Sibling bullying in middle childhood and psychotic disorder at 18 years: a prospective cohort study

Sibling and School Bullying Victimization and Its Relation With Children's Subjective Well-Being in Indonesia: The Protective Role of Family and School Climate

Studies on the influence of family and school climates on the relationships between sibling and school bullying victimization and children's subjective well-being (SWB) in Indonesia are still scarce. The aims of this study are to investigate family and school climates as protective factors for children from the negative consequences of bullying by siblings or other children in school on SWB. The study used the third-wave data of the Children's Worlds survey that was collected in Indonesia in October 2017. Participants of the study were children aged 10 and 12 years old (N = 15,604; 49.8% girls, 50.2% boys, Mean age = 10.55; SD = 1.17). There are four questionnaires used in the study: five items measure bullying at home and at school, the Children's Worlds Subjective Well-Being Scale, six items measure family climate, and four items measure school climate. Data were analyzed using R and the lavaan library for multilevel structural equation modeling, using full information maximum likelihood (FIML) for missing data and robust maximum likelihood (ML) estimation. Results showed that children who experienced bullying incidents, both at home by siblings and at school, predicted lower levels of SWB. School climate and family climate predicted higher levels of SWB. Results also showed that school bullying interacted significantly with school climate, while sibling bullying interacted significantly with family climate. Schools with students that reported more positive levels of family climate also reported higher levels of SWB. Students from public schools reported higher levels of SWB, which is unexpected.

What challenges do siblings of children with chronic disorders express to their parents? A thematic analysis of 73 sibling-parent dialogues

PURPOSE

The study explored challenges experienced by siblings of children with chronic disorders, as expressed by siblings in parent-child dialogues.

DESIGN AND METHODS

Seventy-three parent-child dialogues (M duration = 28.6 min) were analyzed using qualitative thematic analysis. The dialogues took place within the SIBS group intervention for siblings and parents of children with chronic disorders. The siblings (aged 8 to 14 years) had brothers and sisters with autism spectrum disorders, ADHD, rare disorders, cerebral palsy, or severe mental health disorders. The data are from session 5 in the SIBS intervention, in which the siblings are to express their wishes about family-related challenges (e.g., desired changes) to their parents. The parents are encouraged to listen, explore, and validate the child's perspective before discussing solutions.

RESULTS

Most of the family-oriented challenges the siblings expressed were related to the diagnosis of the brother or sister with a disorder. Four main themes were identified: (1) Family life (e.g., limitations in family activities); (2) The diagnosis (e.g., concerns about the future); (3) Violence; and (4) Important relationships.

CONCLUSION

The siblings experienced challenges and difficult emotions in interactional processes in which the diagnosis affected family life and relationships. The study adds a new dimension to the field by identifying siblings' expressed challenges based on parent-child dialogues.

PRACTICE IMPLICATIONS

Identified themes can guide how parents should meet and address siblings' needs, how health care providers inform and support parents in doing so, and emphasize the relevance of interventions targeting family-level risk and resilience factors.

Sibling Violence and Bullying Behaviors in Peers: The Mediational Role of Self-Esteem

In the context of the existing research on families, sibling violence is a less explored area. However, it has seemingly received more attention recently, and it can assume a relevant role in understanding the maladaptive behavior of youngsters and bullying. Additionally, adolescents involved in bullying and self-esteem are associated with disruptive violence inside the family context. This study's sample consisted of 286 students, aged between 12 and 17 years, from both sexes. This study intends to explore the association between sibling violence and bullying behavior in peers and the mediator effect of self-esteem. The measures for data collection were a demographic questionnaire, the Social Exclusion and School Violence Questionnaire, The Revised Conflict Tactics Scales (Portuguese version for siblings), and the Rosenberg Self-Esteem Scale. The results show a negative effect between negotiation in the sibling relationship (victimization) and social exclusion and verbal aggression related to bullying behavior. Self-esteem represents a total and negative mediator in this connection. Our results also show a variety of indirect outcomes amongst the negotiation dimension, psychological aggression and injury between siblings, and the social exclusion and verbal aggression dimensions (on the aggression and victimization scales). The results will be discussed according to the attachment theory but considering the importance of affective bonds with siblings as a predisposing factor to an adaptive development course.

Genetic influences on sibling bullying and mental health difficulties

BACKGROUND

Sibling bullying is associated with mental health difficulties; both in the short and long term. It is commonly assumed that sibling bullying leads to mental health difficulties but additional explanations for the relationship between the two are seldom investigated.

METHODS

To address this gap in knowledge, we used a genetically sensitive design with data from the Avon Longitudinal Study of Parents and Children (maximum N = 3,959, 53% female). At ages 11-13 years, individuals self-reported their involvement in sibling bullying, as a victim and perpetrator, and parents reported on their child's mental health difficulties. Polygenic scores, indices of genetic risk for psychiatric disorders (major depressive disorder and attention deficit hyperactivity disorder) were computed using children's genetic data. Regression and structural equation models were fitted to the data.

RESULTS

Sibling bullying, victimisation and perpetration, and polygenic scores both predicted mental health difficulties in an additive manner but there was no interaction between them. Polygenic scores for mental health difficulties were also associated with sibling bullying.

CONCLUSIONS

These findings suggest that sibling bullying, victimisation and perpetration, is associated with mental health difficulties, even after accounting for some genetic effects. Additionally, the relationship between sibling bullying and mental health difficulties may be, at least partly, due to shared genetic aetiology. One possibility is that genetic risk for mental health difficulties influences the onset of mental health difficulties which in turn make children more susceptible to sibling bullying.

Longitudinal study of peer victimization, social support, and mental health during early adolescence

BACKGROUND

Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link.

METHODS

We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment.

