Tag: bullying

Bullying, depression and suicide.

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In 2016 the New York Post reported that Danny Patrick, a 13-year-old boy from Staten Island, took his own life after he was mercilessly bullied at Holy Angels Catholic School1. The following year Rosalie Avila, a 13-year-old girl from California, hanged herself in her bedroom after months of relentless bullying from her classmates2. In 2018, Amy Everett, a 14-year-old girl from Australia also took her own life as a consequence of cyberbullying3. Her father invited the bullies to her funeral, saying on Facebook: “if by some chance the people who thought this was a joke and made themselves feel superior by the constant bullying and harassment see this post, please come to our service and witness the complete devastation you have created.”

These are three prolific cases of an increasingly common phenomenon: bullying, victimization and suicide. This increased emergence is a worldwide phenomenon, with research groups based in Chile4, Finland5, South Africa6, South Korea7, the United Kingdom8 and the United States9 all reporting associations between bullying, depression and suicidal thoughts in students. A more recent study published in 2020 examined the risk of suicidal behaviours in bullied students between the ages of 12 and 15 in 83 countries. Strikingly, the authors reported that the overall prevalence of suicidal ideation – defined as the formation of ideas or concepts surrounding suicide – suicidal planning and suicide attempts were 16.5%, 16.5% and 16.4%, respectively10. An increased prevalence of bullying was also associated with higher risks of suicidal behaviours. In Africa for example, the overall prevalence for suicidal ideation, suicidal planning and suicide attempts among students were 19.9%, 23.2% and 20.8% respectively, while bullying prevalence was 48%. These statistics were the highest for any of the 83 countries recorded. Why is something so unimaginable happening so frequently? Is there anything we can do about it? If we decipher the social and psychological factors responsible for the long-lasting consequences of bullying, we could successfully protect the Danny’s, Rosalie’s and Amy’s of the future. 

Of course, we all acknowledge that victimization is cruel and entirely unacceptable. However, do we truly understand the bully-victim dynamic? As you are likely aware, bullying involves aggressive behaviour and is associated with either a real or perceived power imbalance. This behaviour is often repeated over time and can take various forms, including rumours, threats, and verbal or physical attacks. It is crucial to emphasise that this kind of emotional manipulation and dysregulation can have serious consequences. For example, it is probable that prolonged reductions in one’s self-esteem due to persistent bullying is responsible for increased depression prevalence in adolescents11. However, depressive symptoms also appear to manifest in preadolescent children. A Netherlands based study of 1118 children aged 9-11 measured victimization associated with bullying alongside a range of psychological and psychosomatic – a physical disorder often made worse due to mental factors, such as stress – symptoms including poor appetite, bedwetting, sleeping problems, depression and anxiety. The authors reported that victims of depressive behaviours had significantly higher chances of developing psychological problems when compared to children who were not bullied12. In some instances, the psychosocial symptoms actually preceded bullying victimization, with children who already displayed depressive symptoms having a greater chance of being newly victimized. 

There is also a credible body of evidence which underlines potential life-long consequences as a result of bullying and victimization at a young age. In 2015, The Lancet published a study which analysed adult mental health consequences of maltreatment and bullying during childhood from two independent cohorts: the Great Smoky Mountains Study (GSMS) in the USA and the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK. Firstly, I should note here that a longitudinal study involves repeated observations of the same variables over a period of time. For example, monitoring weight loss or depressive symptoms over a 2-year period. In the GSMS, annual parent-child interviews were incorporated and bullying repeatedly assessed between the ages of 9 and 16. In contrast, the ALSPAC study assessed bullying with the inclusion of child reports at the ages of 8, 10 and 13. Overall, data from 1420 children in the GSMS and 4026 children in the ALSPAC were acquired for data analysis. The authors reported that children bullied by their peers were more likely to develop mental health problems as adults13. Even more startling, the development of mental health problems was higher in individuals who had been bullied when compared to those defined as being maltreated, which involved either physical, sexual or emotional abuse by an adult caretaker. What makes this study particularly pertinent is the utilisation of two independent cohorts from separate countries, emphasising that the association between childhood bullying and developing mental health problems as an adult is independent of differences in both social environments and cultural factors.  However, the correlation between bullying types, severity and mental health problems needs to be further explored. 

