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Liang Z, Chen Y. An Intersectional Exploration of Outness, Encountered Discrimination and Violence, and Non-Suicidal Self-Injury among Asexual Youth across Gender Identities. J Youth Adolesc 2024:10.1007/s10964-024-01999-4. [PMID: 38739331 DOI: 10.1007/s10964-024-01999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Current research on asexual youth is limited, especially in understanding the impact of their outness and the intersection of sexual orientation with gender minority identities. This study investigates the influence of outness on experiences of harassment, discrimination, violence, and the risk of non-suicidal self-injury (NSSI) among asexual youth, with a focus on those with transgender and non-binary identities. Data for this study were obtained from the 2021 Ace Community Survey, an international online survey designed to assess the needs and health status of the Ace community, targeting respondents aged 13 and older. The analysis involved a subsample of 5574 respondents aged 13 to 24 (mean age = 19.28), including 2361 cisgender (mean age = 19.65), 1,195 transgender (mean age = 18.80), and 2,018 non-binary individuals (mean age = 19.13). The results revealed that experienceds of sexual violence, verbal aggression, and physical harassment and bullying not only correlated with but also completely mediated the relationship between outness and NSSI. Asexual transgender youth experienced heightened levels of discrimination and NSSI but demonstrated notable resilience against the negative effects of identity disclosure, highlighting complex dynamics of vulnerability and protection within these communities.
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Affiliation(s)
- Zurong Liang
- Department of Sociology, Zhejiang University, Hangzhou, China.
| | - Yutian Chen
- Department of Sociology, Zhejiang University, Hangzhou, China
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2
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Zhou SC, Zhou Z, Tang Q, Yu P, Zou H, Liu Q, Wang XQ, Jiang J, Zhou Y, Liu L, Yang BX, Luo D. Prediction of non-suicidal self-injury in adolescents at the family level using regression methods and machine learning. J Affect Disord 2024; 352:67-75. [PMID: 38360362 DOI: 10.1016/j.jad.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Adolescent non-suicidal self-injury (NSSI) is a major public health issue. Family factors are significantly associated with NSSI in adolescents, while studies on forecasting NSSI at the family level are still limited. In addition to regression methods, machine learning (ML) techniques have been recommended to improve the accuracy of family-level risk prediction for NSSI. METHODS Using a dataset of 7967 students and their primary caregivers from a cross-sectional study, logistic regression model and random forest model were used to test the forecasting accuracy of NSSI predictions at the family level. Cross-validation was used to assess model prediction performance, including the area under the receiver operator curve (AUC), precision, Brier score, accuracy, sensitivity, specificity, positive predictive value and negative predictive value. RESULTS The top three important family-related predictors within the random forest algorithm included family function (importance:42.66), family conflict (importance:42.18), and parental depression (importance:27.21). The most significant family-related risk predictors and protective predictors identified by the logistic regression model were family history of mental illness (OR:2.25) and help-seeking behaviors of mental distress from parents (OR:0.65), respectively. The AUCs of the two models, logistic regression and random forest, were 0.852 and 0.835, respectively. LIMITATIONS The key limitation is that this cross-sectional survey only enabled the authors to examine predictors that were considered to be proximal rather than distal. CONCLUSIONS These findings highlight the significance of family-related factors in forecasting NSSI in adolescents. Combining both conventional statistical methods and ML methods to improve risk assessment of NSSI at the family level deserves attention.