RESULTS

20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms.

CONCLUSIONS

Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.

[Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

A longitudinal study of sibling bullying and mental health in autistic adolescents: The role of self-esteem

Sibling bullying is associated with poor mental health in autistic adolescents. The reasons for this remain unknown. In the current study, we attempted to replicate the existing findings on the direct associations between sibling bullying and mental health in autistic adolescents and expand knowledge by focusing on the indirect associations through self-esteem. We made use of existing data from the Millennium Cohort Study, a nationally representative UK-based birth cohort study. We fitted a mediation model to longitudinal data from a sample of 416 autistic adolescents aged 11, 14, and 17 years old who had at least one sibling. We found that sibling bullying was prevalent in the lives of autistic adolescents, especially in those who were late-diagnosed, had a shared bedroom, and lived in a low-income household. Additionally, increased sibling bullying in early adolescence was a significant predictor of reduced self-esteem in mid-adolescence; in turn, reduced self-esteem predicted poorer mental health and wellbeing in late adolescence. Our findings indicate that sibling bullying in early adolescence may indirectly lead to poorer mental health and wellbeing in late adolescence through a reduction in self-esteem in mid-adolescence in autistic adolescents. We discuss the implications of these findings further.

Antecedents of sibling aggression and bullying victimization: The parallel and serial contributions of depressive symptoms and substance use

PURPOSE

Sibling aggression has received attention as a common form of family violence. However, further research is needed to elucidate several antecedents of sibling aggression perpetration and bullying victimization, such as substance use and depressive symptoms. Additionally, more studies are needed to identify the mediating paths of depressive symptoms and substance use, which could explain the association between bullying victimization and sibling aggression perpetration on the one hand and the association between sibling aggression victimization and bullying victimization on the other hand, while controlling for exposure to family violence and demographic variables. The current study tested two separate mediational models guided by the displaced aggression theory and self-medication hypothesis.

METHOD

The present study used the Bullying, Sexual, and Dating Violence Trajectories From Early to Late Adolescence in the Midwestern United States, 2007-2013 dataset. The original sample consisted of 1162 middle school students who were initially surveyed and followed into three high schools. For the current study, the first wave was used, which included a sample of 1101 adolescents. Structural equation modeling (SEM) was conducted to first examine whether bullying victimization was associated with sibling aggression perpetration. Then another model was conducted to test whether sibling aggression victimization was associated with bullying victimization.

RESULTS

In the first model, results suggest bullying victimization is positively associated with sibling aggression. Mediation results indicated depressive symptoms and substance use serially mediated the relation between bullying victimization and sibling aggression. In the second model, results suggest that sibling aggression victimization is positively associated with bullying victimization. Parallel mediation results indicated that depressive symptoms alone and not substance use individually explained the association between sibling aggression victimization and bullying victimization. Finally, serial mediation results indicated that depressive symptoms and substance use serially mediate the association between sibling aggression victimization and bullying victimization.

LIMITATIONS

Limitations include self-report measures and cross-sectional design; therefore, we could not estimate casual relationships.

CONCLUSION

The implications of these findings suggest the need for continued attention to school-based bully prevention efforts and family relations interventions. Such efforts might be associated with reductions in bullying victimization and sibling aggression.

The role of sibling aggression during childhood in decision-making during adulthood

Research shows sibling relationships can influence cognitive development, specifically in terms of high-order processes involved in social functioning. These high-order processes take place in the human prefrontal cortex. While prefrontal connectivity can be influenced by factors experienced during developmental phases, it remains unclear how experiences of aggression towards a sibling in childhood can contribute to high-order processes in adulthood, specifically decision-making. Through two studies, we sought to establish a relationship between sibling aggression and decision-making styles reported in adulthood, as well as real-time risky decision-making. Study 1 examined the relationship between childhood experiences of sibling aggression and high-order function, specifically decision-making. Self-reports from 142 adult participants revealed that using sibling aggression to maintain dominance (ESAS; Harrison, Harrison, N. (2017). Sibling aggression: Associations with parenting styles, social dominance behaviour and co-occurring forms of family aggression (Doctoral thesis, University of Central Lancashire, UK). Retrieved from: https://clok.uclan.ac.uk/20917/) was linked to avoidant and spontaneous decision-making (GDMS; Scott & Bruce, Scott and Bruce, Educational and Psychological Measurement 55:818–831, 1995). The findings reported here indicate a possible role of sibling aggression in the development of avoidant and spontaneous decision-making styles. Study 2 investigated the relationship between childhood sibling aggression (ESAS; Harrison, Harrison, N. (2017). Sibling aggression: Associations with parenting styles, social dominance behaviour and co-occurring forms of family aggression (Doctoral thesis, University of Central Lancashire, UK). Retrieved from: https://clok.uclan.ac.uk/20917/) and performance in risky decision-making tasks (IOWA gambling task; Bechara et al., Bechara et al., Brain 123:2189–2202, 2000) among 75 adult participants. It revealed that experiences of sibling aggression did not predict risky decision-making. These findings indicate that the types of decisions made may be influenced by childhood sibling aggression, but not the level of risk involved in decisions made.

Birth order and sickness absence: Register-based evidence from Finland

BACKGROUND

In working ages, sickness absence is strongly related to persons' health condition. We studied how birth order was associated with receipt of sickness allowance, distinguishing between mental disorders, musculoskeletal disorders and injuries.

METHODS

A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt.

RESULTS

Results of stratified Cox regressions revealed that each increase in birth order was associated with a slightly higher risk of sickness absence from any cause. For mental disorders, associations were stronger; the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98-1.08) of second borns, 1.10 (0.99-1.22) of third borns, and 1.52 (1.25-1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (1.07-1.17), 1.19 (1.09-1.30) and 1.15 (0.96-1.38), and for injuries 1.06 (1.01-1.12), 1.09 (1.21-1.14) and 0.96 (0.77-1.20), respectively.