What about cyberbullying?

Comparatively, cyberbullying is a bit more difficult to define. While several definitions exist, Kowalski and colleagues succinctly defined it in 2014 as “the use of electronic communication technologies to bully others.14” Unfortunately, the global increase in social media presence over the last decade is directly responsible for the uncontrolled aggregation of cyberbullying which has also manifested. Unlike regular bullying which is often limited to school or college, cyberbullying is a constant barrier that many young people face. Further, because anonymity is easily attainable, more people may feel compelled to spit hatred towards others, knowing all too well it would be difficult to be punished for their actions. As a result, cyberbullying is why Amy Everett and so many others take their own life.

Research studies provide considerable evidence to the association between cyberbullying, mental health deficiencies and suicidal tendencies. For example, a 2018 meta-analysis – a type of study which examines data from a number of independent sources on the same subject to determine overall trends – of 26 independent studies identified that children and adolescents who have been victimized through cyberbullying were almost 2.5 times more like to self-harm, 2.15 times more likely to have suicidal thoughts, over 2 times more likely to display suicidal behaviours, and 2.5 times more likely to attempt suicide15. It wasn’t just the victims however, as bullies themselves were 20% more likely to exhibit suicidal behaviours when compared to non-perpetrators.

Perhaps unsurprisingly, cyberbullying appears to also correlate with substance abuse in adolescents. A longitudinal cohort of almost 3,000 students in Los Angeles completed surveys at the beginning of the study (10th Grade, mean age = 15.5), with a 12-month follow up also being incorporated. The study identified five cyberbullying roles at baseline: (1) no involvement, (2) witness only, (3) witness and victim, (4) witness and perpetrator, (5) witness, victim and perpetrator. At follow up, the investigators examined substance reliance over the last 6 months, including alcohol, marijuana, prescription stimulants and prescription opioids. Startlingly, over 50% of the students were involved in more than one of the aforementioned cyberbullying roles, with all four active roles being associated with increased odds of substance abuse at follow-up when compared to students who were given the ‘no involvement’ classification16. The study strongly stresses that cyberbullying can have detrimental consequences not only for the victim, but also the bully and even the witnesses.

Are there any data discrepancies?

With any data, it is crucial to examine both sides of the proverbial coin. As such, it is important to note that a few longitudinal studies have found no associations between bullying, victimization and depression development. One Finnish study examined the correlation between childhood bullying and suicidal ideation17. The study included 2348 boys, all of whom were born in 1981. Bullying information was acquired from the parents, teacher reports and the children themselves at age 8. Depression and suicide ideation were then assessed through participant self-reporting during their Finnish military call-up examination at the age of 18. The study reported that bullies themselves were more likely to be severely depressed and report suicidal ideation when compared to boys who were not identified as bullies during their childhood. Conversely, for boys who were only victimized, the authors did not report any increase in suicide ideation incidence17. While this might seem contradictory to other studies, I need to crucially underline here that self-reporting often opens the door to bias. Firstly, 10 year follow ups may result in participant memory bias, with individuals often choosing to selectively ignore negative experiences from their past. I know this is something I have done on multiple occasions. Further, as an 18-year-old man in 1999, when mental health discussions were still shrouded in stigma (especially for men), would you have wanted to openly talk about victimization and depression associated with bullying? In addition, would reviewing such a circumstance become an issue for the military selection process? Victims in this study may have avoided discussing these negative experiences due to fear of potentially being classified as unsuitable for military selection. There are many confounding factors here that the study does not take into consideration.

What about the bully?

Most of the studies available which analyse the association between bullying and depression focus on the depressive symptoms of the victim. However, there is an increasing concern regarding the mental health of the perpetrators. Multiple cross-sectional surveys have reported elevated depressive symptoms amongst adolescents who report bullying their peers9,18. Cross-sectional studies incorporate a type of analysis which is taken at a specific time point; for example, at a particular age. Interestingly, in another study which compared self-reporting and teacher reported bullying status of students, self-reporting was associated with increased depressive symptoms whereas teacher reported bullying was not19. This study is particularly important, as it suggests that self-identification of bullying behaviour could result in the manifestation of shame, self-blame and guilt, all of which could be instrumental into catalysing an emotional spiral towards depression.