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Affiliation(s)
- Si Chen Zhou
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Zhaohe Zhou
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Qi Tang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Ping Yu
- Wuhan Mental Health Center, Wuhan, China; Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Huijing Zou
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Qian Liu
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Xiao Qin Wang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China
| | - Jianmei Jiang
- The Central Hospital of Enshi Tujia Autonomous Prefecture, Enshi, China
| | - Yang Zhou
- Wuhan Mental Health Center, Wuhan, China; Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lianzhong Liu
- Wuhan Mental Health Center, Wuhan, China; Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bing Xiang Yang
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Dan Luo
- Center for Wise Information Technology of Mental Health Nursing Research, School of Nursing, Wuhan University, Wuhan, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
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Quan F, Huang J, Li H, Zhu W. Longitudinal relations between bullying victimization and aggression: The multiple mediation effects of anger rumination and hostile automatic thoughts. Psych J 2024. [PMID: 38655612 DOI: 10.1002/pchj.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
Bullying victimization is widely accepted to be associated with aggression. However, the mechanisms underlying this relationship remain unknown. To examine the long-term impact of bullying victimization on aggression, the present study tested the potential mediating effects of both anger rumination and hostile automatic thoughts. A total of 809 undergraduates from four universities across China (74.80% female; Mage = 19.63 years, SD = 0.82 years) completed the survey on three occasions, with a 6-month delay between Time 1 and Time 2 and a 1-year interval between Time 2 and Time 3. A cross-lagged model of anger rumination and hostile automatic thoughts was developed to test whether they predicted one another, and two structural models were constructed to test their mediating roles in bullying victimization and aggression. Findings indicated that anger rumination and hostile automatic thoughts are mutually predictable; the correlation between bullying victimization and aggression is mediated independently by anger rumination and hostile automatic thoughts, and the chain mediation of bullying victimization predicting aggression first through anger rumination and then through hostile automatic thinking was established. In addition, an alternative mediation model is also significant, with hostile automatic thoughts as the primary mediator and anger rumination as the secondary mediator. These results highlight the significance of anger rumination and hostile automatic thoughts in the long-term effects of bullying victimization on aggression. Interventions designed to reduce undergraduate students' anger rumination and hostile automatic thoughts may help reduce their aggression.
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Affiliation(s)
- Fangying Quan
- Department of Psychology, Faculty of Education, Guangxi Normal University, Guilin, China
- Guangxi University and College Key Laboratory of Cognitive Neuroscience and Applied Psychology, Faculty of Education, Guangxi Normal University, Guilin, China
| | - Jianjian Huang
- Department of Psychology, Faculty of Education, Guangxi Normal University, Guilin, China
| | - Honghan Li
- Department of Psychology, Faculty of Education, Guangxi Normal University, Guilin, China
- Guangxi University and College Key Laboratory of Cognitive Neuroscience and Applied Psychology, Faculty of Education, Guangxi Normal University, Guilin, China
| | - Wenfeng Zhu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
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Guo X, Wu S, Dong W, Zhang Y, Su Y, Chen C. The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem. Psychol Res Behav Manag 2024; 17:783-797. [PMID: 38444719 PMCID: PMC10911978 DOI: 10.2147/prbm.s450195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Background & Aim Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents. Methods A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects. Results The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect. Conclusion These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.
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Affiliation(s)
- Xiajun Guo
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Sijia Wu
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Wanglin Dong
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yiqiu Zhang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yue Su
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Chaoran Chen
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
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Ruan QN, Liu L, Shen GH, Wu YW, Yan WJ. Alexithymia and peer victimisation: interconnected pathways to adolescent non-suicidal self-injury. BJPsych Open 2024; 10:e46. [PMID: 38344860 PMCID: PMC10897695 DOI: 10.1192/bjo.2023.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The prevalence of non-suicidal self-injury (NSSI) among adolescents underscores the importance of understanding the complex factors that drive this behaviour. Framed within broader constructs of emotional regulation theories, alexithymia and peer victimisation are thought to interact to influence NSSI behaviours. AIM This research addresses whether alexithymia and peer victimisation serve as risk factors for NSSI and, if so, how these factors interact with each other. METHOD This quantitative study analysed data from 605 adolescents, using a range of validated self-report measures including the Toronto Alexithymia Scale. Statistical analyses including one-way analysis of variance, multiple regression and structural equation modelling were employed to scrutinise the relationships among the variables. RESULTS Alexithymia and peer victimisation significantly predicted NSSI behaviours. Specifically, the 'difficulty in identifying feelings' subscale of alexithymia emerged as a noteworthy predictor of NSSI (P < 0.001). Peer victimisation mediated the relationship between alexithymia and NSSI, explaining approximately 24.50% of alexithymia's total effect on NSSI. In addition, age was a significant predictor of NSSI, but gender and education years were not (P > 0.05). These relationships were found to be invariant across genders. CONCLUSIONS This study enriches our understanding of the interplay between alexithymia, peer victimisation and NSSI, particularly within the Chinese context. Its findings have significant implications for a rethinking of alexithymia's theoretical construct and interventions targeting emotional literacy and peer dynamics among adolescents. Future research could benefit from a longitudinal design to establish causality.
