Association of common health symptoms with bullying in primary school children

A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

OBJECTIVES

We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation.

METHODS

We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities.

RESULTS

Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s.

CONCLUSIONS

The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.

Sleep, emotional and behavioral difficulties in children and adolescents

Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties.

Peer victimization as reported by children, teachers, and parents in relation to children's health symptoms

BACKGROUND

Victims of bullying in school may experience health problems later in life. We have assessed the prevalence of children's health symptoms according to whether peer victimization was reported by the children, by their teachers, or by their parents.

METHODS

In a cross-sectional study of 419 children in grades 1-10 the frequency of peer victimization was reported by children, teachers and parents. Emotional and somatic symptoms (sadness, anxiety, stomach ache, and headache) were reported by the children.Frequencies of victimization reported by different informants were compared by the marginal homogeneity test for paired ordinal data, concordance between informants by cross-tables and Spearman's rho, and associations of victimization with health symptoms were estimated by logistic regression.

RESULTS

The concordance of peer victimization reported by children, teachers, and parents varied from complete agreement to complete discordance also for the highest frequency (weekly/daily) of victimization. Children's self-reported frequency of victimization was strongly and positively associated with their reports of emotional and somatic symptoms. Frequency of victimization reported by teachers or parents showed similar but weaker associations with the children's health symptoms.

CONCLUSION

The agreement between children and significant adults in reporting peer victimization was low to moderate, and the associations of reported victimization with the children's self-reported health symptoms varied substantially between informants. It may be useful to assess prospectively the effects of employing different sources of information related to peer victimization.

Bullying among school children: prevalence and association with common symptoms in childhood

OBJECTIVE

To estimate the prevalence of bullying among girls and boys in school and examine its association with psychological and psychosomatic symptoms.

METHODS

500 students aged between 8-14 yrs from 5 randomly selected schools as well as their parents and teachers were interviewed using a pretested questionnaire.

RESULTS

Bullying was reported by 302(60.4%) of the 500 children interviewed. Bullying was seen to be more prevalent among boys than girls, the commonest forms being calling names and making fun of one's looks. Physical abuse was reported by 38 students. Only 65 (39%) parents knew that their children were being bullied. Bullied children were more likely to report symptoms such as headache, loose motions, fever and depression. Teachers were found to be ignorant of the whole issue.

CONCLUSIONS

Bullying is a major problem among school children. Bullied children complained of psychosomatic symptoms which are potentially harmful for development. Teachers must be adequately trained to tackle this problem. Pediatricians should always consider bullying as a causative agent for illness and plan for appropriate interventions.

Stability of early identified aggressive victim status in elementary school and associations with later mental health problems and functional impairments

Aggressive victims-children who are both perpetrators and victims of peer aggression-experience greater concurrent mental health problems and impairments than children who are only aggressive or only victimized. The stability of early identified aggressive victim status has not been evaluated due to the fact that most studies of aggressor/victim subgroups have focused on preadolescents and/or adolescents. Further, whether children who exhibit early and persistent patterns of aggression and victimization continue to experience greater mental health problems and functional impairments through the transition to adolescence is not known. This study followed 344 children (180 girls) previously identified as socially adjusted, victims, aggressors, or aggressive victims at Grade 1 (Burk et al. 2008) to investigate their involvement in peer bullying through Grade 5. The children, their mothers, and teachers reported on children's involvement in peer aggression and victimization at Grades 1, 3, and 5; and reported on internalizing symptoms, externalizing symptoms, inattention and impulsivity, as well as academic functioning, physical health, and service use at Grades 5, 7, and 9. Most children categorized as aggressive victims in Grade 1 continued to be significantly involved in peer bullying across elementary school. Children with recurrent aggressive victim status exhibited higher levels of some mental health problems and greater school impairments across the adolescent transition when compared to other longitudinal peer status groups. This study suggests screening for aggressive victim status at Grade 1 is potentially beneficial. Further early interventions may need to be carefully tailored to prevent and/or attenuate later psychological, academic, and physical health problems.

Peer and teacher bullying/victimization of South Australian secondary school students: Prevalence and psychosocial profiles

This study examined the nature and prevalence of bullying/victimization by peers and teachers reported by 1,284 students (mean age = 15.2 years) drawn from a representative sample of 25 South Australian government and private schools. Students completed a self-report survey containing questions relating to teacher and peer-related bullying, measures of psychosocial adjustment, and personality. The results showed that students could be clearly differentiated according to the type of victimization they had experienced. Students reporting peer victimization typically showed high levels of social alienation, poorer psychological functioning, and poorer self-esteem and self-image. By contrast, victims of teacher victimization were more likely to be rated as less able academically, had less intention to complete school and were more likely to be engaged in high-risk behaviours such as gambling, drug use and under-age drinking. Most bullying was found to occur at school rather than outside school and involved verbal aggression rather than physical harm. Boys were significantly more likely to be bullied than girls, with the highest rates being observed amongst boys attending single-sex government schools. Girls were more likely to be subject to bullying if they attended coeducational private schools. The implications of this work for enhancing school-retention rates and addressing psychological distress amongst adolescent students are discussed.

Peer victimization and depression in early-mid adolescence: A longitudinal study

BACKGROUND

Despite considerable evidence for psychological distress among children and young people who experience peer victimization, cross-sectional studies cannot determine the direction of the relationship. Several recent studies have examined associations between victimization and distress. The majority find evidence for both directions but do not arbitrate between them; only one prior study has attempted to do this.

AIMS

To use longitudinal data to: (1) test competing hypotheses about the direction of the victimization-depression association; (2) investigate gender differences in the resulting models.

