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Bullying and Suicidality in Children and Adolescents Without Predisposing Factors: A Systematic Review and Meta-analysis

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Georgios Katsaras at General Hospital of Pella - Hospital Unit of Edessa
Georgios Katsaras
  • General Hospital of Pella - Hospital Unit of Edessa
Evridiki K Vouloumanou at Alfa Institute of Biomedical Sciences
Evridiki K Vouloumanou
Georgia Kourlaba
Georgia Kourlaba
Georgia Kourlaba
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Eleni Kyritsi Koukoulari
Eleni Kyritsi Koukoulari
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Abstract and Figures

Published evidence has suggested that engaging in school or cyber bullying may potentially be associated with a suicidal ideation and suicide attempts. The aim of our review/meta-analysis was to evaluate the potential association between school and cyber bullying and suicidality (including suicidal ideation, planning and/or committing a suicide attempt) in children and adolescents (< 19 years old) who are considered as a “healthy” population, without predispositions for suicidality factors (not subpopulations with characteristics that may constitute proneness to bullying and its consequences, including sexual minorities, drug users and youth with psychiatric comorbidity). Regarding school bullying, victims and bullies independently, and victims and bullies together, were significantly more likely to present suicidal ideation and commit a suicide attempt, compared to non-involved participants. Victims of school bullying were found to be significantly more likely to commit a suicide attempt that required medical treatment. Victims of cyber bullying were significantly more likely to present suicidal ideation and commit a suicide attempt. A positive relationship between involvement in both school bullying and cyber-bullying with suicidal ideation and suicidal behavior was observed. This review/meta-analysis contributes to further understanding bullying and suicidality as it includes results of participants without any predisposing factors for suicidality, thus providing more clear results with regard to the magnitude of the effects of both school and cyber bullying on suicidality.
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Vol.:(0123456789)
1 3
Adolescent Research Review (2018) 3:193–217
https://doi.org/10.1007/s40894-018-0081-8
QUANTITATIVE REVIEW
Bullying andSuicidality inChildren andAdolescents Without
Predisposing Factors: ASystematic Review andMeta-analysis
GeorgeN.Katsaras1· EvridikiK.Vouloumanou2,3· GeorgiaKourlaba4· EleniKyritsi5· EleniEvagelou5·
ChryssaBakoula6
Received: 10 November 2017 / Accepted: 13 February 2018 / Published online: 17 February 2018
© Springer International Publishing AG, part of Springer Nature 2018
Abstract
Published evidence has suggested that engaging in school or cyber bullying may potentially be associated with a suicidal
ideation and suicide attempts. The aim of our review/meta-analysis was to evaluate the potential association between school
and cyber bullying and suicidality (including suicidal ideation, planning and/or committing a suicide attempt) in children
and adolescents (< 19years old) who are considered as a “healthy” population, without predispositions for suicidality factors
(not subpopulations with characteristics that may constitute proneness to bullying and its consequences, including sexual
minorities, drug users and youth with psychiatric comorbidity). Regarding school bullying, victims and bullies indepen-
dently, and victims and bullies together, were significantly more likely to present suicidal ideation and commit a suicide
attempt, compared to non-involved participants. Victims of school bullying were found to be significantly more likely to
commit a suicide attempt that required medical treatment. Victims of cyber bullying were significantly more likely to present
suicidal ideation and commit a suicide attempt. A positive relationship between involvement in both school bullying and
cyber-bullying with suicidal ideation and suicidal behavior was observed. This review/meta-analysis contributes to further
understanding bullying and suicidality as it includes results of participants without any predisposing factors for suicidality,
thus providing more clear results with regard to the magnitude of the effects of both school and cyber bullying on suicidality.
Keywords School bullying· Cyber bullying· Suicidal ideation· Suicide attempt
Introduction
Existing literature provides a plethora of evidence regarding
increasing rates of school bullying as well as the emerging
type of cyber bullying. Specifically, Indicators of School
Crime and Safety of 2011 suggested that more than 28% of
adolescents 12–18years of age (girls 31% and boys 25%)
have been a victim of school bullying (Finkelhor etal. 2013).