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Affiliation(s)
| | - Linhui Liu
- Lishui Second People's Hospital, Affiliated to Wenzhou Medical University, Lishui, China
| | | | - Yu-Wei Wu
- Student Affairs Division, Wenzhou Business College, Wenzhou, China
| | - Wen-Jing Yan
- Wenzhou Medical University, Wenzhou, China; and Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
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Hong JS, Zhuang L, Thornberg R, Jungert T, Grmusa A. Proposing and testing the pathways from bullying victimization to bringing a weapon to school. J Clin Psychol 2024; 80:97-109. [PMID: 37705494 DOI: 10.1002/jclp.23594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/09/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The current study examined whether bullying victimization was associated with bringing a weapon to school, fully or partly mediated by feeling unsafe in school, negative future education orientation, and skipping school. METHOD Data from 6199 students (12-18 years old), who had filled out the 2017 School Crime Supplement to the National Crime Victimization Survey, were analyzed. RESULTS The results showed a positive association between bullying victimization and bringing a weapon to school. The link was both direct and indirect through the mediating roles of feeling unsafe in school, having a negative future education orientation, and skipping school. CONCLUSION Thus, victims of bullying tended to feel unsafe in school, have a negative future education orientation, and skip school-all of which were positively associated with bringing a weapon to school.
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Affiliation(s)
- Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, Michigan, USA
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Leyi Zhuang
- Department of Psychology, Fudan University, Shanghai, China
| | - Robert Thornberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Tomas Jungert
- Department of Psychology, Lund University, Lund, Sweden
| | - Adrijana Grmusa
- Institute for Political Studies, Belgrade, Republic of Serbia
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Liu S, Qi Q, Zeng Z, Hu Y. Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness. Child Care Health Dev 2024; 50:e13211. [PMID: 38102970 DOI: 10.1111/cch.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway. METHODS A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale. RESULTS (1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents. CONCLUSIONS Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.
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Affiliation(s)
- Shuangjin Liu
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Qi Qi
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Zihao Zeng
- School of Educational Science, Hunan Normal University, Changsha, China
| | - Yiqiu Hu
- School of Educational Science, Hunan Normal University, Changsha, China
- School of Educational Science, Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, China
- School of Educational Science, Research Center for Mental Health Education of Hunan Province, Changsha, China
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8
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Drubina B, Kökönyei G, Várnai D, Reinhardt M. Online and school bullying roles: are bully-victims more vulnerable in nonsuicidal self-injury and in psychological symptoms than bullies and victims? BMC Psychiatry 2023; 23:945. [PMID: 38098002 PMCID: PMC10722836 DOI: 10.1186/s12888-023-05341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/02/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Bullying leads to adverse mental health outcomes and it has also been linked to nonsuicidal self-injury (NSSI) in community adolescents. It is not clear whether different roles of bullying (bully, victim, bully-victim) are associated with NSSI, furthermore the same associations in cyberbullying are even less investigated. METHODS The aim of the current study was to test whether students involved in school or online bullying differed from their not involved peers and from each other in psychological symptoms (externalizing and internalizing problems) and in NSSI severity (number of episodes, number of methods). Furthermore, mediation models were tested to explore the possible role of externalizing and internalizing problems in the association of school and online bullying roles with NSSI. In our study, 1011 high school students (66.07% girls; n = 668), aged between 14 and 20 years (Mage = 16.81; SD = 1.41) participated. RESULTS Lifetime prevalence of at least one episode of NSSI was 41.05% (n = 415). Students involved in bullying used more methods of NSSI than not involved adolescents. In general, victim status was associated mostly with internalizing symptoms, while bully role was more strongly associated with externalizing problems. Bully-victims status was associated with both types of psychological problems, but this group did not show a significantly elevated NSSI severity compared to other bullying roles. Externalizing and internalizing problems mediated the relationship between bullying roles and NSSI with different paths at different roles, especially in case of current NSSI that happened in the previous month. CONCLUSIONS Results highlight that students involved in bullying are more vulnerable to NSSI and to psychological symptoms compared to their peers who are not involved in bullying. It is suggested that bullying roles, especially bully-victim status, need to be identified in school and online settings and thus special attention should be addressed to them to reduce psychological symptoms and NSSI, for example by enhancing adaptive coping skills.