SAMPLE

Data were obtained from a Scottish school-based cohort (N=2,586).

METHODS

Self-completion questionnaires included a depression scale and questions on victimization at each age.

RESULTS

Despite shifts in and out of victim status, there was evidence of stability in both victimization and depression. Bivariate analyses showed positive relationships between victimization and depression. Structural equation modelling (SEM) showed that at age 13, this relationship was reciprocal, with a stronger path from victimization to depression than vice versa. However, at age 15, it was almost entirely due to a path from depression to victimization among boys. Models including cross-lagged paths fitted the data less well than those including simultaneous associations.

CONCLUSIONS

Current policy focuses on victimization as a cause of distress; however, professionals should be aware that vulnerable children and young people are likely to be the targets of victimization.

Negative school perceptions and involvement in school bullying: a universal relationship across 40 countries

Cross-national analyses explore the consistency of the relationship between negative school experiences and involvement in bullying across 40 European and North American countries, using the 2006 (40 countries n = 197,502) and 2002 (12 countries, n = 57,007) WHO-HBSC surveys. Measures include two Cumulative Negative School Perception (CNSP) scales, one based on 6 mandatory items (2006) and another including an additional 11 items (2002). Outcome measures included bullying perpetration, victimization and involvement as both bully and victim. Logistic regression analyses suggested that children with only 2-3 negative school perceptions, experience twice the relative odds of being involved in bullying as compared with children with no negative school perceptions. Odds Ratios (p < 0.001) increase in a graded fashion according to the CNSP, from about 2.2 to over 8.0. Similar consistent effects are found across gender and almost all countries. Further research should focus on the mechanisms and social context of these relationships.

The relationship between anxiety disorders in adults and recalled childhood teasing

This study investigated the relationship between retrospective accounts of childhood teasing and anxiety disorders as well as the relationship between experiences of teasing and more global psychological well-being. Participants (N=377) with social anxiety disorder (SAD), obsessive compulsive disorder (OCD), or panic disorder with or without agoraphobia (PD) were compared on levels of self-reported teasing history using the Teasing Questionnaire-Revised (TQ-R; Storch et al., 2004). Teasing frequency scores were higher for the SAD group compared to both PD and OCD groups. Across all groups, teasing scores were significantly related to increased social anxiety, depression, stress, and greater impairment in functioning. Teasing frequency accounted for unique variance in severity of SAD symptoms even after controlling for concurrent mood, anxiety and stress. These results support and extend previous findings linking childhood teasing to anxiety disorders in adulthood.

Virtual learning intervention to reduce bullying victimization in primary school: a controlled trial

BACKGROUND

Anti-bullying interventions to date have shown limited success in reducing victimization and have rarely been evaluated using a controlled trial design. This study examined the effects of the FearNot! anti-bullying virtual learning intervention on escaping victimization, and reducing overall victimization rates among primary school students using a nonrandomized controlled trial design. The program was designed to enhance the coping skills of children who are known to be, or are likely to be, victimized.

METHODS

One thousand, one hundred twenty-nine children (mean age 8.9 years) in 27 primary schools across the UK and Germany were assigned to the FearNot! intervention or the waiting control condition. The program consisted of three sessions, each lasting approximately 30 minutes over a three-week period. The participants were assessed on self-report measures of victimization before and one and four weeks after the intervention or the normal curriculum period.

RESULTS

In the combined sample, baseline victims in the intervention group were more likely to escape victimization at the first follow-up compared with baseline victims in the control group (adjusted RR, 1.41; 95% CI, 1.02-1.81). A dose-response relationship between the amount of active interaction with the virtual victims and escaping victimization was found (adjusted OR, 1.09; 95% CI, 1.003-1.18). Subsample analyses found a significant effect on escaping victimization only to hold for UK children (adjusted RR, 1.90; CI, 1.23-2.57). UK children in the intervention group experienced decreased victimization rates at the first follow-up compared with controls, even after adjusting for baseline victimization, gender and age (adjusted RR, .60; 95% CI, .36-.93).

CONCLUSIONS

A virtual learning intervention designed to help children experience effective strategies for dealing with bullying had a short-term effect on escaping victimization for a priori identified victims, and a short-term overall prevention effect for UK children.

Does school bullying affect adult health? Population survey of health-related quality of life and past victimization

OBJECTIVE

The purpose of the present study was to determine the proportion of adult South Australians who report having experienced school bullying and to examine the relationship between past victimization and adult health-related quality of life.

METHOD

A representative sample (n=2833) of metropolitan and country South Australian adults were asked in a face-to-face interview whether they had experienced bullying when they were at school. Health-related quality of life was measured using the Medical Outcomes Study Short Form 36-item health survey questions (SF-36). Regression analyses (linear and logistic) were performed, taking into account survey weights.

RESULTS

Nearly one-fifth of adults reported having experienced bullying when they were at school. Older persons and those born overseas were less likely to report having been bullied. Those reporting that they had been bullied experienced significantly poorer mental and physical health compared to those who had not been bullied.

CONCLUSIONS

Adults commonly reported experiencing bullying while at school and these reports were associated with lower health-related quality of life in adulthood. School bullying needs further investigation as a preventable cause of mental health problems across the lifespan.

Victimization by peers and adolescent suicide in three US samples

OBJECTIVE

To investigate the association between victimization by peers and suicidal ideation and behavior in 3 samples of adolescents in the United States.

