Dr Derrick Aarons
HAS the thought ever occurred to you that some of the psychiatric disorders you see in adults might be due to the effects of bullying that they received during childhood?
Well, research has recently shown that this is so.
The largest research study of its kind has revealed just how harmful childhood bullying is, with various anxiety disorders and depression manifesting in adults later on. Paradoxically, bullying usually takes place in secret away from the eyes of adults, and so the only way to become aware of the bullying of children is to be on the lookout for their reluctance or refusal to go to school, failing grades, and social isolation.
Published in the JAMA Psychiatry Journal, the research revealed that a poor prognosis or outcome also occurred not only in those who were frequently bullied, but also for those children who witnessed the bullying.
The study was part of a multi-centre nationwide birth cohort study in Finland, which included more than 60,000 children followed from their birth in 1981 through to adulthood.
At age eight, children were asked whether they were victims of bullying or whether they bullied other children, and if so, how often. Subsequently, during follow-up, researchers determined whether the participants in the study required treatment for psychiatric disorders from ages 16 to 29 years.
PSYCHOSIS, ANXIETY OR DEPRESSION
Among those who had engaged in frequent bullying, 20 per cent of them received a psychiatric diagnosis at the follow-up. For those who had been frequently exposed to bullying, 23 per cent received a psychiatric diagnosis subsequently. For those who both frequently engaged in bullying and who were also frequently exposed to it, 31 per cent were found to have received a psychiatric diagnosis by the time of the follow-up.
After adjusting for family factors and the presence of psychiatric symptoms at age eight years, the researchers found independent positive associations between treatment of any type of psychiatric disorder and frequent experiences of bullying and being a bully, as well as being exposed to bullying.
Participants who were frequently exposed to bullying had almost a twofold increased risk of receiving a psychiatric diagnosis, including psychosis, anxiety and depression by the age of 29 years, when compared with people who did not frequently bully or who were not frequently exposed to bullying.
ANTI-BULLYING CAMPAIGNS NOT ENOUGH
The researchers found that bullying behaviour was therefore a “red flag” that something was wrong, and that the children involved (the bully as well as the bullied) needed to be assessed.
As bullying behaviour is a complex phenomenon, it is crucial that it be recognised and addressed. Beyond anti-bullying campaigns, the researchers recommended the integration of school-based interventions and mental health perspectives within the school health system.
Parents, teachers, and paediatricians need to be further educated about the association between bullying and the probable psychiatric outcomes in order to properly screen children and to intervene if needed.
The message has to get out that bullying is a form of abuse that should be adequately and effectively addressed, even when other problems may not exist at the time.
Policymakers and health care professionals should be aware of the complex association between bullying and psychiatric outcomes when they implement prevention and treatment interventions.
CROSSING THE LINE
Many people, children and sometimes adults, are often the targets of bullying, particularly if they belong to vulnerable groups or communities that are frequently the targets of bullying (for example, in the lesbian, gay, bisexual, and transgender or inner-city communities). The researchers warned that whilst there is a general belief that a certain amount of bullying toughens up children, and there is a kind of admiration for rough-and-tumble play, if this is not done in a well-supervised and friendly environment, then harm can occur.
The line separating friendly play from serious intimidation can be crossed very easily, resulting in children or adults being afraid to go to school or work, and afraid to trust anybody.
Alarmingly, some children will not tell their parents or teachers that they are being harassed because they are frightened for their lives. This kind of experience among children can clearly lead to anxiety and other psychiatric disorders in adulthood, with people being unable to trust anyone because no one stepped in to protect them as children.
We therefore need to work with young children, generally, to help them distinguish between what is normal fun versus what crosses the line into bullying. We have to teach them early how not to cross that line.
Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)