An increased risk of depression and suicidal thoughts appears to be particularly pertinent for teenage girls18. Research by Brunstein and colleagues identified that girls who reported bullying others more frequently may be at a higher risk for depression and attempted suicide when compared to boys18. This perpetrator-depression link appears to also hold true in children, although a study from the Isle of Wight reported that the probability of presenting psychiatric disturbances were highest amongst male bullies, presenting a 9.5-fold increased risk, followed by male bully-victims (7.9-fold) and female victims (4.3-fold)20. The study also reported that children who bullied others had a 5-fold increased chance of being in contact with mental health services compared to non-bullies. A more recent study by Dr. William Copeland and Dr. Elizabeth Costello from Duke University provides additional credence to these findings, wherein they repeatedly examined 1,420 children between the ages of 9-16 over several years, determining whether bullying could predict psychiatric issues and suicide. The authors reported that both victims and bullies alike had an increased risk of depression and panic disorders, alongside behavioural, educational and emotional issues21. Thus, social interaction and development may have stark implications for the development of mental health difficulties associated with the bullying-victim-perpetrator dynamic.

Summary

I wanted to emphasize here that bullying has devastating consequences, with mental health problems often manifesting for both the victims and the perpetrators. In many circumstances, bullies themselves undergo episodes of considerable unhappiness, frequently resulting to substance abuse and suicide, not dissimilar to that observed in victims. As a community, we need to identify this and help educate the youth of our society so they can learn become the best of us. It is time that we helped them learn from our mistakes. We owe it to ourselves to help them do better.

If you yourself want to learn more about the presence of bullying, depression and suicide within the youth, the CDC have an informative online booklet which is easily digestible. It provides insights into what school personnel can do to help, alongside providing links to further information for those who seek it22.

References

  1. https://nypost.com/2016/08/13/staten-island-boy-takes-his-own-life-after-ripping-school-bullies-in-suicide-note/
  2. https://abcnews.go.com/US/family-13-year-california-girl-committed-suicide-months/story?id=51820650
  3. https://www.bbc.com/news/world-australia-42631208
  4. Fleming L, Jacobsen K. Bullying and symptoms of depression in Chilean middle school students. J Sch Health. 2009;79:130–137. 
  5. Kaltiala-Heino R, Rimpelä M, Marttunen M, Rimpelä A, Rantanen P. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. Br Med J. 1999;319:348–351.
  6. Liang H, Flisher AJ, Lombard CJ. Bullying, violence and risk behavior in South African school students. Child Abuse Negl. 2007;31:161–171
  7. Kim YS, Koh YJ, Leventhal B. School bullying and suicidal risk in Korean middle school students. Pediatrics. 2005;115:357–363.
  8. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-harm, suicidal behaviours and cyberbullying in children and young people: systemati review. J Med Internet Res. 2018: 20: e129.
  9. Fitzpatrick K, Dulin A, Piko Bullying and depressive symptomatology among low-income, African-American youth. J Youth Adolesc. 2010;39:634–645. 
  10. Tang JJ, Yizhen Y, Wilcox HC, Kang C, Wang K, Wang C, Wu Y, Chen R. Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries. EClinicalMedicine. 2020;19:100253.
  11. McLaughlin K, Hatzenbuechler M, Hilt L. Emotion dysregulation as a mechanism linking peer victimization to internalizing symptoms in adolescents. J Consult Clin Psychol. 2009;77:894–904.
  12. Fekkes M, Pijpers F, Fredriks A, Vogels T, Verloove-Vanhorick S. Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the relationship between bullying and health-related symptoms. Pediatrics. 2006; 117:1568-1574.
  13. Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry 2015;2:524-31.
  14. Kowalski RM, Giumetti GW, Schroeder AN, Lattanner MR. Bullying in the digital age: a critical review and meta-analysis of cyberbullying research among youth. Psychol Bull. 2014;140:1073-137.
  15. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-harm, suicidal behaviours, and cyberbullying in children and young people: Systematic review. J Med Internet Res. 2018; 20:e129.
  16. Yoon Y, Olivia Lee J, Cho J, Bello MS, Khoddam R, Riggs NR, Leventhal AM. Association of cyberbullying involvement with subsequent substance use among adolescents. J Adolesc Health. 2019;65:613-620.
  17. Brunstein Klomek A, Sourander A, Kumpulainen K, Piha J, Tamminen T, Moilanen I, Almqvist F, Gould MS. Childhood bullying as a risk factor for later depression and suicidal ideation among Finnish males. J Affect Disord. 2008;109:47-55.
  18. Brunstein Klomek A, Marrocco F, Kleinman M, Schonfeld I, Gould M. Bullying, depression and suicidality in adolescents. J Am Acad Child Adolesc Psychiatry. 2007;46:40-49.
  19. Wienke Totura C, Green A, Karver M, Gesten E. Multiple informants in the assessment of psychological, behavioral, and academic correlates of bullying and victimization in middle school. J Adolesc. 2009;32:193–211. 
  20. Kumpulainen K, Räsänen E, Puura K. Psychiatric disorders and the use of mental health services among children involved in bullying. Aggress Behav. 2001;27:102–110.
  21. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70:419-26.
  22. https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf

Bullying: a victim’s perspective and experience.

tedwicksteadLeave a comment

Take a second to close your eyes and visualize your life, from childhood right up until this morning. Try to focus on your most principle experiences, associating these specific events with particular feelings and emotions. Now, what did they mean to you? What feelings do you cling onto the most? It is sadness? Happiness? What about regret? Upon reflection, it is often easy for us to linger on the negative. During our childhood, this is especially true if we were plagued by bullying. The innate ability of our peers to manipulate the direction of our social development and emotional stability is really quite impressive, many times cultivating a negative mentality not dissimilar to an overgrown weed. A pest, often too difficult to remove.

Overall, my childhood was pretty good. Until around the age of eight, I lived in a small street called Church Leys in Harlow, Essex. I was pretty lucky in that many other families in the neighbourhood had kids around my age. This was before the development and widespread accretion of the internet, cell phones or social media. Thus, the other kids and I would usually spend the majority of our spare time together, trading Pokémon cards, playing football, or glued to the Nintendo 64. A distant time, void of any pertinent obstacles. 

Unfortunately, negative emotions often cloud positive thoughts. My experience with secondary school and sixth form was the parasitic catalyst for this prolonged negative outlook. Many days were unpleasant, and the emotions associated with those moments often mean I forget to appreciate the enjoyable experiences in my past and present. Retrospectively, I often forget how enjoyable both my childhood and my peers could actually be. Instead, I attached myself to the disapproval I was relentlessly fed by others. This was a direct outcome of persistent peer-associated bullying.

I was an incredibly introverted and pretty weird kid. As such, I was probably an easy target. Slightly overweight, I was fat-shamed practically every day. I also had long curly hair similar to Slash, the guitarist from Guns N’ Roses. As cool as I thought it was, I was often coined the ‘yeti’ or ‘sasquatch’. Otherwise, ‘tramp’ would resonate in the days someone wanted to shake up the name-calling schedule. Eventually, these insults metamorphosized into commonplace nicknames. Understanding that resistance would likely result in further ridicule, I attempted to wear them like a badge of honour, despite being necrotic in nature. 

Eventually, I was gifted a reprieve. I managed to make some of my bullies snigger during an English class, while my teacher glared at me with absolute distain. It was a lightbulb moment. While quite depressing in reality, I realized my way out of constant victimization and shame presented itself before me; position myself as the class clown. My agenda? Disruption, disobedience and disorder. My goal was to ruin every fucking class for the teacher so the popular kids would hopefully view me as three-dimensional and interesting. While it didn’t stop the bullying entirely, it put a muzzle on it for a while. As you might expect, this shift in behaviour resulted in educational penalties. I was switched into lower class sets because my teachers thought I was apathetic about my tutelage. To their credit, that did appear true. In actuality, because my mental health and self-esteem were so devastatingly damaged, my interests aligned with being in favour of my bullies rather than developing my academic abilities.