CONCLUSIONS

Birth order effects were generally stronger for women than men, and to some extent influenced by educational level, occupation, income, and family composition. Possible latent mechanisms behind the associations may relate to within-family dynamics at childhood.

Psychosis spectrum illnesses as disorders of prefrontal critical period plasticity

Emerging research on neuroplasticity processes in psychosis spectrum illnesses-from the synaptic to the macrocircuit levels-fill key gaps in our models of pathophysiology and open up important treatment considerations. In this selective narrative review, we focus on three themes, emphasizing alterations in spike-timing dependent and Hebbian plasticity that occur during adolescence, the critical period for prefrontal system development: (1) Experience-dependent dysplasticity in psychosis emerges from activity decorrelation within neuronal ensembles. (2) Plasticity processes operate bidirectionally: deleterious environmental and experiential inputs shape microcircuits. (3) Dysregulated plasticity processes interact across levels of scale and time and include compensatory mechanisms that have pathogenic importance. We present evidence that-given the centrality of progressive dysplastic changes, especially in prefrontal cortex-pharmacologic or neuromodulatory interventions will need to be supplemented by corrective learning experiences for the brain if we are to help people living with these illnesses to fully thrive.

A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder

This study aimed to systematically review the evidence for an association between adversity experienced in childhood (≤ 17 years old), and the diagnosis of psychiatric disorder in adulthood. Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies examining child or adolescent exposure to adversity, and adult-diagnosed depression, anxiety, psychotic disorder, eating disorders, substance abuse disorder, illness anxiety disorder, somatoform disorder, or personality disorder. A total of 39 manuscripts were retained. Results revealed a significant association between the following childhood exposures and adult mental disorder (1.24 ≤ Odds ratios ≤ 2.09): bullying (victimhood, and frequency); emotional abuse; neglect; physical abuse; parental loss; and general maltreatment (unspecified and/or multiple adversity exposure). There were opposing results for being a victim and perpetrator of bullying, and the result for sexual abuse was not statistically significant. There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more two and a half times odds of developing a mental disorder (Odds ratio = 2.59). The result for sexual abuse is likely an artefact of the prospective assessment of this adversity. In summary, there was strong evidence of an association between childhood adversity and later mental illness, and this supports previously reported meta-analyses. The evidence suggests that childhood and adolescence is an important time for risk for later mental illness, and an important period in which to focus intervention strategies for those known to have been exposed to adversity, particularly multiple adversities.

Effect of frequency of parent to child maltreatment on symptoms of anxiety disorder in Pakistani adolescents: A community based cohort study

OBJECTIVE

To investigate the association between Parent to Child Maltreatment and the occurrence of anxiety disorder symptoms among Pakistani adolescents under 18 years.

METHOD

A prospective study was conducted to examine the effect of frequency of Parent to child maltreatment (PTC) on the occurrence of anxiety disorders in a community setting. A sample of 800 adolescents who reported none to rare, occasional, and frequent were followed for the occurrence of anxiety disorder symptoms over two years. PTC was evaluated using ICAST-C (International child abuse screening tool). Anxiety disorder symptoms were evaluated using the SCARED (Screen for children anxiety-related disorders) tool. Risk ratios were estimated using Cox Proportional Algorithm.

RESULTS

The risk of occurrence of anxiety disorder symptoms in adolescents who have exposure to frequent PTC is 3.8 times (2.9, 4.9) as compared to those with none to rare exposure to PTC. Among adolescents suffering frequent PTC whose, mothers also reported a history of domestic violence, the risk of anxiety disorder symptoms is 3 times (2.2, 4.1) higher. Female gender (RR 1.5; 1.2-1.9), stressful home environment (RR 1.4; 1.1-1.8), and parental substance abuse (RR 1.6; 1.2-2.0) are significant predictors of anxiety disorder symptoms.

CONCLUSION

Frequent PTC is significantly associated with the occurrence of anxiety disorder symptoms among Pakistani adolescents. Given these findings, there is a dire need to develop specific interventions to address anxiety disorder symptoms among adolescents and to develop programs to prevent parent to child maltreatment.

The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: The mediating role of psychotic-like experiences

AIM

This study investigated the influence of childhood adversity, such as peer bullying and socioeconomic status, on the suicidal behaviour of left-behind Chinese adolescents to determine whether psychotic-like experiences (PLEs) mediated the associations between these childhood adversities and suicidality; suicidal ideation (serious thoughts about taking one's own life), suicide plans, and suicide attempts.

METHODS

A representative group of rural adolescents (n = 3346) was recruited from 16 rural high schools in China. Suicidality was assessed using the suicide module from the Mini International Neuropsychiatric Interview Kid. Participants also completed questionnaires on bullying, socioeconomic status, left-behind characteristics, and PLEs. Structural equation modelling was then employed to explore the relationships between these variables.

RESULTS

Peer bullying, poverty, and left-behind status were all found to significantly increase adolescent suicide risk, the relationships between which were mediated by PLEs. Peer bullying was found to play the most significant role in the PLEs and suicidality, with the risk of suicide increasing with the length of time a child had been left behind.

CONCLUSION

Adverse life events can lead to a high risk of PLEs, which in turn can increase the risk of suicide. These results could assist in identifying individuals at risk of suicidality and the design of appropriate interventions. The results also highlighted the role PLEs play in suicidality and highlighted the need for further research in this area.