Yet, the prevalence of cyber bullying seems to be more diffi-
cult to be estimated, as evidence from relevant studies ranges
* Evridiki K. Vouloumanou
e.vouloumanou@aibs.gr
George N. Katsaras
gkatsaras84@gmail.com
Georgia Kourlaba
kurlaba@gmail.com
Eleni Kyritsi
ekyr@teiath.gr
Eleni Evagelou
elevagel@teiath.gr
Chryssa Bakoula
cbakoula@med.uoa.gr
1 NICU, General Hospital ofNikaia-Piraeus “Ag.
Panteleimon”, Nikaia-Piraeus, Greece
2 Department ofPaediatrics, Tzaneion General Hospital, Zanni
and Afentouli 1, Piraeus, Greece
3 Alfa Institute ofBiomedical Sciences (AIBS), 9 Neapoleos
Street, Marousi, Athens, Greece
4 The Stavros Niarchos Foundation-Collaborative Center
forClinical Epidemiology andOutcomes Research (CLEO),
National andKapodistrian University ofAthens, School
ofMedicine, Thivon&Papadiamantopoulou, 11527Athens,
Greece
5 Nursing Department A, Technological Educational Institute
ofAthens, Athens, Greece
6 1st Department ofPaediatrics, Children’s Hospital
“Agia Sophia”, Medical School, University ofAthens,
Thivon&Papadiamantopoulou, 11527Athens, Greece
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Studies in high-and low-income countries, including Uganda, show that the factors that affect depression and suicide in adolescence and young adulthood exist across the levels of the social ecology and include political instability, unemployment, low family cohesion, intergenerational, genetic and epigenetic factors [5,6], internalising problems in childhood, and experiences of violence, among others [7][8][9][10][11][12]. Many cross-sectional and cohort studies in high-income countries (HIC) have specifically explored links between experiencing violence and mental health and find that violence is associated with anxiety, depression, suicidal ideation, and suicide attempts in adulthood [13][14][15][16][17][18][19]. ...
... Table 1 describes the sociodemographic characteristics of the study sample. The median age was 13 years IQR (12,14) at Wave 1 and 18 years IQR (16,19) ...
Associations between violence in childhood, depression and suicide attempts in adolescence: evidence from a cohort study in Luwero district, Uganda
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Background Many studies have documented an association between violence victimisation and poor mental health. However, few studies use longitudinal data from low- and middle-income countries with attention to how associations differ by experiencing specific types of violence or alongside different contexts of peer and family support. In this study, we quantify the association between experiences of violence in early adolescence and depression and suicide attempts in late adolescence and explore whether this association is modified by family and peer connectedness. Methods Data came from the Contexts of Violence Against Children (CoVAC) cohort study in Luwero District, Uganda, involving 2773 participants aged 11–14 years at Wave 1 (2014) and 15–18 years at Wave 2 (2018). Physical, sexual, and emotional violence were measured at Wave 1. Mental health outcomes, depression symptoms in the past two weeks, and lifetime suicide attempts were measured at Wave (2) We used logistic regression models, stratified by sex, to estimate adjusted odds ratios with an interaction term to test for effect modification by peer and family connectedness at Wave 1. Findings At Wave 1, the prevalence of any violence from any perpetrator was 90% (physical violence: 87%, physical violence excluding caning: 68%, sexual violence: 6.3%, emotional violence: 56.8%). At Wave 2, 13.3% of participants had scores indicative of depression and 4.3% reported ever attempting suicide. Physical violence excluding caning, emotional violence, and sexual violence during early adolescence increased the odds of depression and attempting suicide in late adolescence for both boys and girls. Experiencing any violence (including caning) in early adolescence was not associated with depression in late adolescence, including in sex-stratified models. Childhood experience of any violence was associated with a suicide attempt violence in early adolescence (aOR: 2.60; 95%CI: 1.08, 6.27). High peer support mitigated the effect of any violence and physical violence on depression. Conclusions Findings highlight the importance of efforts to prevent violence and improve access to response and support services for violence and mental health for young people. Findings also underscore the important role friends and peer networks can play in mitigating the effects of violence as young people grow up.