I almost ruined my education because of this manipulated mentality, all because a few insignificant bullies were flinging their own mental health and insecurity problems towards me. I adapted to fit into their crowd of callous clowns, attempting to avoid further harassment. Not dissimilar to a chameleon, I blended into my new social surroundings, but the ramifications were severe. Peer-pressure got the better of me. At the age of fourteen, I ended up being rushed to hospital due to alcohol poisoning. To impress my bully-perpetrating peers, I decided drinking a bottle of vodka would make me look dangerous, daring and most of all, sufficient. The worst thing about the entire experience? It wasn’t even these ‘peers’ that dialled for an ambulance. Instead, it was a stranger in the street who witnessed me repeatedly collapsing at a local park. I will never forget that feeling of utter loneliness and isolation upon understanding a stranger cared more about my health and safety than the people I associated myself with. I was rushed to hospital, wherein I woke up the next morning. Informed that I spent the majority of the night before throwing up on the nurse, the doctor explained how lucky I was to be alive. The hammer hit home for my mum when he turned to her and explained the situation would have been considerably worse if I was smaller in size. After this declaration, it should have been a turning point. Instead, the notion of being a smaller kid reverberated around my head. Irrationally, I extrapolated his conclusion to mean that I was obscenely overweight. The socially developing brain, huh? What a fun fucking ride. Hey, what did it matter? Nearly killing myself got me in their good books! As an insecure, vulnerable and lonely kid, I managed to turn this into a twisted positive. 

Obviously, this ‘respect’ didn’t last long. In fact, the harassment expanded. In my later years at secondary school (I’d say between the ages of fourteen and sixteen), I was bullied in my morning and afternoon registration group, and the prospect of a reprieve appeared bleak. After about twelve weeks, I identified a way out. For the majority of my childhood, I lived alone with my mum. I used this to my advantage and started bunking off school. My mum would often leave for work after I left for school, so I began hiding in the nearby woods until I witnessed her drive off into the distance. My truanting lasted for approximately two weeks before my brother dropped by to collect something. Because I lacked any real ability to provide a show stealing performance in lying aptitude, he quickly put two-and-two together. 

I became so mentally disenfranchised that I gave up on the entire education process. As a result, I coasted through my penultimate year, often attempting to nullify my chronic negativity through self-harm and emotional withdrawal. I began to disrupt practically every class wherein a potential bully was also present. Talking, throwing stuff and swearing at the teacher were all commonalities in my troublesome approach. The result? About 180 detentions in a single academic year. I think I received five or six a week on average, surmounting to an hour each day after school. I intentionally skipped out on the majority of these, resulting in extended ninety-minute detentions instead, as was the rule if you missed any. Clearly, I wasn’t making the wisest of decisions at the time. Looking back, I find that entire detention process infuriating. Teachers could have allocated detention time to force students to carry out class activities focused on the core fundamentals: English, Maths and Science. If standard protocol, perhaps I would have identified my passion for the latter far earlier. 

Eventually, a lifeline presented itself in the form of my drama and performing arts teacher. Patrick Walker was always cool, calm and collected. His approach commanded authority, but in an unthreatening and empathetic way. Dedicated to helping his students’ development, he understood that belittling someone would only result in revolt and rebellion. My mum and I were called in for a meeting with him once, as he also had a crucial role in the senior leadership team. He emphasized that I was at an inflection point. The choices? Continue on my current path, ruining my life as a result, or actively apply my academic ability towards bettering myself and my future. As a direct consequence, I began to focus on my classes, rather than my bullies. While the victimization continued, I learned to ignore it for the most part. My newly found focus towards education helped me realize I attained genuine enjoyment from science, performing arts and computing. This alone was the spark responsible for a miraculous turnaround; I developed a hard-working mindset. But despite this newly discovered surge of motivation, I was unable to reach the goal I desperately set myself; an A grade in science. In fact, I mostly received C grades across the board. As such, that prospect of a better tomorrow rapidly mutated into uncertainty, depression and inescapable self-doubt. 