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Affiliation(s)
- Boglárka Drubina
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Dóra Várnai
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Melinda Reinhardt
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- 14th District Medical Center, Child and Adolescent Psychiatry, Budapest, Hungary
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McEvoy D, Brannigan R, Cooke L, Butler E, Walsh C, Arensman E, Clarke M. Risk and protective factors for self-harm in adolescents and young adults: An umbrella review of systematic reviews. J Psychiatr Res 2023; 168:353-380. [PMID: 37972513 DOI: 10.1016/j.jpsychires.2023.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
We conducted an umbrella review to synthesise the evidence from systematic reviews and meta-analyses that examined the risk and protective factors for self-harm in young people. We searched six different databases and used the AMSTAR-2 checklist for quality assessment. The importance of each risk and protective factor was determined based on (1) the number of times it was identified by general reviews examining any risk or protective factor, and (2) the effect sizes from meta-analyses. There were 61 systematic reviews included in this review. The most frequently identified risk factors for self-harm in young people included childhood abuse, depression/anxiety, bullying, trauma, psychiatric illnesses, substance use/abuse, parental divorce, poor family relationships, lack of friends, and exposure to self-harm behaviour in others. The risk factors with the strongest evidence for an association with self-harm were behavioural disorders, personality disorders and depression or anxiety. There was a dearth of systematic reviews examining protective factors but good family/friend relationships were most frequently identified. There was also evidence to show that non-suicidal and suicidal self-harm shared many of the same risk factors. Clinicians and other professionals who work with young people should be particularly cognisant of the psychiatric and adverse life event risk factors as well as the substance use, education-related and individual-level (e.g. being LGB) risk factors for self-harm. Knowledge of risk factors for self-harm can potentially be used to inform the design and implementation of prevention measures and further research is needed on the protective factors for self-harm.
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Affiliation(s)
- David McEvoy
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Ross Brannigan
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Lorcan Cooke
- School of Medicine, Royal College of Surgeons Ireland (RCSI), Dublin, 2, Ireland.
| | - Emma Butler
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland.
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Ella Arensman
- School of Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Ireland; National Suicide Research Foundation (NSRF), Western Gateway Building, University College Cork, Ireland.
| | - Mary Clarke
- School of Population Health, Royal College of Surgeons Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, 2, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
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Xing J, Peng M, Deng Z, Chan KL, Chang Q, Ho RTH. The Prevalence of Bullying Victimization and Perpetration Among the School-Aged Population in Chinese Communities: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:3445-3460. [PMID: 36331136 DOI: 10.1177/15248380221129595] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Though bullying was predominantly documented in Western societies, increasing attention has been paid to bullying in Chinese communities during recent years. It remains unknown whether bullying among youngsters in the Chinese communities is similar to or different from their counterparts in Western societies. A systematic review was primarily conducted in English and Chinese databases from the start to December 31, 2021. This study estimated the prevalence of overall (integrating both face-to-face and cyber forms), face-to-face, and cyber bullying victimization and perpetration using random-effects models. Based on 68 eligible studies, this study revealed a pooled prevalence of overall bullying victimization of 22.7% (95% Confidence Interval [CI] [17.7, 28.6]) and a pooled prevalence of overall bullying perpetration of 15.7% (95% CI [6.7, 32.3]). Besides, the estimated prevalence were 20.8% and 10.3% for face-to-face bullying victimization and perpetration, while 9.6% and 8.4% for cyberbullying victimization and perpetration. The subgroup analyses showed that the high heterogeneity of prevalence among the studies estimating bullying victimization and perpetration could be accounted for by sample characteristics and the measurement approaches. This study suggests that bullying is prevalent in the Chinese communities, comparable to, if not higher than, in the Western societies. Prevention and intervention programs are urgently required to reduce bullying among the school-aged population in Chinese communities.
