
"Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood," the authors write. "The school health and educational system has a central role to play in detecting these boys at risk."
Limitations of the study include lack of generalizability to girls, and psychiatric diagnoses not determined through a structured diagnostic interview.
"Proponents of preventing or stopping bullying in schools should consider the provision of individual psychiatric assessments for those involved, and subsequently offering them mental health treatment for their problems," the authors conclude. "Additional studies that address resilience factors (eg, parental and social support systems and the child's cognitive and social skills in dealing with bullying behavior) are warranted. Because childhood bullying is a complex behavior with potentially serious consequences, the early identification of children at risk should be a priority for society."
The Pediatric Research Foundation (Lastentautien Kummisäätiö) supported this study.
One of the authors has disclosed various financial relationships with McNeil, Pfizer, Best Practice, Inc, Shire, Janssen, Novartis, UCB, Janssen-Ortho, Alza, CME Outfitters, the Neuroscience Education Institute, and Eli Lilly. The other authors have disclosed no financial relationships.
Pediatrics. 2007;120:397-404.