Co-occurrence of sibling and peer bullying victimization and depression and anxiety among Chinese adolescents: The role of sexual orientation

BACKGROUND

Bullying victimization is a robust predictor of mental distress among lesbian/gay, bisexual, and questioning (LGBQ) adolescents. However, few research accounted bullying victimization within the context of both sibling and peer relationships.

OBJECTIVE

To examine the effect of sibling and peer bullying victimization on depression and anxiety between heterosexual adolescents and LGBQ adolescents.

METHOD

This was a cross-sectional study with a random sample of 3062 Chinese senior high school students (56.0% female) aged 14 to 18. Related information was collected through a self-reported questionnaire. The associations were examined via a set of logistic regression analysis.

RESULTS

Of the participants, 12.5% were victims of sibling bullying only, 10.1% reported peer victimization only, and 4.7% were involved in both sibling and peer victimization. Compared to heterosexuals, LGBQ adolescents had increased risks of sibling victimization only, peer victimization only, and both sibling and peer victimization. The prevalence of major depression and generalized anxiety disorder were 24.9% and 18.7% respectively. Bullying victimization and sexual orientation were independently associated with depression and anxiety. Furthermore, the stratified analysis indicated that sibling victimization only was significantly associated with depression and anxiety for heterosexual adolescents, while the associations were not significant for LGBQ adolescents.

CONCLUSIONS

Sexual orientation and bullying victimization are predictive factors of depression and anxiety. In particular, bullying victimization shows the different effects on depression and anxiety between heterosexual and LGBQ adolescents. Anti-bullying intervention could take distinct strategies based on different sexual orientation to reduce risks of adolescents' mental health problems.

Prevalence and Associated Family Factors of Sibling Bullying Among Chinese Children and Adolescents

Sibling bullying is the most common form of aggression within family worldwide, while the prevalence and correlations of sibling bullying is little known in China. The current research focused on the association between family factors and sibling bullying among Chinese adolescents, and explore sex differences in sibling bullying in the context of Chinese culture. A cross-sectional study was conducted to explore the characteristics of sibling bullying by sampling 6302 children and adolescents who had at least 1 sibling living in the household. Of the participants, 1827 (29.0%) were involved in sibling bullying over the past half year, and pure victims, pure bullies, and bully-victims were 486 (7.7%), 510 (8.1%), and 831 (13.2%), respectively. Family factors of sibling bullying were partly different between boys and girls. Parental absence of both father and mother was a risk factor of being a pure bully and a bully-victim for boys, and of being a pure victim for girls. Parental son preference increased the odds of being a pure victim and a bully-victim for boys, and of being all roles of sibling bullying involvement for girls. Besides, parent–parent violence, parent–child violence, and living with a single parent were risk factors of sibling bullying. The results underline the importance of home environment on sibling relationship, and intervention of sibling bullying should include improving family climate.

Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents

STUDY OBJECTIVES

The physical and mental health of adolescents is an important study area. This study aims to examine the occurrence of aggression, sleep disturbances, and suicide risk among Chinese adolescents, along with the relationships between these factors.

METHODS

This is a cross-sectional study conducted through an online survey. Of the original 7011 Chinese adolescent respondents, the analysis included data from 6122 adolescents, aged between 12 and 18 years, from 23 regions, whose average age was 16.12 (±1.44) years, with 48.8% being male. While the chi-square test and t-test were used for analyzing demographic data and continuous variables, respectively, mediation analysis was used to explore the mechanism of experiencing aggression on suicide risk. The respondents' sleep quality, nightmare distress, daytime sleepiness, fatigue, and suicide risk were assessed using the Pittsburgh Sleep Quality Index (PSQI), Nightmare Distress Questionnaire-Chinese version (NDQ-CV), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Multidimensional Fatigue Inventory (MFI-20), and the suicide risk module of the Mini-International Neuropsychiatric Interview (MINI), respectively. Four items were used to assess adolescents' experiences with aggression.

RESULTS

Of the respondents, 42% reported experiencing aggression by others, especially parental physical maltreatment. Furthermore, 26.9% of adolescents in school, and in particular, 31.8% in senior high school experienced insomnia symptoms. Adolescents who reported experiences of aggression had more severe insomnia symptoms, nightmare distress, fatigue, and a higher risk of suicide when compared with those who did not (all ps < 0.001). Insomnia symptoms, nightmare distress, and fatigue all mediated the relationship between aggression and suicide risk, and there was a chain of mediating effects between these factors [for total indirect effect β = 1.1512, 95% CI (0.9671 to 1.3426), direct effect β = 0.4934, 95% CI (0.1978 to 0.7891), and total effect β = 1.6446, 95% CI (1.3479 to 1.9414)].

CONCLUSIONS

Our findings indicate that among adolescents, experiencing aggression is associated with an increased suicide risk. In addition to the direct effect of aggression on suicide risk, insomnia, nightmare distress, and fatigue mediate the relationship between aggression and suicide risk. More attention should be paid to adolescents experiencing aggression, and interventions should be implemented and strengthened.

Sibling conflict during COVID-19 in families with special educational needs and disabilities

Young people with special educational needs and disabilities (SENDs) and their families have been particularly hard hit by the COVID-19 pandemic. In this longitudinal study, sibling conflict in these families during and after the first lockdown in the United Kingdom was investigated. Online questionnaires were completed by 504 parents of young people with SENDs at four time points between 23 March 2020 and 10 October 2020 (over half completed the questionnaire at multiple time points). As lockdown progressed, young people with SENDs were more likely to be picked on or hurt by their siblings compared with earlier stages of the lockdown but there was no change in how frequently they harmed or picked on their siblings. After lockdown, both perpetration and victimization decreased but not to the same rates as the first month of lockdown. Young people with SENDs with severe or complex needs were somewhat protected from sibling conflict. Findings are discussed with reference to implications for support and planning for future pandemics.

