Reprint of: Bullying victimisation, self harm and associated factors in Irish adolescent boys

[Adolescents' Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Stud]

PURPOSE

This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents.

METHODS

Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis.

RESULTS

The results yielded 5 main themes and 18 subthemes. The main themes were 'a silent cry to an indifferent world', 'a heartache that one endures with scars', 'an inescapable cycle', 'filling the space in one's heart', and 'healing the wounds'. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so.

CONCLUSION

This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

Substance Use, Internet Risk Behavior, and Depressive Symptoms as Predictors of Self-harm Thoughts in Adolescents: Insights from the 2019 ESPAD Survey in Croatia

Self-harm has become a nonspecific symptom of mental distress that is most prevalent in the adolescent population. Since it is often a hidden problem, it is important to focus on preventing it. This study used the data from the Croatian leg of the European School Survey Project on Alcohol and Other Drugs to assess certain risk factors and possible protective factors for self-harm thoughts among 16-year-olds in Croatia. Using binary logistic regression, we identified that being female, having less family support and less parental knowledge of adolescents' activities, more frequent cannabis use, more compulsive Internet use and more frequent depressive symptoms significantly increased the likelihood of self-harm thoughts in this sample. Identifying factors that lead to thoughts of self-harm may open a potential space for self-harm prevention before those thoughts progress into behavior.

Gender inequalities in the prevalence of low mood and related factors in schooled adolescents during the 2019-2020 school year: DESKcohort project

BACKGROUND

Mood disorders are the second most prevalent mental disorders in childhood and adolescence. Many undiagnosed people manifest subthreshold symptoms, like low mood, and present worse prognoses than asymptomatic healthy subjects. The aim of this study was to estimate the prevalence of low mood, gender inequalities, and associated factors, in 12- to 18-year-old adolescents in the rural and medium-sized urban areas of Central Catalonia during the 2019-2020 academic year.

METHODS

Cross-sectional study with data from a cohort of high-schooled students (2019-2020), with a convenience sample of 6428 adolescents from the Central region of Catalonia (48.3 % boys and 51.7 % girls). Prevalence of low mood was estimated by gender and exposure variables, and ratios were obtained using Poisson regression models, adjusting for several exposure variables one by one, and for all of them jointly.

RESULTS

The prevalence of low mood was 18.6 %, with statistically significant differences between genders (11.6 %, 95 % CI: 10.5-12.8 in boys and 25.1 %, 95 % CI: 23.7-26.6 in girls). Being an immigrant, dieting, and daily tobacco smoking were only associated with low mood in girls, whereas risky alcohol consumption was only associated in boys. Sexual violence was found to account for 36.2 % of low mood problems in girls.

LIMITATIONS

The main limitation of the study is its cross-sectional design, which means that no casual relationships can be extracted of this study.

CONCLUSIONS

The prevalence of low mood varies between the sexes, highlighting the importance of developing gender-specific interventions to reduce its incidence in young people, considering the factors associated with this condition.

Prevalence and associated factors of school bullying among Chinese college students in Changsha, China

BACKGROUND

School bullying has attracted worldwide attention for its adverse outcomes; however, there is still a lack of research among college students. The aim of this study was to investigate the prevalence of school bullying victimization and the associated factors among Chinese college students.

METHODS

8098 Chinese college students from two universities in Hunan province were recruited in this cross-sectional study, and data on participants' demographic information, bullying history, suicidal behaviors, anxiety (Self-Rating Anxiety Scale) and depression (Self-reporting Depression Scale) were collected. Binary logistic regression was used to analyze the independent correlates of school bullying.