STUDY DESIGN

This study was a secondary analysis of data from 3 cohorts of adolescents: (1) a nationally representative survey of adolescents in grade 7 through 12, Wave I of the National Longitudinal Study of Adolescent Health, conducted by the Carolina Population Center in 1994-1995; (2) a nationally representative survey, the Youth Risk Behavior Surveillance System, conducted by the Centers for Disease Control and Prevention in 2005; and (3) a survey in a high-risk community conducted by the Centers for Disease Control and Prevention in 2004.

RESULTS

Controlling for differences in age, sex, race/ethnicity, and depressive symptomology, adolescents reporting more frequent victimization by peers were more likely to report suicidal ideation and suicidal behavior. Adjusted odds ratios ranged from 1.67 (95% confidence interval [CI] = 1.30-2.15) to 3.83 (95% CI = 2.78-5.27) for the different outcome measures and data sets.

CONCLUSIONS

Our results provide further support for the need for effective prevention of peer victimization. Inclusion of questions about victimization experiences might aid formal and informal suicide screening efforts.

Social support, peer victimisation, and somatic complaints: a mediational analysis

AIM

This study investigated the associations among social support, peer victimisation and somatic problems in children and adolescents. Specifically, we tested a model that posited a mediational role of peer victimisation on the association between low social support and somatic symptoms in three age groups.

METHODS

A total of 1570 Italian children and adolescents aged 9 to 15 years participated in this study during Winter 2006. Students completed self-report measures of perceived social support, somatic complaints and peer victimisation. A series of regression analyses were used to test the hypothesised mediational model.

RESULTS

Age differences emerged for somatic complaints and peer victimisation, with primary school children reporting more somatic problems and victimisation experiences than older participants. Three series of regression analyses, performed separately for the three age groups, confirmed the mediational model. Low levels of social support received by peers were associated with more reported somatic complaints and more peer victimisation. When victimisation was entered as the mediator variable in the last regression equation, the association between social support and somatic problems was non-significant.

CONCLUSIONS

In our sample, social support was negatively associated with somatic complaints. In all age groups, this association was completely mediated by peer victimisation experiences. These findings may suggest the importance of using targeted screening and interventions to address peer victimisation and its negative consequences on children's and adolescents' health.

School, neighborhood, and family factors are associated with children's bullying involvement: a nationally representative longitudinal study

OBJECTIVE

To test whether school, neighborhood, and family factors are independently associated with children's involvement in bullying, over and above their own behaviors that may increase their risk for becoming involved in bullying.

METHOD

We examined bullying in the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative 1994-1995 birth cohort of 2,232 children. We used mother and teacher reports to identify children who experienced bullying between the ages of 5 and 7 years either as victims, bullies, or bully-victims. We collected information about school characteristics from the Department for Children, Schools and Families. We collected reports from mothers about children's neighborhood and home environments and reports from mothers and teachers about children's internalizing and externalizing problems when they were 5 years old.

RESULTS

Multinomial logistic regressions showed that over and above other socioenvironmental factors and children's behavior problems, school size was associated with an increased risk for being a victim of bullying, problems with neighbors was associated with an increased risk for being a bully-victim, and family factors (e.g., child maltreatment, domestic violence) were associated with all groups of children involved in bullying.

CONCLUSIONS

Socioenvironmental factors are associated with children's risk for becoming involved in bullying over and above their own behaviors. Intervention programs aimed at reducing bullying should extend their focus beyond schools to include local communities and families.

Wohlbefindensforschung im Kindes- und Jugendalter

Zusammenfassung. In diesem Beitrag werden einführend die Konstrukte subjektives Wohlbefinden und gesundheitsbezogene Lebensqualität näher beleuchtet. Des Weiteren wird ein Überblick über Korrelate des Wohlbefindens gegeben. Unter Berücksichtigung der Entwicklungsdynamik sowie von Alters- und Geschlechtsunterschieden wird die Bedeutung sozialer Beziehungen für Wohlbefinden bzw. Wohlbefindensbeeinträchtigungen aufgezeigt. Thematisiert werden zudem Zusammenhänge zwischen dem sich entwickelnden Körperkonzept und dem Wohlbefinden. Auffällig ist die gesteigerte Unzufriedenheit mit Gewicht und Figur, die sich bei weiblichen Heranwachsenden zeigt. Auch im Zusammenhang mit Risikoverhaltensweisen wie Alkohol- und Nikotinkonsum, die gehäuft im Jugendalter in Erscheinung treten, werden Konsequenzen für das Wohlbefinden aufgezeigt. Abschließend werden entwicklungsbezogene Prinzipien vorgestellt, welche bezüglich der Erarbeitung von Präventions- und Gesundheitsförderungsmaßnahmen in Kindheit und Jugend Berücksichtigung finden sollten.

Approach to bullying and victimization

OBJECTIVE

To review the epidemiology, identification, and management of bullying and victimization among children in the primary care setting.

SOURCES OF INFORMATION

Information was obtained from PsycINFO and MEDLINE databases, as well as the authors' own clinical and research experience. Information is based on levels II and III evidence.

MAIN MESSAGE

Involvement in bullying is a destructive relationship problem, with important health implications. Physicians need to be aware of the physical and psychosocial symptoms commonly associated with involvement in bullying so that they can screen and identify those children involved. This article presents a review of bullying and associated symptoms, a tool for assessing bullying involvement, and an overview of intervention and management.

CONCLUSION

Bullying is a substantial problem affecting Canadian children. With an increased awareness and understanding of bullying as a health problem, physicians can play an instrumental role in identifying children involved in bullying and providing them with the support needed to develop healthy relationships.