Traumatic experiences in childhood and adolescence: a meta-analysis of prospective studies assessing risk for psychosis

Evidence of the association between traumatic experiences and psychosis are uncertain with respect to temporal order, clinical outcomes and the role of the age and genetic liability. The aim of the present meta-analysis was to explore the temporal relationship between the development of psychosis and traumatic exposure using prospective studies and to examine the role of moderation factors on overall effect sizes. Studies were identified by searching Embase-Ovid, PsycINFO (EBSCO), Pubmed, Scopus, Web of Science databases, and yielded an initial total of 9016 papers, leaving finally 23 after the screening process. Three sets of meta-analyses estimated the risk of developing psychotic experiences or full clinical psychosis by having experienced maltreatment by an adult or bullying by peers or parental death, using the random-effects model. Bullying by peers (OR = 2.28 [1.64, 4.34]), maltreatment by an adult (OR = 2.20 [1.72, 2.81]) and parental death (OR = 1.24 [1.06, 1.44]) all increased the risk of psychosis. Moderator analysis showed that negative effects of bullying were detected especially in those with genetic liability for psychosis and exposure to multiple trauma types; studies with higher prevalence of males showed a stronger risk for those exposed to parental death. No significant meta-regression was found between the risk of developing a full clinical psychosis or a psychotic experience. Lack of studies hampered the results about the age of trauma occurrence. The cumulative effect of being bullied from peers and experiencing other adversities during childhood and/or adolescence, together with genetic liability for psychosis, appears to confer the highest risk for developing psychotic symptoms later in life.

Family Bullying in Childhood: Consequences for Young Adults

This study investigated childhood family bullying and explored any ongoing impacts for young adults. Research has demonstrated that peer bullying leads to contemporaneous poor consequences and some inquiries establish adverse effects of peer bullying lasting into adult life. However, family bullying is much less studied and the effects are not well understood. While there is urgency to intervene in peer bullying, this does not extend to family bullying. The aims of this inquiry were to discover what types of childhood bullying occur in families, any ongoing consequences, and how young adults define bullying. The study was a retrospective qualitative inquiry with a purposive sample. There were 43 participants: the majority were female, mean age 24.3 years, and 27% represented minorities. A qualitative description approach based in naturalistic inquiry was employed for data analysis to understand the lived experiences of young adults. NVivo 11 was used for data storage and analysis. A multi-phase coding process was utilized along with thematic analysis. Types of family bullying and participants' definitions of bullying were generated. Thematic analysis revealed lasting consequences in (a) low self-esteem and shame, (b) eating disorders, and (c) behavioral issues and relationship problems. Outcomes indicate the importance of further research on childhood family bullying as it affects young adult life and the need for researchers as well as practitioners to understand its lifelong impact.

Sibling, Peer, and Cyber Bullying Among Children and Adolescents: Co-occurrence and Implications for Their Adjustment

Bullying across the sibling, peer, and cyber context has consistently been associated with a range of long-term health and well-being consequences for children and adolescents. Although research examining different bullying forms simultaneously in the same study are emerging, it remains unclear to what extend sibling, peer, and cyber bullying co-occur and in what ways they are associated. Moreover, previous work has demonstrated that children and adolescents who experience multiple forms of victimization are at a particular risk of adverse outcomes. However, whether different constellations of co-occurring bullying forms have differential impacts has not yet been investigated sufficiently. The aim of the present study was to examine the frequencies of isolated and co-occurring sibling, peer, and cyber bullying as well as to explore their independent and cumulative relationships with child adjustment. This study was based on a sample of 329 children and adolescents aged between 9 and 15. Bullying experiences across the sibling, peer, and cyber context in the previous 6 months were assessed via self-report. Youth further reported on emotional problems, conduct problems, sleep problems, and academic achievement via an online questionnaire. Sibling, peer, and cyber bullying were uniquely associated with child outcomes. A cumulative relationship between bullying victimization across contexts and emotional problems, conduct problems, and sleep problems could be identified, while bullying perpetration across contexts was only linked to more conduct problems in a cumulative manner. The findings have important practical implications arguing for the adoption of a holistic approach toward bullying in prevention and intervention.

The Impact of Formal School Entry on Children's Social Relationships with Parents, Siblings, and Friends

The normative transition to formal schooling confronts children with social challenges but also opportunities. Longitudinal research on how school entry impacts children's family and friend-ship relationships is scarce. This study investigated social relationship qualities with parents, siblings, and friends among 1110 children (49.9% female) from the prospective, population-based Bavarian Longitudinal Study at 6 years (before school entry) and 8 years using a forced-choice card-sorting task. Multivariate analyses of variance revealed significant effects of age (i.e., school entry) on social relationship qualities with mothers (Pillai's Trace (PT) = 0.28, F(9, 1101) = 47.73, p < 0.001), fathers (PT = 0.14, F(9, 1101) = 19.47, p < 0.001), siblings (PT = 0.27, F(9, 1101) = 46.14, p < 0.001), and friends (PT = 0.21, F(9, 1101) = 32.57, p < 0.001). On average, children reported higher levels of parental comfort after school entry. Companionable qualities increased in relationships with friends, whereas sibling relationships became more conflictual from preschool to early school age. Findings provide unique insights into how social relationships develop from preschool to early school age, supporting evidence of the growing importance of friends. Conflict was predominant and increasing in sibling relationships and should be considered more in future research.