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Affiliation(s)
- Jianli Xing
- China Youth University of Political Studies, Beijing, China
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11
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Bhatia R. The impact of bullying in childhood and adolescence. Curr Opin Psychiatry 2023; 36:461-465. [PMID: 37781982 DOI: 10.1097/yco.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Bullying is a common adversity affecting many children and adolescents. It has been shown to negatively impact the psychological well being not only of targets of bullying, but also that of bullying perpetrators and those witnessing bullying. Bullying is linked to depression and poorer mental health and functioning among children and adolescents. Given the high prevalence of bullying among children and adolescents and the negative mental health sequelae of bullying, this is an area of urgent public health concern. This narrative review brings forth recent research findings in this arena, which could help shape public health policies for addressing and preventing bullying. RECENT FINDINGS Recent findings demonstrate an association of bullying among children and adolescents with depression, nonsuicidal self-injury, sleep loss, reduced health-related quality of life, poorer rates of graduation from high school and later mental health problems. A recent systematic review also showed an association of peer-victimization among children and adolescents with activation of amygdala, left parahippocampal gyrus and fusiform gyrus, and alterations in other brain areas. SUMMARY Evidence indicates that bullying in childhood and adolescence is associated with higher odds of developing mental health problems; therefore, early identification and timely intervention is crucial.
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Affiliation(s)
- Richa Bhatia
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Wang L, Gu C, Zhou S, Wen S, Zhang Y, Li Q. Can the Negative Cognitive Bias Be Predicted by Early Victimization of College Students? The Dual Role of Resilience. THE JOURNAL OF PSYCHOLOGY 2023; 157:409-422. [PMID: 37498950 DOI: 10.1080/00223980.2023.2225138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023] Open
Abstract
Victimization could cause cognitive dysfunction like negative cognitive bias. While there are studies of contemporaneous consequences, there is insufficient research on whether and how early victimization will affect adult negative cognitive bias. This study examined the dual role of resilience (i.e., whether resilience would moderate the relationship between early victimization and negative cognitive bias, and/or whether resilience would mediate the same relationship). A total of 972 college students (40% were males, Mage = 19.25, SD = 1.17, range = 16-25) from three universities in Central China completed a series of anonymous questionnaires on early victimization, resilience, and negative cognitive bias. After controlling for demographic variables, the results indicated that early victimization was positively correlated with negative cognitive bias of college students. Moderation analysis indicated that resilience moderated the relationship between early victimization and negative cognitive bias. Mediation analysis revealed that resilience partially mediated the same relationship. Specifically, the effect of early victimization on negative cognitive bias was stronger for college students with high level of resilience than those with low level of resilience. Meanwhile, early victimization affected negative cognitive bias partially through resilience. The findings elucidate the dual role of resilience in the relationship between early victimization and negative cognitive bias. On the one hand, negative cognitive bias can be reduced by enhancing resilience among victims, on the other hand, the protective role of resilience may be weakened with the increase of victimization, reminding us to pay more attention to victims with high level of resilience.
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Affiliation(s)
- Lixia Wang
- Central China Normal University
- Xinyang Normal University
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Wen X, Shu Y, Qu D, Wang Y, Cui Z, Zhang X, Chen R. Associations of bullying perpetration and peer victimization subtypes with preadolescent's suicidality, non-suicidal self-injury, neurocognition, and brain development. BMC Med 2023; 21:141. [PMID: 37046279 PMCID: PMC10091581 DOI: 10.1186/s12916-023-02808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Although both peer victimization and bullying perpetration negatively impact preadolescents' development, the underlying neurobiological mechanism of this adverse relationship remains unclear. Besides, the specific psycho-cognitive patterns of different bullying subtypes also need further exploration, warranting large-scale studies on both general bullying and specific bullying subtypes. METHODS We adopted a retrospective methodology by utilizing the data from the Adolescent Brain and Cognitive DevelopmentSM Study (ABCD Study®) cohort collected between July 2018 and January 2021. Participants were preadolescents aged from 10 to 13 years. The main purpose of our study is to examine the associations of general and specific peer victimization/bullying perpetration with preadolescents' (1) suicidality and non-suicidal self-injury; (2) executive function and memory, including attention inhibition, processing speed, emotion working memory, and episodic memory; (3) brain structure abnormalities; and (4) brain network disturbances. Age, sex, race/ethnicity, body mass index (BMI), socioeconomic status (SES), and data acquisition site were included as covariates. RESULTS A total of 5819 participants aged from 10 to 13 years were included in this study. Higher risks of suicide ideation, suicide attempt, and non-suicidal self-injury were found to be associated with both bullying perpetration/peer victimization and their subtypes (i.e., overt, relational, and reputational). Meanwhile, poor episodic memory was shown to be associated with general victimization. As for perpetration, across all four tasks, significant positive associations of relational perpetration with executive function and episodic memory consistently manifested, yet opposite patterns were shown in overt perpetration. Notably, distinct psycho-cognitive patterns were shown among different subtypes. Additionally, victimization was associated with structural brain abnormalities in the bilateral paracentral and posterior cingulate cortex. Furthermore, victimization was associated with brain network disturbances between default mode network and dorsal attention network, between default mode network and fronto-parietal network, and ventral attention network related connectivities, including default mode network, dorsal attention network, cingulo-opercular network, cingulo-parietal network, and sensorimotor hand network. Perpetration was also associated with brain network disturbances between the attention network and the sensorimotor hand network. CONCLUSIONS Our findings offered new evidence for the literature landscape by emphasizing the associations of bullying experiences with preadolescents' clinical characteristics and cognitive functions, while distinctive psycho-cognitive patterns were shown among different subtypes. Additionally, there is evidence that these associations are related to neurocognitive brain networks involved in attention control and episodic retrieval. Given our findings, future interventions targeting ameliorating the deleterious effect of bullying experiences on preadolescents should consider their subtypes and utilize an ecosystemic approach involving all responsible parties.