RESULTS

The prevalence of school bullying was 8.03% in our study. Gender (OR,0.792;95%CI[0.660,0.950]; p = 0.012); depression (OR,1.979; 95%CI[1.359,2.883]; p < 0.001); anxiety (OR,1.996; 95%CI[1.388, 2.869]; p < 0.001); suicidal ideation (OR,1.353;95%CI[1.087,1.684]; p = 0.007); suicide attempts (OR,1.772;95%CI[1.306,2.403]; p < 0.001); family income between 30,000 and 70,000/year (yuan) (OR,0.763;95% CI[0.627,0.929]; p = 0.007) and family income more than 70,000/year (yuan) (OR,0.578;95%CI[0.461,0.725]; p < 0.001) were independent correlates of school bullying. The bullying score was positively correlated with physical or mental disorder history, family history of mental disorder, suicidal ideation, suicide plans, suicide attempts, anxiety, depression, smoking and drinking alcohol (all p < 0.05), and negatively correlated with right-handedness, good relationship with parents and family income (all p < 0.05).

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSION

School bullying is quite common among college students. In order to improve students' mental health and prevent suicide, we should pay attention to the negative effects of bullying victimization such as depression, anxiety, suicidal behaviors and so on, apart from putting in place anti-bullying interventions.

Deliberate self-harm among adolescents: A structural equation modelling analysis

Deliberate self-harm is an intentional behaviour involving direct destruction of body tissues that causes non-fatal physical trauma to the extent that bleeding or bruising occurs without conscious suicidal intent. Adolescents' self-harm is an important issue in mental health work due to its high prevalence in Thailand. This study aims to test a causal model of deliberate self-harm and identify how sex, family relationship, school connectedness, stress, resilience, and self-control influenced deliberate self-harm behaviour in Thai adolescents. A model-testing, cross-sectional study was conducted to test a causal model of deliberate self-harm in Thai adolescents. Multi-stage random sampling was used to recruit 360 adolescents. Adolescents completed six self-report instruments: the family relationship questionnaire, student-school connectedness scale, resilience factors scale for Thai adolescents, self-control questionnaire, Perceived Stress Scale-10 (Thai version), and Deliberate Self-Harm Inventory. Internal consistencies ranged from 0.81 to 0.89. Data were analysed by using descriptive statistics and structural equation modelling. The findings found sex, resilience, stress, and school connectedness had direct effects on deliberate self-harm (β = -0.139, β = -0.266, β = 0.163, and β = -0.671, respectively). Resilience and stress also mediated the links between sex (female), family relationship, school connectedness, and deliberate self-harm. The variables accounted for 65.2% of the variance in the prediction of deliberate self-harm behaviour in Thai adolescents. These findings suggest the causal model of deliberate self-harm fit the empirical data. Interventions to reduce stress and strengthen school connectedness, family relationship, and resilience among Thai adolescents should be implemented, particularly for boys, to prevent deliberate self-harm.

Evaluating Risk and Protective Factors for Suicidality and Self-Harm in Australian Adolescents With Traditional Bullying and Cyberbullying Victimizations

PURPOSE

To identify and compare important risk and protective factors associated with suicidality and self-harm among traditional bullying and cyberbullying victims aged 14-17-years in Australia.

DESIGN

Cross-sectional population-based study.

SETTING

Young Minds Matter, a nationwide survey in Australia.

SUBJECTS

Adolescents aged 14-17-years (n = 2125).

MEASURES

Suicidality and self-harm were outcome variables, and explanatory variables included sociodemographic factors (age, gender, country of birth, household income, location, family type), risk factors (parental distress, family functioning, family history of substance use, child substance use, mental disorder, psychosis, eating disorders, sexual activity) and protective factors (high self-esteem, positive mental health or resilience, school connectedness, sleep) among 2 types of bullying victims-traditional and cyber. Traditional bullying includes physical (hit, kick, push) or verbal (tease, rumors, threat, ignorance), and cyberbullying includes teasing messages/pictures via email, social medial using the internet and/or mobile phones.

ANALYSIS

Bivariate analysis and binary logistic regression models. Statistical metrics include Hosmer-Lemeshow Goodness-of-Fit-test, VIF test, Linktest and ROC curve for model performance and fitness.