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Importance This study presents evidence that cyberbullying victimization relates to internalizing, externalizing, and substance use problems in adolescents and that the frequency of family dinners attenuate these associations.Objectives To examine the unique association between cyberbullying victimization and adolescent mental health (after controlling differences in involvement in traditional, face-to-face bullying) and to explore the potential moderating role of family contact in this association.Design, Setting, and Participants This cross-sectional, observational study used survey data on 18 834 students (aged 12-18 years) from 49 schools in a Midwestern US state. Logistic regression analysis tested associations between cyberbullying victimization and the likelihood of mental health and substance use problems. Negative binomial regression analysis tested direct and synergistic contributions of cyberbullying victimization and family dinners on the rates of mental health and substance use problems.Exposures Frequency of cyberbullying victimization during the previous 12 months; victimization by traditional (face-to-face) bullying; and perpetration of traditional bullying.Main Outcomes and Measures Five internalizing mental health problems (anxiety, depression, self-harm, suicide ideation, and suicide attempt), 2 externalizing problems (fighting and vandalism), and 4 substance use problems (frequent alcohol use, frequent binge drinking, prescription drug misuse, and over-the-counter drug misuse).Results About one-fifth (18.6%) of the sample experienced cyberbullying during the previous 12 months. The frequency of cyberbullying positively related to all 11 internalizing, externalizing, and substance use problems (odds ratios from 2.6 [95% CI, 1.7-3.8] to 4.5 [95% CI, 3.0-6.6]). However, victimization related more closely to rates of problems in adolescents that had fewer family dinners.Conclusions and Relevance Cyberbullying relates to mental health and substance use problems in adolescents, even after their involvement in face-to-face bullying is taken into account. Although correlational, these results suggest that family dinners (ie, family contact and communication) are beneficial to adolescent mental health and may help protect adolescents from the harmful consequences of cyberbullying.
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Associations between Cyberbullying and School Bullying Victimization and Suicidal Ideation, Plans and Attempts among Canadian Schoolchildren
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Purpose The negative effects of peer aggression on mental health are key issues for public health. The purpose of this study was to examine the associations between cyberbullying and school bullying victimization with suicidal ideation, plans and attempts among middle and high school students, and to test whether these relationships were mediated by reports of depression. Methods Data for this study are from the 2011 Eastern Ontario Youth Risk Behaviour Survey, which is a cross-sectional regional school-based survey that was conducted among students in selected Grade 7 to 12 classes (1658 girls, 1341 boys; mean±SD age: 14.3±1.8 years). Results Victims of cyberbullying and school bullying incurred a significantly higher risk of suicidal ideation (cyberbullying: crude odds ratio, 95% confidence interval = 3.31, 2.16–5.07; school bullying: 3.48, 2.48–4.89), plans (cyberbullying: 2.79, 1.63–4.77; school bullying: 2.76, 2.20–3.45) and attempts (cyberbullying: 1.73, 1.26–2.38; school bullying: 1.64, 1.18–2.27) compared to those who had not encountered such threats. Results were similar when adjusting for sociodemographic characteristics, substance use, and sedentary activities. Mediation analyses indicated that depression fully mediated the relationship between cyberbullying victimization and each of the outcomes of suicidal ideation, plans and attempts. Depression also fully mediated the relationship between school bullying victimization and suicide attempts, but partially mediated the relationship between school bullying victimization and both suicidal ideation and plans. Conclusion These findings support an association between both cyberbullying and school bullying victimization and risk of suicidal ideation, plans and attempts. The mediating role of depression on these links justifies the need for addressing depression among victims of both forms of bullying to prevent the risk of subsequent suicidal behaviours.