Mental and somatic health complaints associated with school bullying between 10th and 12th grade students; results from cross sectional studies in Oslo, Norway

BACKGROUND

Bullying is a widespread and serious problem that might influence both mental and psychical well being as well as school performance and social life. The aim of this study was to describe the prevalence of bullying, mental health problems and psychical complaints among 10th and 12th grade students and to analyze the association between bullying, mental health problems and muscle and skeletal complaints.

METHODS

Two cross sectional studies of adolescents living in Oslo, Norway the first conducted in 2001 among 10th grade students (15/16 years old) and the second in 2004 among 12th grade students (18/19 years old). Both surveys were based on self report, were mostly school based and had almost identical questionnaires. There were around 3700 participants in both surveys, but the participation rate was lower in the latter survey (88 versus 80%). The Hopkins Symptoms Check List (HSCL-10) and the Strength and Difficulties Questionnaire (SDQ) were used to measure mental health problems.

RESULTS

Bullying is decreasing both among boys and girls while the prevalence of internalized mental health problems are increasing from 10th to 12th grade. For muscle and skeletal pain there is a diverging trend between boys and girls, with an increase among girls and a decrease among boys. The highest Odds Ratios, as a measure for the association between bullying, mental health problems and pain, were found for internalized mental health problems at both 10th and 12th grade both for boys and girls.

CONCLUSION

Both internalized and externalized mental health problems together with pain seem to be associated with bullying irrespective of school type and gender.

Socioeconomic inequality in exposure to bullying during adolescence: a comparative, cross-sectional, multilevel study in 35 countries

OBJECTIVES

We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment.

METHODS

We used an international survey of 162,305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001-2002 school year. The survey used standardized measures of exposure to bullying and socioeconomic affluence.

RESULTS

Adolescents from families of low affluence reported higher prevalence of being victims of bullying (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10, 1.16). International differences in prevalence of exposure to bullying were not associated with the economic level of the country (as measured by gross national income) or the school, but wide disparities in affluence at a school and large economic inequality (as measured by the Gini coefficient) at the national level were associated with an increased prevalence of exposure to bullying.

CONCLUSIONS

There is socioeconomic inequality in exposure to bullying among adolescents, leaving children of greater socioeconomic disadvantage at higher risk of victimization. Adolescents who attend schools and live in countries where socioeconomic differences are larger are at higher risk of being bullied.

Association between bullying and psychosomatic problems: a meta-analysis

CONTEXT

In the last few years, there has been an increasing amount of research showing the concurrent and long-term consequences of bullying and being bullied by peers. OBJECTIVE. We performed a meta-analysis to quantify the association between involvement in bullying and psychosomatic complaints in the school-aged population.

METHODS

We searched online databases (Embase, Medline, PsychInfo, Scopus) up to March 2008, bibliographies of existing studies, and qualitative reviews for studies that examined the association between involvement in bullying and psychosomatic complaints in children and adolescents. The original search identified 19 studies, of which 11 satisfied prestated inclusion criteria.

RESULTS

Three random-effects meta-analyses were performed for the following 3 groups of children aged between 7 and 16 years: victims, bullies, and bully-victims. Bully-victims, victims, and bullies had a significantly higher risk for psychosomatic problems compared with uninvolved peers.

CONCLUSIONS

The association between involvement in bullying and psychosomatic problems was demonstrated. Given that school bullying is a widespread phenomenon in many countries around the world, the present results suggest that bullying be considered a significant international public health issue.

Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

BACKGROUND

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.

OBJECTIVES

To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children.

SEARCH STRATEGY

The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched . Where appropriate, search filters were employed. Researchers working in this area were asked to identify relevant studies.

SELECTION CRITERIA

Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis.

MAIN RESULTS

Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.26 (0.25, 6.29). Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial. Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21).

AUTHORS' CONCLUSIONS

There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

Victimization and bullying among 8-year-old Finnish children: a 10-year comparison of rates

OBJECTIVE

There are only few population-based time-trend studies on changes in prevalence of bullying and victimization among children. The main aim of this study was to find out whether changes have occurred in prevalence rates of bullying and victimization from 1989 to 1999 among eight-year-old children. The associations between victimization and bullying and psychiatric symptoms and their possible differences in the statistical strengths of associations between the years 1989 and 1999 were also studied.

METHOD

Two cross-sectional, representative samples from southern Finland were compared. All children born in 1981 (1989 sample, n = 985, response rate 95%) and 1991 (1999 sample, n = 962, response rate 86%) and living in the selected school district were included in the study samples. Children, parents and teachers were asked about bullying and victimization. The Children's Depression Inventory and Rutter's parent and teacher scales were used to study psychiatric symptoms.

RESULTS

In 1999, fewer 8-year-old children were victims of bullying than in 1989. There was a decrease in the number of bullies but the change was statistically significant only in the parental reports. The statistical strengths of associations of victimization and bullying with psychiatric symptoms were mainly the same in 1989 as in 1999.

CONCLUSIONS

Slightly decreased levels of victimization among 8-year-old Finnish children is a promising result, but further time-trend studies are needed, as well as qualitative studies, to obtain a deeper understanding of the bullying phenomenon and the factors reducing it. It might be that especially young children are suspectible to influences diminishing victimisation and bullying.

Bullying victimization among 13 to 15-year-old school children: results from two comparative studies in 66 countries and regions

AIM

to examine the prevalence of bullying victimization in 66 countries and territories from five continents based on data from two large international surveys: the 2001/2 Health Behavior in School-aged Children survey (HBSC) and the Global School-based Students Health Survey (GSHS). The surveys provide nationally representative, cross-sectional information on 13-15-year-old school children (N = 218,104).