RESULTS

Overall, 25.6% of adolescents were traditional bullying victims and 12% were cyberbullying victims. The percentages of suicidality (34.4% vs 21.6%) and self-harm (32.8% vs 22.3%) were higher in cyberbullying victims than in traditional bullying victims. Girls were more often bullied and likely to experience suicidal and self-harming behavior than boys. Parental distress, mental disorder and psychosis were found to be significantly associated with the increase risk for self-harm and suicidality among both bullying victims (p < 0.05). While, eating disorder and sexual activity increased the risk of suicidality in traditional bullying victims and self-harm in cyberbullying victims, respectively. Positive mental health/resilience and adequate sleep were found be significantly associated with decreased suicidality and self-harm in both bullying victims.

CONCLUSION

Suicidality and self-harm were common in bullying victims. The findings highlight that the risk and protective factors associated with suicidality and self-harm among adolescent who experienced traditional and cyberbullying victimization should be considered for the promotion of effective self-harm and suicide prevention and intervention programs.

The relationship between self-harm and bullying behaviour: results from a population based study of adolescents

Background

This study aims to better understand the association between bullying behaviour (the bullied, the bullies and the bully-victims) and self-harm, and which protective factors moderate this association.

Methods

A total of 16,182 adolescents, aged 12 to 19 years, were invited to participate in the cross-sectional Ung-data survey. This survey covered various aspects of young people’s lives. The response rate was 87%. To assess the relationship between self-harm and bulling behaviour, and psychological- and environmental covariates, we conducted logistic regression analyses. In addition, we tested for potential interaction effects between protective factors and the three bullying groups on self-harm.

Results

Fifteen percent of participating adolescents reported engaging in self-harm during the last year. The risk of self-harm was six times higher for the “bully-victims”, five times higher for the bullied, and three times higher for the bullies, compared to the “neither-bullied nor bullies”. The risk of self-harm in the face of being bullied was significantly greater for girls than boys. Depression, anxiety and parental conflict accounted for some of the association between being bullied and self-harm, and between bully-victims and self-harm. School behavioural problems accounted for some of the association between the bullies and self-harm and the bully-victims and self-harm. The relationship between the bullied and self-harm was significantly moderated by parental support and school well-being, while the relationship between “bully-victims” and self-harm was moderated by school well-being.

Conclusion

There is a strong link between bullying and self-harm. Interventions to address bullying may reduce self-harm. Our findings also suggest that high levels of parental support and school well-being may buffer the harmful relationship between bullying behaviour and self-harm. Addressing these factors may be important in reducing the risk of self-harm among those experiencing bullying.

Victimization in traditional and cyberbullying as risk factors for substance use, self-harm and suicide attempts in high school students

Background:

Traditional bullying (or peer bullying) is considered a common and unpleasant experience among students and has serious consequences such as mental health problems and unhealthy behavior. In recent years, another type of bullying named cyberbullying has emerged as a growing problem with negative effects on school achievement, physiology, and mental health of its victims.

Objective:

The purpose of this research is to examine and compare the roles of traditional and cyberbullying victimization in substance use, self-harm and suicide attempts.

Methods:

This was a cross-sectional study and conducted in 2019. A total of 425 high school students were selected for the study in Kermanshah, Iran. For conducting the survey, a multi-stage cluster randomized procedure was used and 18 classes in six different high schools in three urban areas were selected. A total of 400 students (mean age 16.61 years, 53.2% girls) responded to the survey, and it provided usable information for the research. Data were analyzed through binary logistic regression analyses.

Results:

The analysis results revealed that 54.2% of students (n = 217) have experienced traditional or cyber victimization. Any kind of victimization was associated with self-harm. Cyber victimization alone and the combination of cyber plus traditional victimization showed significant association with suicide and substance use. Risk of substance use, self-harm, and suicide was higher when students experienced both types of bullying than when they experienced just one kind of bullying alone.