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Affiliation(s)
- Xue Wen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yinuo Shu
- Chinese Institute for Brain Research, Beijing, 102206, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yinzhe Wang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, 102206, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China.
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
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Wang L, Zou HO, Liu J, Hong JF. Prevalence of Adverse Childhood Experiences and Their Associations with Non-Suicidal Self-Injury Among Chinese Adolescents with Depression. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01508-x. [PMID: 36811752 DOI: 10.1007/s10578-023-01508-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
The presence of adverse childhood experiences (ACEs) in adolescents diagnosed with depression has been associated with an extensive range of mental health issues, including non-suicidal self-injury (NSSI). However, there has been a dearth of research into the prevalence of ACEs and their associations with NSSI among depressed adolescent populations in China. This study aimed to investigate the prevalence of different types of ACEs and their associations with NSSI in depressed Chinese adolescents. Utilizing Chi-squared tests, latent class analysis (LCA), and multinomial logistic regression, the prevalence of different types of ACEs and their associations with NSSI were determined in a sample of 562 adolescents with depression. Among depressed adolescents. 92.9% of depressed adolescents reported ACEs, and the prevalence of emotional neglect, physical abuse, caregiver treated violently, and bullying was relatively high. ACEs, including sexual abuse (OR = 5.645), physical abuse (OR = 3.603), emotional neglect (OR = 3.096), emotional abuse (OR = 2.701), caregiver divorce/family separation (OR = 2.5), caregiver treated violently (OR = 2.221), and caregiver substance abuser (OR = 2.117), were associated with increased odds of exposure among depressed adolescents with NSSI. The high ACEs class (19%), the moderate ACEs class (40%), and the low ACEs class (41%) were identified as latent classes. NSSI was more prevalent in the high/moderate ACEs class compared to the low ACEs class, particularly in the high ACEs class. The situation of the prevalence of ACEs among adolescents with depression was unsatisfactory, and certain types of ACEs were associated with NSSI. Eliminating potential risk factors for NSSI requires the early prevention and targeted intervention of ACEs. Moreover, additional large-scale longitudinal studies are necessary to assess the different development trajectories associated with ACEs, such as the relationships between the different development periods of ACEs and NSSI, and to ensure the adoption of evidence-based prevention and intervention strategies.
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Affiliation(s)
- Lu Wang
- School of Nursing, Anhui Medical University, No. 81 Mei Shan Road, Shu Shan District, He Fei, 230032, Anhui Province, China
| | - Hai-Ou Zou
- School of Nursing, Peking Union Medical College, No. 33 Ba Da Chu Road, Shi Jing Shan District, 100144, Beijing, China
| | - Jun Liu
- Department of Nursing, Beijing Anding Hospital, Capital Medical University, No. 5 An Kang Hutong, Xi Cheng District, 100088, Beijing, China
| | - Jing-Fang Hong
- School of Nursing, Anhui Medical University, No. 81 Mei Shan Road, Shu Shan District, He Fei, 230032, Anhui Province, China.