OUTCOME MEASURES

Bullying victimization, once or more within the past 2 months (HBSC)/30 days (GSHS).

RESULTS

On average, 32.1% of the children were bullied at school at least once within the past 2 months in countries involved in the HBSC study and 37.4% of children were bullied at least one day within the past 30 days in countries involved in the GSHS study. In both surveys, a large variation in prevalence was found across countries. The lowest prevalence in the GSHS survey was observed in Tajikistan (7.1% for both boys and girls) and among HBSC countries in Sweden (16.0% for boys and 14.6% for girls) and the Czech Republic (17.1% for boys and 14.2% for girls). The highest prevalence for boys in the GSHS survey was found in Zimbabwe (Bulawayo) (70.2%) and for girls in Zambia (67.1%). In the HBSC survey, Lithuania had the highest prevalence of bullying victimization (62.7% for boys and 64.4% for girls).

CONCLUSION

Victimization to bullying violates the fundamental rights of children; our study suggests that although many countries signed the United Nations Convention on the Rights of the Child, many have to work harder to fulfill the goals of the Convention.

Bullying and suicide. A review

Being a victim or perpetrator of school bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems. Suicide is third leading cause of mortality in children and adolescent in the United States of America and around the world. This paper provides a systematic review of the previous 37 studies conducted in children and adolescents from communities, as well as in special populations that examined the association between bullying experiences and suicide, with an emphasis on the strengths and limitations of the study designs. Despite methodological and other differences and limitations, it is increasingly clear that any participation in bullying increases the risk of suicidal ideations and/or behaviors in a broad spectrum of youth.

Associations between bullying behaviour, psychosomatic complaints, emotional and behavioural problems

OBJECTIVE

Bullying or being bullied have been demonstrated to be related to a broad spectrum of behavioural, emotional and social problems. The present study aimed at analysing psychosomatic, emotional and behavioural problems among Italian bullies, victims and bully victims.

STUDY DESIGN

In a cross-sectional study, 565 primary-school children completed self-reported measures for bullying, victimisation and psychosomatic complaints. Teachers rated each child on the Strengths and Difficulties Questionnaire.

RESULTS

Within our sample, 11.2% of children were classified as bullies, 7.1% were classified as victims and 10.4% were classified as bully victims. Compared with the students who were not involved in bullying, victims had a higher risk for conduct problems (2.43 (1.18-5.03)), hyperactivity (2.41 (1.05-5.53)) and problems with peers (4.40 (2.08-9.33)). Bully victims had a higher risk for conduct problems (2.41 (1.28-4.54) and hyperactivity (2.58 (1.25-5.32)). Finally, bullies had higher risk for hyperactivity (2.06 (1.01-4.21)). All groups of children also had a higher risk for several psychosomatic symptoms than uninvolved children.

CONCLUSIONS

Children involved in bullying as victims and bully victims had significantly higher risk for psychosomatic problems and psychosocial maladjustment than uninvolved children, whereas bullies manifested the fewest number of adjustment problems. When addressing bullying in a school community, particular care should be devoted to the identification and help of children who are involved as victims or bully victims.

Primary headache in Italian early adolescents: the role of perceived teacher unfairness

BACKGROUND

The impact of perceived teacher unfairness on headache incidence has previously been insufficiently investigated.

OBJECTIVE

The aims of the study are to analyze the prevalence of headache among Italian early adolescents as well as to examine the role of perceived teacher unfairness and classmate social support in predicting this health outcome.

METHODS

Data were taken from the "Health Behaviour in School Aged Children," a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. Headache, perceived teacher unfairness, and classmate social support were measured through a self-administered questionnaire filled out by a representative sample of 4386 (48.4% males) Italian students (11, 13, and 15 years old). Covariates included demographic characteristics (age, gender) and socioeconomic status (parental educational attainment), and other confounding psychological factors (eg, family empowerment, bullying).

RESULTS

Prevalence of frequent headaches (at least once a week) was about 40%. Girls were more likely to report frequent headaches compared with boys. Prevalence of frequent headaches increased with age. After adjusting for age and gender, teacher unfairness showed a significant association with frequent headache (P < .001). This relationship remained significant even after additional adjustment for several psychosocial factors. Classmate social support seems to act as a protective factor, but not as a buffering mechanism against the negative effects of teacher unfairness.

CONCLUSIONS

Italian early adolescents show a quite high prevalence of frequent headache. Results show that characteristics of the school setting, such as teacher unfairness and classmate social support, can be significant predictors of frequent headache among early adolescents. Longitudinal research is needed to delineate causal relationships between school factors and recurrent headache.

Peer rejection and physical health problems in early adolescence

OBJECTIVE

Rejection from the peer group may constitute an important source of stress that may weaken children's immune system and leave them vulnerable to infection and physical illness. Controlling for family adversity and depressed mood, this study examined the predictive link between peer rejection and physical health problems, as well as the putative moderating effect of adolescents' reactivity/emotional negativity in this context.

METHOD

A total of 122 high school students (50% girls) were assessed over two consecutive years in grades 7 (time [T] 1) and 8 (time [T] 2). More than 90% of the participants were white and French speaking and were from average socioeconomic backgrounds. Physical health problems at T1 and T2 as well as depression symptoms at T1 were assessed using adolescent self-reports. Peer rejection at T1 was assessed through peer nominations. Reactivity/negative emotionality at T1 was assessed via teacher ratings. Family adversity at T1 was assessed via mother reports.