Conclusions:

The results of this study suggest that traditional and cyber victims may require immediate intervention to reduce the negative effects of victimization. Also, prevention programs should consider the possible relationship between traditional and cyber victimization and substance use, self-harm, and suicide.

Using a Mixed-Methods Approach to Analyze Traumatic Experiences and Factors of Vulnerability Among Adolescent Victims of Bullying

A number of studies have analyzed the bullying phenomenon among adolescent victims. Relatively few studies, however, have specifically addressed the associated post-traumatic stress disorder (PTSD). Our clinical practice and therapeutic encounters with adolescents reveal that the majority of bullied adolescents suffer from high levels of PTSD. The objective of this study is to further explore bullied adolescents' traumatic experiences. In an attempt to analyze these experiences, this article presents a mixed-methods approach. Such an approach will allow to analyze the PTSD that results from bullying as well as subjects' psychic and family-relevant vulnerabilities. First, bullying will be defined in the context of adolescence. Then the main studies on bullying will be presented. The objectives, tools and methods of analysis will be presented. The interviews will be analyzed according to the Interpretative Phenomenological Analysis (IPA) method. Projective tools, family drawings, Rorschach and Thematic Apperception Test (TAT), will be analyzed using a psychoanalytic interpretation method. Each qualitative tool will be used alongside a validated quantitative tool. The Clinical Administered PTSD Scale (CAPS-CA-5 questionnaire) and the interviews conducted will thus allow to analyze PTSD and traumatic experiences. The Family Assessment Device (FAD) and the family drawing test will enable to assess family functioning; lastly, the Symptom Check List (SCL-90) that will be used alongside Rorschach and TAT tests will allow to analyze individual psychological vulnerabilities. This approach will increase data validity. The originality of this research study is based on a mixed-methods approach, our methodology which is based on clinical psychology, and the choice of certain research tools which have received little attention to date. Ultimately, this study may help improve how bullying is identified and could contribute toward the reinforcement or revision of the criteria that characterize bullying. Lastly, it may help us explore various unexamined dimensions of bullying. A possible limitation is the complexity associated with such a protocol.

Are Bullying Perpetration and Victimization Associated with Adolescent Deliberate Self-Harm? A Meta-Analysis

This study sought to appraise internationally published literature investigating bullying in its association with deliberate self-harm (DSH). A systematic review and series of meta-analyses using random effects models were conducted. A total of 68 effect sizes, analyzing data from 156,284 adolescents aged 11-19 years were examined. Results showed significant associations between both traditional bullying perpetration (OR 1.81, 95% CI [1.33, 2.47], p < .0001) and victimization (OR 2.34, 95% CI [1.89, 2.89], p < .0001) and DSH. Cyber-bullying victimization (OR 3.55, 95% CI [2.71, 4.65], p < .0001) and the co-occurrence of traditional and cyber-bullying victimization (OR 3.39, 95% CI [1.56, 7.37], p = .002) were also associated with DSH. Moderator analyses showed variation in results based on methodological- and sample-level variables. Findings suggested that exposure to bullying, either as perpetrators or victims, poses risks for DSH.

Attitudes toward adolescent self-harm and its prevention: The views of those who self-harm and their peers

PROBLEM

Adolescent self-harm is a common phenomenon; however, little is known about young peoples' attitudes toward self-harm and what they believe can be done to prevent it. This study aimed to identify adolescents' attitudes about self-harm and their perspectives on preventing it.

METHODS

A cross-sectional anonymous survey was administered to 856 post-primary school students across 11 schools in Dublin, Ireland. Attitudes toward self-harm were captured through a five-item scale and views on prevention of self-harm were captured through an open-ended survey question. Responses from those who self-harmed and those who did not were compared to identify differences.

FINDINGS

Significant differences were identified between those who self-harmed and their peers. Those who self-harmed were less likely to believe that self-harm was carried out to get attention or was a result of loneliness or depression; they were more likely to believe that self-harm was impulsive. Findings demonstrated that a majority of young people believed that self-harm could be prevented and a number of preventative strategies were identified.