Sibling Bullying: A Prospective Longitudinal Study of Associations with Positive and Negative Mental Health during Adolescence

Sibling bullying is associated with poor mental health outcomes, but the relevance of specific bullying roles remains unclear. Data from a population-based study (n = 17,157, 48% female) focusing on early (11 years), middle (14 years), and late (17 years) adolescence were analyzed. Associations between sibling bullying roles in early adolescence and positive and negative mental health outcomes in late adolescence were investigated. Generally, bullying, irrespective of role, was associated with poorer mental health outcomes in late adolescence. As the frequency of bullying victimization increased between early and middle adolescence so did the severity of mental health outcomes in late adolescence. The developmental trajectories of externalizing problems were influenced by bullying in early adolescence. Sibling bullying, irrespective of role, is associated with poor mental health outcomes.

Peer-reported bullying, rejection and hallucinatory experiences in childhood

OBJECTIVE

Psychotic experiences, such as hallucinations, occur commonly in children and have been related to bullying victimization. However, whether bullying perpetration, peer rejection, or peer acceptance are related to hallucinatory experiences has remained under-examined. We used a novel peer nomination method to examine whether (i) bullying perpetration and (ii) social positions within peer networks were associated with future hallucinatory experiences.

METHODS

This prospective study was embedded in the population-based Generation R Study. Bullying perpetration, peer rejection, and peer acceptance were assessed using peer nominations at age 7 years (N = 925). Using a social network analysis, we estimated social positions within peer rejection and acceptance networks. Bullying victimization was assessed using self-reports. Self-reported hallucinatory experiences were assessed at age 10 years. Analyses were adjusted for sociodemographic covariates.

RESULTS

Higher levels of bullying perpetration were prospectively associated with an increased burden of hallucinatory experiences (OR = 1.22, 95% CI 1.05-1.43, p = 0.011). Bullies had a 50% higher, and bully-victims had a 89% higher odds, of endorsing hallucinatory experiences three years later than children who were not involved in bullying (OR_bully = 1.50, 95% CI 1.01-2.24, p = 0.045; OR_bully-victim = 1.89, 95% CI 1.15-3.10, p = 0.012). Unfavorable positions within peer rejection networks, but not peer acceptance networks, were associated with an increased risk for hallucinatory experiences (OR_{peer rejection} = 1.24, 95% CI 1.07-1.44, p_{FDR-corrected} = 0.024).

CONCLUSION

Using peer reports, we observed that bullies and socially rejected children have a higher likelihood to report hallucinatory experiences in pre-adolescence. Children who are both a bully and a victim of bullying (ie, bully-victims) may be particularly vulnerable for psychotic experiences.

The association between sibling bullying and psychotic-like experiences among children age 11-16 years in China

BACKGROUND

Few studies exist on sibling bullying or even sibling aggression more generally in the past 30 years. Studies of sibling bullying have shown that sibling bullying may associate with depression, anxiety, self-harm, suicide ideation in early adulthood. Nevertheless, few studies have explored the relationship between sibling victimization types and the occurrence of psychosis, not to mention that psychotic-like experiences (PLEs) always occur before psychotic disorders. Therefore, the current study aims to examine the association between sibling bullying and PLEs among children age 11-16 years in China.

METHOD

This is a cross-sectional study which included 3231 students from eight junior middle schools in three cities of Hunan Province, China. Frequency and types of sibling bullying was assessed with Sibling Bullying Questionnaire and PLEs was assessed with Community Assessment Psychic Experiences-42.

RESULTS

The percentage of sibling bullying were 12.9% for victimization and 10.8% for perpetration. Sibling bullying plays as an independent influence factor for all subtypes of PLEs, and verbal victimization was the most important risk factor in developing different subtypes of PLEs followed by physical victimization and verbal perpetration.

CONCLUSION

The current study found that sibling bullying is associated with PLEs. Intervention programs should be conducted to focus on those children and adolescents who are involved in multiple types of sibling victimization or perpetration.

Psycho-social factors associated with high depressive symptomatology in female adolescents and gender difference in adolescent depression: an epidemiological survey in China's Hubei Province

BACKGROUND

Exploring etiological clues to adolescent depression, especially in female adolescents, might be helpful to improve the social environment of female adolescents. The aim at this study is to explore psycho-social factors of female adolescents with high depressive symptomatology and gender differences in depressive symptoms among Chinese adolescents.

METHOD

We examined 4100 adolescents from Wuhan city and Jianli county via a cross-sectional study. Depressive symptomatology was screened through the Chinese version of Center for Epidemiology Studies Depression Scale. Multivariate logistic regression was performed to explore the factors related to high depressive symptomatology in female and male adolescents, respectively.

RESULTS

The prevalence of high depressive symptomatology in female and male were 38.9 and 30.2% respectively. The psycho-social factors of high depressive symptomatology in female adolescents were age (Adjusted odds ratio [aOR] = 1.201, 95% confidence interval [CI], 1.076 ~ 1.341), single parent family (aOR = 2.004, 95%CI, 1.448 ~ 2.772) and fathers' education level (compared to primary school and below, [Junior middle school, aOR = 0.641, 95%CI, 0.439 ~ 0.934; Senior middle school, aOR = 0.603, 95%CI, 0.410 ~ 0.888; College degree and above, aOR = 0.639, 95%CI, 0.437 ~ 0.936]).

CONCLUSION

Fathers' education level was associated with high depressive symptomatology in female adolescents. Female adolescents whose father with primary school education or below deserves more attention. Further epidemiologic researches need to be conducted to explore the different risk factors between female and male adolescents in China.

Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies

OBJECTIVE

To systematically review evidence for the association between trauma experienced in childhood or adolescence, and the subsequent experience of affective or psychotic mental disorders in adulthood.

METHODS

Electronic databases (Scopus, Medline (for Ovid), EMBASE and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies in the English language examining child or adolescent exposure to trauma, and adult-diagnosed depression, anxiety, psychotic disorder or bipolar disorder. A total of 23 manuscripts were retained.