RESULTS

Peer rejection at T1 predicted an increase in physical health problems from T1 to T2, even when controlling for physical health problems and depression symptoms at T1. This result, however, was only true for girls with moderate or high levels of reactivity/negative emotionality. For boys, peer rejection was unrelated to change in physical health problems.

CONCLUSIONS

The present findings are in line with the diathesis stress model of disease and emphasize the need for health education programs that specifically target girls and that foster problem-solving skills to help vulnerable adolescents cope more effectively with peer conflict.

Variation in hypothalamic-pituitary-adrenal axis activity among bullied and non-bullied children

We examined the relationship between being bullied during childhood and activity of the hypothalamic-pituitary-adrenal (HPA) axis as assessed through repeated measures of salivary cortisol. A non-clinical sample of 154 (74 boys) predominantly Caucasian middle-class 12-year-olds each provided detailed information about their experiences with bullying and six saliva samples were standardized across time and day. Children with a history of child maltreatment, diagnosed psychiatric illness, foster care placement, medication use (psychotropic and oral contraception) and aggression directed toward peers and/or family members were excluded. Using multilevel regression and applying orthogonal polynomial contrasts to model the observed circadian pattern in the data, we found that occasional and frequent verbal peer victimization was associated with hyposecretion of cortisol when controlling for sex, pubertal status, age, depression and anxiety. This relation, however, was moderated by sex. For boys, occasional exposure was associated with higher cortisol levels, whereas for girls exposure was associated with lower cortisol levels. The present study highlights the need to consider the plight of peer-victimized children seriously, as it is associated with alterations to the HPA axis that affect males and females differently, and likely diminishes a person's ability to cope with stress, possibly placing them at risk for psychopathology and ill health.

Peer victimization, depression, and suicidiality in adolescents

The association between specific types of peer victimization with depression, suicidal ideation, and suicide attempts among adolescents was examined. A self-report survey was completed by 2,342 high-school students. Regression analyses indicated that frequent exposure to all types of peer victimization was related to high risk of depression, ideation, and attempts compared to students not victimized. Infrequent victimization was also related to increased risk, particularly among females. The more types of victimization the higher the risk for depression and suicidality among both genders. Specific types of peer victimization are a potential risk factor for adolescent depression and suicidality. It is important to assess depression and suicidality among victimized students in order to develop appropriate intervention methods.

Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

BACKGROUND

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority no organic cause for their pain can be found on physical examination or investigation and although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.

OBJECTIVES

To determine the effectiveness of medication for recurrent abdominal pain in school-age children.

SEARCH STRATEGY

The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters

SELECTION CRITERIA

Studies on school age children with RAP (Apley or the Rome II criteria for gastrointestinal diseases) allocated by random or quasi-random methods to a drug treatment vs. placebo/ no treatment were included.

DATA COLLECTION AND ANALYSIS

References identified by the searches were screened against the inclusion criteria by two independent reviewers. Data was extracted and analysed using RevMan 4.2.10.

MAIN RESULTS

Three trials met the inclusion criteria. Symon et al report a cross-over trial comparing pizotifen and placebo in 16 children with "abdominal migraine". Data before cross-over was not available. Results for 14 children showed Mean fewer days in pain of 8.21 (95% CI 2.93, 13.48) while taking the active drug. Kline et al compared peppermint oil capsules with placebo in a randomised trial in 50 children with RAP and IBS. 42 children completed the study. OR for improvement was 3.33 (95% CI 0.93-12.1)See et al compared famotidine with placebo in a randomised cross-over trial in 25 children with RAP and dyspepsia. OR for improvement before cross-over was 11 (95%CI 1.6, 75.5).

AUTHORS' CONCLUSIONS

This review provides weak evidence of benefit on medication in children with RAP. The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials. Clinicians may choose to prescribe drugs in children with severe symptoms that have not responded to simple management. However, if using drugs as a "therapeutic trial", clinicians should be aware that, RAP is a fluctuating condition and any "response" may reflect the natural history of the condition or a placebo effect rather than drug efficacy.

Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

BACKGROUND

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.

OBJECTIVES

To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children.

SEARCH STRATEGY

The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched . Where appropriate, search filters were employed. In addition, researchers working in this area were asked to identify relevant studies.

SELECTION CRITERIA

Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis.

MAIN RESULTS

Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.16 (95% CI 0.45-2.87). Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial. Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21).

AUTHORS' CONCLUSIONS

There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

BACKGROUND

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended.

OBJECTIVES

To determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children.

SEARCH STRATEGY

The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters.

SELECTION CRITERIA

Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected.

DATA COLLECTION AND ANALYSIS

References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10.

MAIN RESULTS

Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data.

AUTHORS' CONCLUSIONS

The included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.

Bullying and school safety

OBJECTIVE

To identify an association between involvement in bullying and problems in school.

STUDY DESIGN

This was a cross-sectional study of 5391 students in grades 7, 9, and 11 in an urban public school district. The main outcome measure was involvement in bullying. Secondary outcomes included attendance, grade point average, psychosocial distress, and perceived acceptability of carrying guns to school.

RESULTS

Of the 5391 children surveyed, 26% were involved in bullying either as victim, bully, or both (bully-victim). All 3 groups were significantly more likely than bystanders to feel unsafe at school and sad most days. Victims and bully-victims were more likely to say they are "no good." Victims were more likely to feel that they "do not belong" in their school. The odds of being a victim (vs a bystander) were 10% lower for every 1 point increase in grade point average. Bully-victims were more likely to say that it is "not wrong" to take a gun to school.