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15
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Gu H, Fang L, Yang C. Peer Victimization and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Alienation and Moderating Role of Mindfulness. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3864-3882. [PMID: 35861266 DOI: 10.1177/08862605221109903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Peer victimization and non-suicidal self-injury (NSSI) are two major public health problems, with the former being associated with outward attack and the latter characterizing inward attack. Peer victimization has been shown to be associated with adolescents' NSSI. However, less is known about the mechanism underlying the association. Based on the experiential avoidance model of NSSI, this study tested whether the sense of alienation mediated the association between peer victimization and NSSI, and whether this process was weakened by mindfulness. A total of 1,574 Chinese adolescents (51.1% girls; ages 12-16 years) completed questionnaires concerning NSSI, peer victimization, alienation, and mindfulness. Regression-based analyses indicated that peer victimization predicted adolescents' NSSI through the indirect effect of alienation, and mindfulness weakened this indirect effect. These findings suggest that victimized adolescents may injure themselves as an emotion regulation strategy. The results highlight the importance to implement programs aimed to improve the school climate to reduce the risk of adolescent NSSI. Furthermore, we underscore the need to include emotion-regulation training (e.g., mindful practice) into bully intervention programs to prevent NSSI.
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Affiliation(s)
- Honglei Gu
- Hunan Normal University, Changsha, China
| | | | - Cong Yang
- Hunan Normal University, Changsha, China
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16
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Zhang Y, Jia X. When fate hands you lemons: A moderated moderation model of bullying victimization and psychological distress among Chinese adolescents during floods and the COVID-19 pandemic. Front Psychol 2023; 14:1010408. [PMID: 36935965 PMCID: PMC10020194 DOI: 10.3389/fpsyg.2023.1010408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Bullying is a major problem worldwide and has numerous detrimental effects on the mental health of victims. The link between bullying and psychological distress in adolescents is well known. However, few studies have analyzed the impact of combined interpersonal, peer, and cultural factors on psychological distress using a social-ecological system framework in Eastern countries. Negotiable fate is a cultural belief common in Eastern societies that suggests that people can negotiate with fate for more control by exercising personal agency within the limits of what fate has determined. This study examined the moderating effects of neuroticism and negotiable fate on the relationship between bullying victimization and psychological distress among Chinese adolescents. Moreover, human society commonly suffers from multiple disasters that lead to severe mental health problems. There are few empirical studies on the effects of bullying among adolescents in multiple disaster contexts. This study included participants who experienced floods and COVID-19 simultaneously in 2021. Materials and methods We conducted a cross-sectional cluster sampling study from August 6 to 9, 2021, approximately 2 weeks after the start of the Zhengzhou City flooding and 7 days after the new wave of the COVID-19 outbreak in Zhengzhou City. The study included 1,207 participants (52.4% men, n = 633; M age = 14.36, SD = 0.94) from a middle school in Zhengzhou City, China. Results The results revealed that bullying was positively linked to psychological distress (β = 0.5.34, p < 0.001, [0.73, 9.95]). Neuroticism and negotiable fate significantly moderated the relationship between the effects of bullying and psychological distress (β = -3.58, p < 0.05, 95% CI [-6.12, -1.04]). Specifically, high neuroticism increased the risk of psychological distress in adolescents bullied before a disaster. High or low neuroticism and high negotiable fate buffered the link between bullying and psychological distress. Conclusion This study showed that neuroticism and negotiable fate moderated the relationship between bullying victimization and psychological distress in Chinese students with COVID-19 and flood disasters. High negotiable fate and high or low neuroticism could help adolescents bullied in school to be immune from psychological distress in catastrophe. The results highlight the importance of considering the interplay between bullying, neuroticism, and a sense of controllable destiny when examining adolescents' psychological distress.
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Affiliation(s)
- Yuchi Zhang
- Department of Educational Technology, School of Smart Education, Jiangsu Normal University, Xuzhou, China
| | - Xiaoyu Jia
- College of Teacher Education, Southwest University, Chongqing, China
- *Correspondence: Xiaoyu Jia,
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Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents. Biol Psychiatry 2022:S0006-3223(22)01657-2. [PMID: 36411092 DOI: 10.1016/j.biopsych.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity. METHODS One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up. RESULTS Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not. CONCLUSIONS Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.