RESULTS

Results revealed a significant association between the following childhood exposures and adult mental disorder: bullying (victimhood, perpetration and frequency); emotional abuse; physical neglect; parental loss; and general maltreatment (unspecified and/or multiple trauma exposure). There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more than three times the odds of developing a mental disorder (Odds ratio = 3.11, 95% CI = 1.36-7.14). There was no significant association found between physical or sexual abuse and adult mental disorder; however, this is likely an artefact of how these adversities were assessed.

CONCLUSION

There is strong evidence of an association between childhood trauma and later mental illness. This association is particularly evident for exposure to bullying, emotional abuse, maltreatment and parental loss. The evidence suggests that childhood and adolescence are an important time for risk for later mental illness, and an important period in which to focus intervention strategies.

Physical and Emotional Sibling Violence in the Time of COVID -19

The COVID-19 pandemic has impacted families in a variety of ways with much being written on the potential impact of sheltering in place and quarantining on intimate partner violence and parent-to-child abuse. One area that has received scant attention is that of physical and emotional sibling violence. While physical and emotional sibling violence is a predominant form of family violence, discussion of violence between siblings in the time of COVID-19 has not received the attention it warrants. This article examines the potential for family stress to place siblings at risk for engaging in physical and emotional sibling violence and how this is exacerbated in the time of COVID-19. Also discussed is the the connection between physical and emotional sibling violence and other forms of family violence including intimate partner violence and parent-to-child abuse and neglect which underwrites the need to place physical and emotional sibling violence on the radar of practitioners, policy makers, and researchers. Finally, implications for practice, policy, and research on physical and emotional sibling violence in the context of COVID-19 are discussed.

Precursors of sibling bullying in middle childhood: Evidence from a UK-based longitudinal cohort study

BACKGROUND

There is increasing evidence that sibling bullying is associated with various social, emotional, and mental health difficulties. It is, however, unclear which factors predict sibling bullying in middle childhood and whether child-level individual differences make some children more susceptible to sibling bullying involvement.

OBJECTIVE

To investigate the precursors of sibling bullying in middle childhood in a UK based population sample.

PARTICIPANTS AND SETTING

Existing data from the prospective Millennium Cohort Study (N = 16,987) were used. Primary caregivers reported on precursors (child age 7 years or earlier) whilst children self-reported on sibling bullying (child age 11 years).

ANALYSIS

A series of multinomial logistic regression models were fitted. First, testing for crude associations between sibling bullying and the precursors individually. Culminating in a final model with the significant predictors from all of the previous models.

RESULTS

Structural family-level characteristics (e.g. birth order, ethnicity, and number of siblings) were found to be the strongest predictors of sibling bullying involvement followed by child-level individual differences (e.g. emotional dysregulation and sex). Parenting and parental characteristics (e.g. primary caregiver self-esteem and harsh parenting) predicted sibling bullying, but to a lesser extent.

CONCLUSIONS

These findings suggest that structural family characteristics and child-level individual differences are the most important risk factors for sibling bullying. If causality can be established in future research, they highlight the need for interventions to be two-pronged: aimed at parents, focusing on how to distribute their time and resources appropriately to all children, and the children themselves, targeting specific sibling bullying behaviors.

The relationship between childhood trauma and schizophrenia in the Genomics of Schizophrenia in the Xhosa people (SAX) study in South Africa

BACKGROUND

Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa.

METHODS

Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia.

RESULTS

Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77-3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28-1.97), neglect (OR 1.39, CI 1.16-1.68), and sexual abuse (OR 1.22, CI 1.03-1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose-response relationship.

CONCLUSION

Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia.

Sibling Bullying in Middle Childhood is Associated with Psychosocial Difficulties in Early Adolescence: The Case of Individuals with Autism Spectrum Disorder

Sibling bullying is associated with various psychosocial difficulties. We investigated this in 231 individuals with Autism Spectrum Disorder (ASD) and 8180 without ASD between middle childhood (age 11 years) and early adolescence (age 14 years). On the whole, self-reported sibling bullying decreased from middle childhood to early adolescence. Despite this, individuals with ASD continued to report more sibling bullying as both perpetrator and victim in early adolescence than those without ASD. We found that self-report sibling bullying in middle childhood was associated with psychosocial difficulties in early adolescence. Moreover, individuals with ASD were more likely to report being bullied by both siblings and peers in middle childhood and this pattern of victimisation was associated with concurrent and longitudinal psychosocial difficulties.

Association Between Sub-types of Sibling Bullying and Mental Health Distress Among Chinese Children and Adolescents

Sibling bullying is a common phenomenon in childhood and adolescence worldwide and has a significant association with mental health distress. However, there have been few studies that have examined the associations between any specific sub-type of sibling bullying and depression as well as anxiety. Besides, the association between sibling bullying and psychological well-being was never explored among the Chinese population. The purpose of this cross-sectional study was to examine the associations between the number of sub-types of sibling bullying involvement and depression as well as anxiety among Chinese children and adolescents. Multi-stage stratified cluster sampling was used to recruit 5,926 participants aged 10 to 18 who had at least one sibling living in the household. Different sub-types of sibling bullying involvement were determined by using Olweus Bully/Victim Questionnaire (OBVQ). The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder Scale (GAD-7) were used to screen clinical ranges of major depression and generalized anxiety disorder, respectively. Of the participants, 1,235 (20.8%) were bullied by siblings, and 1,230 (20.8%) perpetrated bullying behavior against siblings over the past 6 months. After controlling potential confounders, adjusted model of logistic regression analyses indicated that all three sub-types of sibling victimization and perpetration were significantly associated with both depression and anxiety. There were linear associations between the number of sub-types of sibling bullying victimization and depression (adjusted OR = 1.49, 95% CI 1.32 to 1.68) as well as anxiety (adjusted OR = 1.68, 95% CI 1.48 to 1.90). Besides, linear trends were found between the number of sub-types of sibling bullying perpetration and depression (adjusted OR = 1.44, 95% CI 1.26 to 1.64) as well as anxiety (adjusted OR = 1.63, 95% CI 1.42 to 1.87). The findings underline dose-response relationships between the number of sub-types of sibling bullying involvement and mental health distress. Intervention programs should be conducted to focus on developing mental health status of those children and adolescents who are involved in multiple sub-types of sibling victimization or perpetration.