CONCLUSIONS

Associations between involvement in bullying and academic achievement, psychological distress, and the belief that it is not wrong to take a gun to school reinforce the notion that school environment is interrelated with mental health and school success.

Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark

OBJECTIVE

The goal was to examine whether being a victim of bullying was associated with medicine use, taking into account the increased prevalence of physical and psychological symptoms.

METHODS

The study population included all students in grades 5, 7, and 9 (mean ages: 11.6, 13.6, and 15.6 years, respectively) in a random sample of schools in Denmark (participation rate: 88.5%; N = 5205). The students reported health problems, medicine use, bullying, and a range of psychosocial conditions in an anonymous standardized questionnaire. The outcome measure was self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness. The determinant was frequency of exposure to bullying, measured with 1 item.

RESULTS

In multivariate models adjusted for age and social class, we found that adolescent victims of bullying used medicine for pains and psychological problems more often than did adolescents who were not bullied. The increased odds of using medicine were not explained by the higher prevalence of symptoms among the bullied children.

CONCLUSIONS

We found victimization from bullying to be associated with medicine use, even when we controlled for the higher prevalence of symptoms among bullied victims. The medications that adolescents use can have adverse effects, in addition to the potentially health-damaging effects of bullying. Policy makers, health care professionals, and school staff should be aware that the adolescent victims of bullying are prone to excess use of medicine, and preventive actions should be taken to decrease the level of bullying as well as the use of medicine among adolescents.

Intra- and extra-familial adverse childhood experiences and a history of childhood psychosomatic disorders among Japanese university students

Background

Japan has been witnessing a considerable increase in the number of children with psychosomatic disorders. The purpose of this study is to examine the relationship between the risk of psychosomatic disorder in adolescents and intra- and extra-familial adverse childhood experiences (ACEs).

Methods

A retrospective cohort study of 1592 Japanese university students (52% male, mean age 19.9 years) who completed a survey about intra- and extra-familial ACEs and the incidence of childhood psychosomatic disorders. Intra-familial ACEs included domestic violence, physical violence, emotional abuse, illness in household, parental divorce, no parental affection, and dysfunctional family. Extra-familial ACEs included physical violence or negative recognition by teachers, being bullied in elementary or junior high school, or sexual violence.

Results

The frequency of psychosomatic disorders among the respondents was 14.8%. Among the 7 intra-familial ACEs, emotional abuse (relative risk, RR = 1.9) and illness in household (RR = 1.7) increased the risk of psychosomatic disorders. Estimates of the relative risk for the 5 extra-familial ACEs were statistically significant and ranged from 1.5 for being bullied in elementary school or physical violence from teachers to 2.4. Students who had 3 or more intra-familial ACEs and 2 or more extra-familial ACEs had a 3.0 relative risk for psychosomatic disorder.

Conclusion

These results suggest that intra- and extra-familial ACEs are associated with the development of psychosomatic disorders. Therefore, sufficient evaluation of ACEs should be performed in adolescent patients with psychosomatic disorder.

Bullying, depression, and suicidality in adolescents

OBJECTIVE

To assess the association between bullying behavior and depression, suicidal ideation, and suicide attempts among adolescents.

METHOD

A self-report survey was completed by 9th- through 12th-grade students (n = 2342) in six New York State high schools from 2002 through 2004. Regression analyses were conducted to examine the association between being victimized and bullying others with depression, ideation, and attempts.

RESULTS

Approximately 9% of the sample reported being victimized frequently, and 13% reported bullying others frequently. Frequent exposure to victimization or bullying others was related to high risks of depression, ideation, and suicide attempts compared with adolescents not involved in bullying behavior. Infrequent involvement in bullying behavior also was related to increased risk of depression and suicidality, particularly among girls. The findings indicate that both victims and bullies are at high risk and that the most troubled adolescents are those who are both victims and bullies. Psychopathology was associated with bullying behavior both in and away from school.

CONCLUSIONS

Victimization and bullying are potential risk factors for adolescent depression and suicidality. In evaluations of students involved in bullying behavior, it is important to assess depression and suicidality.

A Twin-Study of Sleep Difficulties in School-Aged Children

This study examines frequency, overlap, and genetic and environmental influences on sleep difficulties, which are understudied in school-aged children. The Sleep Self Report and the Children's Sleep Habits Questionnaire were completed by 300 twin pairs (aged 8 years) and their parents. Child report suggested more frequent sleep problems than parent report (e.g., regular sleep onset delay was reported by 45% of children and 17% of parents). Associations between most of the sleep difficulties were small but significant (e.g., r(s)=.16 for parent report of bedtime resistance and sleep onset delay). Twin correlations based on parent reports suggest greater genetic influence (M=50%) than those based on child self-report (M=18%). Possible rater effects should be considered when evaluating children's sleep problems.

Morbidities associated with bullying behaviors in adolescents. School based study of American adolescents

To assess the prevalence of bullying behaviors and morbidities, including overweight/obesity and frequent physical and emotional symptoms, and the associations between such morbidities and frequent involvement in bullying behaviors among US adolescents in grades 6 through 10.

DESIGN, SETTING, AND PARTICIPANTS

This study was based on an analysis of US data from the 1998 World Health Organization Health Behavior in School-aged Children survey. The survey provides nationally representative, cross-sectional survey information on 15,686 US students in grades 6 through 10.

OUTCOME MEASURES

Involvement in bullying as a victim and/or as a bully; body mass index; and self-reported headaches, stomachaches, backaches, dizziness, irritability, "feeling low", "feeling nervous", and sleeping difficulties.