I scraped into sixth form. By this point, the feeling of negativity and worthlessness felt permanently engraved into my brain. Instead of thankfulness and pride due to acceptance, I assumed the school took pity on me. I felt inadequate and expected to fail. While my hardworking mindset remained, my insecurity was rife. Life became study-centric. I did have friends during my time at sixth form (many of which remain my friends today), but I didn’t actively see them all that often outside of class. Because my mentality was infected with so much rotten self-doubt and paranoia, I never allowed myself to enjoy some of the better moments during those years.

Many of the bullies at my secondary school performed poorly in their exams, decided to take a different career path, or both. I didn’t see them again. Instead, I exposed myself to new bullies: the cool-intelligent crowd. Do you remember that kid that always got straight A’s despite never paying attention in class? All while taking the piss out of how hard you worked or how weird you were? Yeah, that came to ahead here. Around the same time, emotional withdrawal became second nature, but I considered it a positive thing. Facilitating me to work non-stop, it helped me to shrug off the snide comments from others. The work ethic I developed helped me attain the grades I needed for acceptance into a top-tier university. However, the social sacrifice was severe, and feelings of insufficiency aggregated once again.

My experience with university was better. Upon arrival at my dorm, feelings of acceptance and belonging really took over. On the most part, I met a range of different individuals from all walks of life who shifted my world view significantly. Regrettably, a small number of privileged students would often make snide comments, but fortunately they were located in a separate building. I recall that prior to moving in, there was a Facebook group set up by the university for the different accommodations located around London, so all incoming students had the opportunity to engage with others prior to arrival. For someone as timid and shy as I was at the time, this was a social security net. Though, I remember some individuals mocking me for my apparent eagerness on the group. While university is often distinguished as a potent primer for maturation towards adulthood, this association was clearly lost on some. Instead, they ridiculed me for being lonely and wanting a fresh start.

My first year as an undergraduate student made me realize that anyone has the ability to become a bully, regardless of their previous circumstances. I also began to understand that chronic bullying often results in long-lasting consequences, with depressive experiences in both childhood and adolescence resulting in life-long effects. For example, I still feel overweight to this day despite exercising four times a week and eating healthily.  The consequences of fat-shaming during my adolescence really came to a head during my first year at university. I decided that my body was unbearable, so I employed a crash diet. I think my daily food regime was two slices of brown bread, a tin of baked beans and a roasted chicken breast, which is far from ideal for an active university student. The result? I dropped around 5 stone (70 pounds) in as many months. I was underweight and unhealthy.

After that initial year, things changed. I was selected to participate in an exchange program for my second year, wherein I decided to study at the National University of Singapore. The experience was the catalyst for priming the development of who I am today. It flipped my preconceptions and assumptions about myself, fuelling endless ideas of what I could potentially be. I still suffer with body confidence issues, but now I understand where it stems from. I take the time to rationalise my insecurities, target their original source, and remind myself that those feelings often manifested due to negative situations. While it remains to be completely effective, this approach to acknowledgement and acceptance helps me to rationalise my issues, allowing escape from an otherwise inescapable chokehold. 

For this topic, I wanted to highlight my own personal experiences with victimization and bullying to really drive home that it can have immense implications. To this day, I still find it difficult to accept a compliment, and this had negative implications for previous relationships. For me, it was primarily due to bullying. Today, the only compliments I can really recognise are based on my previous successes. For example, I can accept the notion of someone referring to me as articulate, based on the fact I managed to navigate the PhD process and emerge with a doctorate. However, I still find it difficult to accept compliments associated with my appearance, my cultural taste or my social skills. Thus, I just hope that people become more aware about the consequences of long-term bullying, whether in childhood, adolescence or adulthood. There is a fine line between good-hearted ‘banter’ and just being degrading and hurtful. Locate the line, be mindful of it, and it will have long-lasting benefits for the mental health of yourself and your peers.

Please, always remember that random acts of kindness are far more rewarding.