Bullying and Depression in Youths

During an evaluation, a 10-year-old girl who was depressed said that classmates called her stupid and laughed at her all the time. Fortunately, the teachers stopped this verbal bullying. However, unbeknownst to the teachers, the students would text disparaging comments to the girl throughout the school day. She was reluctant to inform the teachers because she thought it would worsen the situation.

A 14-year-old girl in treatment for depression reported that she was being bullied in school. She said that girls in her classes constantly made negative comments about her appearance, dress, and behavior. They excluded her from social activities despite her desire to participate. She said that the girls were telling lies about her to boys in the class, which was damaging her reputation. What upset her the most was that an online site had been created in which students were encouraged to write all the reasons they hated her. She cried and said that she could not avoid the bullying even outside of school. She believed the only way to escape the bullying was to not exist anymore, and she confirmed that she was suicidal.

Cyberbullying

[[{"type":"media","view_mode":"media_crop","fid":"46113","attributes":{"alt":"© SPEEDKINGZ/SHUTTERSTOCK.COM","class":"media-image media-image-right","id":"media_crop_2157319895923","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5325","media_crop_rotate":"0","media_crop_scale_h":"93","media_crop_scale_w":"150","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"© SPEEDKINGZ/SHUTTERSTOCK.COM","typeof":"foaf:Image"}}]]Cyberbullying, which allows bullying to extend beyond face-to-face contact into electronic media, has received considerable recent attention. Hamm and colleagues¹ examined its effects via social media among children and adolescents. They included 36 studies of cyberbullying in their review. Most youths in these studies were middle and high school students, aged 12 to 18 years. The majority were female (55.8%).

Across these studies, 23% of the youths reported having been bullied online. The most common electronic social media platforms for bullying included message boards, social networking sites, blogs, Twitter, and Web pages. The most common types of cyberbullying were name-calling or insults, circulating pictures, and spreading gossip and rumors. Often relationship issues preceded the bullying. Girls were more likely to be cyberbullied than boys.

Adolescents who had been cyberbullied reported becoming more withdrawn, losing self-esteem, and feeling uneasy. There were adverse effects on relationships with family and friends. School grades worsened, there were more school absences, and behavior problems in school became common.

Depression was associated with cyberbullying. The adolescent’s level of depression increased significantly with exposure to cyberbullying. In some cases, cyberbullying was associated with self-harm behavior and suicidal ideation and attempts.

The most common strategies employed by the adolescents to deal with cyberbullying were to block the sender, ignore or avoid messaging, and protect personal information. Nearly 25% of the adolescents did not tell anyone about the cyberbullying. If they did tell someone, it was most likely to be a friend rather than an adult. Often adolescents perceived that nothing could be done to prevent the bullying, and if they told their parent about the bullying, they would lose access to the computer. Researchers suggest that increased awareness of the prevalence of cyberbullying and its adverse effects may lead to better prevention and management strategies.

The correlation between depression and bullying

In a recent study, Bowes and colleagues² examined the association between being bullied by peers at age 13 and the occurrence of depression at 18 years. The study comprised 6719 adolescents from the Avon Longitudinal Study of Parents and Children cohort in the UK. About 10% (n = 683) of the participants reported frequent bullying at age 13. The proportion of youths with depression increased with the frequency of bullying: 14.8% of the youths who were frequently bullied met criteria for depression, whereas 7.1% of youths who were occasionally bullied and 5.5% of youths who were not bullied met criteria for depression.

The odds ratio was 2.96 for increased rates of depression for youths who were frequently bullied compared with those who were not bullied, even after controlling for previous bullying in childhood and previous depressive symptoms. This association was found for both males and females.

Overall 29.2% of the total risk of depression at age 18 years could be explained by peer bullying during adolescence. The researchers caution that these are observational data; therefore, it is not possible to be certain about causal associations. Nevertheless, they recommend the prevention of bullying in schools as a means to reduce the incidence of depression in adolescence and early adulthood.

Exercise

Physical exercise has been linked to improved mental health. Can exercise diminish the likelihood of depressed mood and suicidality in youths who are being bullied? Sibold and colleagues³ examined whether physical activity is a protective factor that can reduce the likelihood of sadness, suicidal ideation, and suicide attempts in adolescents who are bullied. Data were obtained from the 2013 National Youth Risk Behavior Survey (N = 13,583), a representative survey of public and private high schools in the US. The survey question for physical activity was: “During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?” The question related to sadness was: “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?”

There were also questions about whether in the past 12 months the student had ever seriously considered attempting suicide or had made a plan about how to attempt suicide, the number of suicide attempts, and whether the attempts resulted in the need for medical treatment. Students were classified as having been bullied if they answered yes to questions about being bullied on school property or being electronically bullied (eg, via email, chat rooms, instant messaging, websites, texting) in the past 12 months.

In the total sample, 30% of the students felt sad for 2 or more weeks; 22.2% reported suicidal ideation; and 8.2% reported a suicide attempt in the past 12 months. Slightly over a quarter (25.2%) of the overall sample reported being bullied in the past 12 months. Students who were bullied were significantly more likely to feel sad (51.3%) or to report suicidal ideation (39.3%) or a suicide attempt (18.3%) compared with those who were not bullied.

The students who were more physically active-both those who were bullied and those who were not bullied-were less likely to report feelings of sadness, suicidal ideation, and suicide attempts. Students who were bullied and exercised 4 or more days per week had a lower likelihood of feeling sad or hopeless compared with bullied students who exercised 0 or 1 day. Similarly, students who were bullied and exercised 4 or more days had a lower incidence of suicidal ideation and attempts than those who exercised 0 or 1 day.

Overall, students who were physically active 4 or more days per week had approximately a 23% reduction in both the odds of suicidal ideation and suicide attempts compared with those bullied adolescents who rarely exercised. The researchers noted that these are associations and do not imply causality. However, the results suggest that exercise may be a possible strategy for decreasing sadness and suicidality in bullied students.

Conclusion

Inquiring about bullying/cyberbullying should be a routine part of clinical evaluations of children and adolescents. Youths are often reluctant to volunteer this information. Strategies to address bullying should be incorporated into treatment plans.

This article was originally posted on 1/8/2016 and has since been updated.

Disclosures:

Dr Wagner is the Marie B. Gale Centennial Professor and Chair Ad Interim in the department of psychiatry and behavioral sciences and Director of Child and Adolescent Psychiatry at the University of Texas Medical Branch at Galveston.

References:

1. Hamm MP, Newton AS, Chisholm A, et al. Prevalence and effect of cyberbullying on children and young people: a scoping review of social media studies. JAMA Pediatr. 2015;169:770-777.

2. Bowes L, Joinson C, Wolke D, Lewis G. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ. 2015;350:h2469.

3. Sibold J, Edwards E, Murray-Close D, et al. Physical activity, sadness, and suicidality in bullied US adolescents. J Am Acad Child Adolescent Psychiatry. 2015;54:808-815.14.