CONCLUSIONS

It is important that the views of adolescents are incorporated into the design and delivery of youth-friendly services and that there is a focus on increasing awareness of the youth-orientated services that currently exist.

Nonsuicidal self-injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years

AIM

This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years.

METHODS

Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19-24 years.

RESULTS

Sexual minority youth had 6.6-fold (95% CI 1.7-24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3-18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8-32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6-27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers.

CONCLUSIONS

This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth.

Mental health of sexual minorities. A systematic review

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

Resilience in young people living with violence and self-harm: evidence from a Norwegian national youth survey

The aim of this article is to explore the relationship between resilience and the psychological problems of young people who reported being victims of violence and who engaged in self-harm. We used data from a national survey conducted in 2007 asking young people in Norway (N=6,034; ages 18–19 years) about their experiences with violence during their childhood and during the past 12 months, and also about their mental health and experiences of self-harm. Our analyses revealed that resilience, as measured by the Resilience Scale for Adolescents, correlates significantly and negatively with psychological problems among all young people, and that this correlation is substantially stronger for those youths who reported violent experiences and those who engaged in self-harm.

Trauma experience of youngsters and Teens: A key issue in suicidal behavior among victims of bullying?

This study examines the association between suicide and bullying among teenagers and adolescents in school besides exploring strategies to prevent acts of bullying. "Bullying" is a risk factor that is linked to suicidal ideation and attempts among school-age children and teenagers. Since youth suicide is an urgent and serious problem, we conducted a systematic review of 28 previous studies conducted in children and adolescents which examined the connection between bullying experiences and suicide.

DATA COLLECTION

A literature search was carried out using 4 databases, without date description including: PubMed, PsychInfo, Medline and Google Scholar. The search terms contained: bullying, suicide and bullying, suicide in teens, school bullying, and peer victimization. An initial search generated about 97 articles; however, only 28 articles were appropriate for inclusion in the current review. Inclusion criteria was (1) Cross-sectional studies published from 1997-2013. (2) Study based on school bullying and suicidal risk in adolescents and teens 18 years or less (3) Studies had enough information to calculate effect sizes that did include a control group. (4) Studies based on gender discrimination. Papers that focused on specific populations, that did not include quantitative data, that did not use a control group of non-bullied subjects and studies based on cyber bullying, studies with longitudinal design were excluded. The risk of suicide attempts was higher in girls, who were involved in bullying, either as the victim or perpetrator, than in boys. Depression, feelings of hopelessness and loneliness can develop in the child after being bullied for long periods of time; these feelings are indirectly related to suicidal ideation and attempts. Involvement in bullying increases the likelihood of suicidal ideation and attempts in children and teenagers.

A cross-sectional study of victimisation of bullying among schoolchildren in Sweden: background factors and self-reported health complaints

AIM

To examine background factors for bullying and associations between bullying victimisation and health problems.

METHODS

A cross-sectional study on all pupils in grades 7 and 9 in a Swedish county was conducted in 2011 (n=5248). Data have been analysed with bi- and multivariate models.

RESULTS

14% of the children reported that they had been bullied during the past 2 months. Background factors for bullying were: gender (girls more often); age (younger students more often); disability/disease; high body mass index, and having parents born abroad. There were strong associations between being bullied and poor health and self-harm. Associations with poor general health for boys and girls and mental health problems for girls showed stronger associations with higher frequency of bullying than with lower. For boys, physical bullying had stronger correlations with poor general health than written-verbal bullying.

CONCLUSIONS

Bullying is a serious public health problem among young people and healthcare professionals have an important task in identifying exposed children. Children who are "different" are more exposed to bullying, which implies that school personnel, parents, and other adults in these children's social networks can play an important role in paying attention to and preventing the risk of bullying.