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School Bullying, Cyberbullying, or both: Correlates of Teen Suicidality in the 2011 CDC Youth Risk Behavior Survey
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  • Feb 2014
While school bullying has been shown to be associated with depression and suicidality among teens, the relationship between these outcomes and cyberbullying has not been studied in nationally representative samples. Data came from the 2011 CDC Youth Risk Behavior Survey (YRBS), a nationally representative sample of high-school students (N=15,425). We calculated weighted estimates representative of all students in grades 9-12 attending school in the US. Logistic regression was used to calculate adjusted odds ratios. Overall, girls are more likely to be report being bullied (31.3% vs. 22.9%), in particularly to be cyberbullied (22.0% vs. 10.8%), while boys are only more likely to report exclusive school bullying (12.2% vs. 9.2%). Reports of 2-week sadness and all suicidality items were highest among teens reporting both forms of bullying, followed by those reporting cyberbullying only, followed by those reporting school bullying only. For example, among those reporting not being bullied 4.6% reported having made a suicide attempt, compared to 9.5% of those reporting school bullying only (adjusted odd ratio (AOR) 2.3, 95% C.I. 1.8-2.9), 14.7% of those reporting cyberbullying only (AOR 3.5 (2.6-4.7)), and 21.1% of those reporting victimization of both types of bullying (AOR 5.6 (4.4-7)). Bullying victimization, in school, cyber, or both, is associated with higher risk of sadness and suicidality among teens. Interventions to prevent school bullying as well as cyberbullying are needed. When caring for teens reporting being bullied, either at school or in cyberbullying, it's important to screen for depression and suicidality.
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Cyber and Traditional Bullying Victimization as a Risk Factor for Mental Health Problems and Suicidal Ideation in Adolescents
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To examine whether traditional and cyber bullying victimization were associated with adolescent's mental health problems and suicidal ideation at two-year follow-up. Gender differences were explored to determine whether bullying affects boys and girls differently. A two-year longitudinal study was conducted among first-year secondary school students (N = 3181). Traditional and cyber bullying victimization were assessed at baseline, whereas mental health status and suicidal ideation were assessed at baseline and follow-up by means of self-report questionnaires. Logistic regression analyses were conducted to assess associations between these variables while controlling for baseline problems. Additionally, we tested whether gender differences in mental health and suicidal ideation were present for the two types of bullying. There was a significant interaction between gender and traditional bullying victimization and between gender and cyber bullying victimization on mental health problems. Among boys, traditional and cyber bullying victimization were not related to mental health problems after controlling for baseline mental health. Among girls, both traditional and cyber bullying victimization were associated with mental health problems after controlling for baseline mental health. No significant interaction between gender and traditional or cyber bullying victimization on suicidal ideation was found. Traditional bullying victimization was associated with suicidal ideation, whereas cyber bullying victimization was not associated with suicidal ideation after controlling for baseline suicidal ideation. Traditional bullying victimization is associated with an increased risk of suicidal ideation, whereas traditional, as well as cyber bullying victimization is associated with an increased risk of mental health problems among girls. These findings stress the importance of programs aimed at reducing bullying behavior, especially because early-onset mental health problems may pose a risk for the development of psychiatric disorders in adulthood.
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Association of Being Bullied in School With Suicide Ideation and Planning Among Rural Middle School Adolescents
Article
  • Nov 2014
  • J SCHOOL HEALTH
BACKGROUND This study examined the association of ever being bullied in school with suicide ideation (ever thinking about killing oneself) and ever seriously making a plan to kill oneself (suicide planning) among rural middle school adolescents.METHODS Using the US Centers for Disease Control and Prevention's Middle School Youth Risk Behavior Survey instrument, 2 cross-sectional surveys were conducted among middle school adolescents (N = 1082) in a rural Appalachian county in Ohio in 2009 and 2012. Multivariable logistic regression models assessed the relationship of ever being bullied in school with suicide ideation and planning.RESULTSOverall, a total of 468 participants (43.1%) reported ever being bullied in school, and 22.3% and 13.2% of the adolescents surveyed reported suicide ideation and planning, respectively. In the multivariable analyses, ever being bullied in school was significantly associated with both suicide ideation (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.7-3.5) and planning (OR = 2.5; 95% CI: 1.6-3.8).CONCLUSIONS The results show a strong association between being bullied in school and suicide ideation and planning among rural middle school adolescents. Prevention of bullying in school as early as in middle school should be a strategy for reducing suicide ideation and planning among adolescents.
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