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Menken MS, Isaiah A, Liang H, Rivera PR, Cloak CC, Reeves G, Lever NA, Chang L. Peer victimization (bullying) on mental health, behavioral problems, cognition, and academic performance in preadolescent children in the ABCD Study. Front Psychol 2022; 13:925727. [PMID: 36225678 PMCID: PMC9549775 DOI: 10.3389/fpsyg.2022.925727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/26/2022] [Indexed: 02/01/2023] Open
Abstract
Objective Peer victimization is a substantial early life stressor linked to psychiatric symptoms and poor academic performance. However, the sex-specific cognitive or behavioral outcomes of bullying have not been well-described in preadolescent children. Methods Using the baseline dataset of the Adolescent Brain Cognitive Development (ABCD) Study 2.0.1 data repository (N = 11,875), we evaluated associations between parent-reported bullying victimization, suicidality (suicidal ideation, intent, and/or behavior), and non-suicidal self-injury (NSSI), as well as internalizing and externalizing behavioral problems, cognition, and academic performance. Results Of the 11,015 9-10-year-old children included in the analyses (5,263 girls), 15.3% experienced bullying victimization, as reported by the primary caregiver. Of these, boys were more likely to be bullied than girls (odds ratio [OR], 1.2 [95% CI, 1.1-1.3]; p = 0.004). Children who were bullied were more likely to display NSSI or passive suicidality (OR, 2.4 [95% CI, 2.0-2.9]; p < 0.001) and active suicidality (OR, 3.4 [95% CI, 2.7-4.2]; p < 0.001). Bullied children also had lower cognitive scores, greater behavioral problems, and poorer grades (p < 0.001). Across all participants, boys had poorer grades and greater behavioral problems than girls; however, bullied boys had greater behavioral problems than girls in several areas (p < 0.001). Compared to their non-bullied peers, bullied children with greater non-suicidal self-injury or suicidality also had greater behavioral problems and poorer grades (p < 0.001). Conclusion These findings highlight the sex-specific effects of bullying, and the negative associations of bullying victimization with cognitive performance, behavioral problems, and academic performance. Future longitudinal studies will identify the natural history and neural correlates of these deficits during adolescence.
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Affiliation(s)
- Miriam S. Menken
- Chang Laboratory, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Amal Isaiah
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Huajun Liang
- Chang Laboratory, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Pedro Rodriguez Rivera
- Chang Laboratory, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Christine C. Cloak
- Chang Laboratory, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Nancy A. Lever
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Linda Chang
- Chang Laboratory, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Linda Chang,
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19
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Gatta M, Raffagnato A, Mason F, Fasolato R, Traverso A, Zanato S, Miscioscia M. Sociodemographic and clinical characteristics of paediatric patients admitted to a neuropsychiatric care hospital in the COVID-19 era. Ital J Pediatr 2022; 48:23. [PMID: 35123540 PMCID: PMC8817472 DOI: 10.1186/s13052-022-01213-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Since the first months of 2020, Italy and the world have been facing the COVID-19 pandemic. In addition to the dangerous and potentially deadly effects on physical health, it has caused a radical change in the lifestyle of the population and a potential danger for mental health too. These events were inserted into the context of a growing epidemiological trend regarding children’s psychiatric disorders in the past decade. Aim To study the population of patients admitted to a Neuropsychiatric Hospital Unit of North Italy in the first COVID-19 year, comparing them with the population of patients hospitalised during the year immediately before, according to sociodemographic and clinical variables. Methodology The study is an observational retrospective cohort. In total, 198 patients hospitalised due to neuropsychiatric problems from February 2019 to March 2021 were recruited. Data were analysed through mean and standard deviation, t-test, percentages, chi square test, and the Fischer exact test. Results Risk factors associated with mental health disorders were similar between the two years. The hospitalisation modality showed a decrease in scheduled hospitalisations compared to urgent ones, and among the reasons that led patients to hospitalisation there was a conspicuous increase in eating disorders. More suicidal and self-harming behaviours occurred in the COVID-19 group too, compared to the previous year. The methods used to attempt suicide were changed considerably, with a prevalence of that attempted within the home. Changes in pharmacological therapies also occurred, necessary for more than 80% of inpatients during the COVID year, with a greater use of neuroleptics. There were alarming data about hospitalisation relapses, which increased from 12.2% in the pre-COVID year to 35.0% in the COVID year. Conclusion Data shed light on clinical and policy issues in mental health care during the developmental age. Since the COVID-19 health emergency is not yet over, and its effects, especially on mental health, will be long-term, it is necessary to implement services and activities dedicated to both primary and secondary prevention of neuropsychiatric diseases especially during adolescent ages.
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