RESULTS

Fifteen per cent of the students were involved in bullying others and/or were victims of bullies at least once a week. The bullying activities took place both at school and elsewhere. Students who suffered from at least one or more frequent physical or emotional symtom, occuring several times a week, were at 2.4 to 3.5 times more likely to be involved in frequent bullying incidents, as compared to students, who did not experience frequent symptoms.

CONCLUSIONS

The present study confirmed that frequent participation in bullying behaviors, as a bully, a victim, or both, was associated with poor health status. The existence of a morbidity spectrum associated with participation in bullying behaviors is important information for pediatric practice and merits further investigation.

Associations between sleep problems, anxiety, and depression in twins at 8 years of age

OBJECTIVES

Associations between sleep and internalizing problems are complex and poorly understood. To better understand these covarying difficulties, genetic and environmental influences were estimated by using a twin design.

METHODS

Three hundred 8-year-old twin pairs reported on their anxiety and depression by completing the Screen for Childhood Anxiety Related Emotional Disorders and the Children's Depression Inventory. Parents reported on their children's sleep problems by completing the Child Sleep Habits Questionnaire.

RESULTS

Children reported by their parents to have different types of sleep problems self-reported more depression symptoms than those without. The correlation between total sleep-problem score and depression was moderate. That between sleep problems and anxiety was smaller and was not examined further. The association between sleep problems and depression was mainly explained by genes, and there was substantial overlap between the genes influencing sleep problems and those influencing depression. There was smaller influence from environmental factors making family members alike, and environmental factors making family members different decreased the association between sleep problems and depression.

CONCLUSIONS

A range of sleep difficulties are associated with depression in school-aged children, and the overall association between the 2 difficulties may be largely influenced by genes.

Bullying victimization uniquely contributes to adjustment problems in young children: a nationally representative cohort study

OBJECTIVE

It has been shown that bullying victimization is associated with behavior and school adjustment problems, but it remains unclear whether the experience of bullying uniquely contributes to those problems after taking into account preexisting adjustment problems.

METHODS

We examined bullying in the Environmental Risk Study, a nationally representative 1994-1995 birth cohort of 2232 children. We identified children who experienced bullying between the ages of 5 and 7 years either as pure victims or bully/victims. We collected reports from mothers and teachers about children's behavior problems and school adjustment when they were 5 years old and again when they were age 7.

RESULTS

Compared with control children, pure victims showed more internalizing problems and unhappiness at school when they were 5 and 7 years. Girls who were pure victims also showed more externalizing problems than controls. Compared with controls and pure victims, bully/victims showed more internalizing problems, more externalizing problems, and fewer prosocial behaviors when they were 5 and 7 years. They also were less happy at school compared with control children at 7 years of age. Pure victims and bully/victims showed more behavior and school adjustment problems at 7 years of age, even after controlling for preexisting adjustment problems at 5 years of age.

CONCLUSIONS

Being the victim of a bully during the first years of schooling contributes to maladjustment in young children. Prevention and intervention programs aimed at reducing mental health problems during childhood should target bullying as an important risk factor.

Longitudinal associations between submissive/nonassertive social behavior and different types of peer victimization

Previous research, primarily in North America, has found that submissive and nonassertive behaviors are associated with peer victimization during childhood. A limitation of this work has been the failure to examine the relationships between such behaviors and different types of peer victimization. To overcome this weakness, we developed an inventory to assess the bidirectional longitudinal associations between three different types of victimization and submissive/nonassertive social behavior. The inventory was completed by 449 children aged 9 to 11 years at two time points over the course of an academic year. The inventory generated self-report scores and peer nominations. A robust finding was that submissive/nonassertive social behavior predicted an increase in social exclusion only. In examining the other direction of the relationship, we found that only social exclusion predicted changes in submissive/nonassertive social behavior over time. The findings advance our understanding of the social skills deficits that put children at risk for peer victimization, and of the implications of victimization for the development of submissive/nonassertive social skills problems.

Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the relationship between bullying and health-related symptoms

OBJECTIVES

A number of studies have shown that victimization from bullying behavior is associated with substantial adverse effects on physical and psychological health, but it is unclear which comes first, the victimization or the health-related symptoms. In our present study, we investigated whether victimization precedes psychosomatic and psychosocial symptoms or whether these symptoms precede victimization.

DESIGN

Six-month cohort study with baseline measurements taken in the fall of 1999 and follow-up measurements in the spring of 2000.

SETTING

Eighteen elementary schools in the Netherlands.

PARTICIPANTS

The study included 1118 children aged 9 to 11 years, who participated by filling out a questionnaire on both occasions of data collection.

OUTCOME MEASURES

A self-administered questionnaire measured victimization from bullying, as well as a wide variety of psychosocial and psychosomatic symptoms, including depression, anxiety, bedwetting, headaches, sleeping problems, abdominal pain, poor appetite, and feelings of tension or tiredness.

RESULTS

Victims of bullying had significantly higher chances of developing new psychosomatic and psychosocial problems compared with children who were not bullied. In contrast, some psychosocial, but not physical, health symptoms preceded bullying victimization. Children with depressive symptoms had a significantly higher chance of being newly victimized, as did children with anxiety.

CONCLUSIONS

Many psychosomatic and psychosocial health problems follow an episode of bullying victimization. These findings stress the importance for doctors and health practitioners to establish whether bullying plays a contributing role in the etiology of such symptoms. Furthermore, our results indicate that children with depressive symptoms and anxiety are at increased risk of being victimized. Because victimization could have an adverse effect on children's attempts to cope with depression or anxiety, it is important to consider teaching these children skills that could make them less vulnerable to bullying behavior.