The Independent and Cumulative Effects of Sibling and Peer Bullying in Childhood on Depression, Anxiety, Suicidal Ideation, and Self-Harm in Adulthood

Sibling and peer bullying are reported as the most frequent forms of violence experienced across childhood. There is now ample evidence indicating an association between sibling and peer bullying, with those reporting sibling bullying at an increased risk of peer bullying. While there is convincing evidence of a causative association between peer bullying and a range of mental health outcomes, sibling bullying continues to receive far less attention. The aim of this study was to explore whether sibling bullying roles (non-involved, victim, bully-victim, bully) in middle childhood were independently associated with clinical diagnoses of depression and anxiety and reports of suicidal ideation and self-harm in early adulthood. We further tested whether there was a cumulative relationship between involvement in sibling and peer bullying victimization. This study was based on up to 3,881 youth from the Avon Longitudinal Study of Parents and Children, a prospective birth-cohort based in the United Kingdom. Sibling and peer bullying was assessed via self-report when youth were 12 years of age, while depression, anxiety, suicidal ideation, and self-harm were assessed via self-administered computerized interviews at 24 years of age. Involvement as a sibling bully-victim was associated with clinical diagnosis of depression (OR = 1.91, 95% CI: 1.33-2.72), while sibling victims were at increased odds of both suicidal ideation (OR = 1.52; 95% CI, 1.16-1.98) as well as suicidal self-harm (OR = 2.20, 95% CI, 1.36-3.58) in early adulthood, even after accounting for concurrent peer bullying and a range of other pre-existing childhood confounders. Sibling and peer bullying were further associated in a homotypic manner. A dose-response relationship of bullying in the home and school across mental health outcomes was found. Youth victimized by both their siblings and peers displayed the highest odds of developing clinical depression, suicidal ideation, and self-harm. Children bullied at home and at school had no safe place to escape the bullying and torment. Our findings highlight the need for intervention studies tailored toward reducing sibling bullying, as these may hold large promise for alleviating a range of adverse outcomes, including the prevention of peer bullying, which may be contingent on early bullying experiences in the home environment.

Do Cross-National and Ethnic Group Bullying Comparisons Represent Reality? Testing Instruments for Structural Equivalence and Structural Isomorphism

Bullying in schools is a widespread phenomenon, witnessed worldwide, with negative consequences for victims and perpetrators. Although it is an international issue, there are several issues with cross-national and cross-cultural/ethnic research that can make comparisons between countries and cultures/ethnic groups difficult including language, cultural perception, and/or methodological issues. As statistical techniques rapidly develop, there may be more scope to be statistically creative in how we assess the utility of one tool across different groups such as cultures, nations, etc. At the very least, an attempt to do this should be paramount in studies investigating different groups (e.g., from different countries) at one time. This study investigated bullying and victimization rates in a large cross-ethnic and -country comparison between adolescents from four countries and five different ethnic groups including: Israel (Jewish Israelis and Arab Palestinian Israelis), Palestine (the Gaza Strip), Germany, and Greece. A total of 3,186 school children aged 12-15 years completed self-report questionnaires of peer bullying/victimization. A stepwise data analytic approach was used to test comparability of the psychometric properties: (1) Structural equivalence contributes to the valid use of the instrument in cultural contexts other than the one for which the instrument has been developed. Structural equivalence is a necessary condition for the justification of indirect or direct comparisons between cultural groups. (2) Additionally, structural isomorphism is necessary to demonstrate that the same internal structure of the instrument applies to the cultural and individual levels. Findings support the internal structural equivalence of the questionnaire with the exception of the Palestinian sample from the Gaza Strip. Subsequently, exploratory factor analysis on the cultural level structure revealed a one-factor structure with congruence measure below 0.85. Thus, no evidence was found for internal structural isomorphism suggesting that no direct comparisons of cultural samples was justified. These results are discussed in detail and the implications for the international research community and cross-national/-ethnic comparison studies in bullying are addressed.

Bullying by siblings and peers: Poly-setting victimization and the association with problem behaviours and depression

BACKGROUND

In recent times, sibling bullying has emerged of interest to researchers concerned with the emotional and behavioural implications for victimization regardless of type and setting.

AIMS

This research attempts to extend current knowledge on both peer and sibling bullying and to determine the effects of poly-setting victimization. This paper is concerned with the following objectives: (1) determining the current rate of bullying and victimization among siblings and peers in a large sample of adolescents; (2) investigating the relationship between sibling and peer bullying and depression and behaviour; (3) highlighting the carry-over effects of bullying from one setting to another; and (4) determining the overall association of poly-setting victimization with depression and behaviour.

SAMPLE AND METHODS

Over 2,000 adolescents aged between 12 and 15 years participated in an online survey.

RESULTS

Results found lower rates of sibling bullying compared to international studies. Sibling victims of bullying were at increased risk of becoming peer victims. Poor friendship quality, disliking school, along with peer and sibling bullying involvement predicted scores in the clinical range for outcome measures of internalizing and externalizing problem.

CONCLUSIONS

The current study has clinical and educational implications for working with all important stakeholders (i.e., schools, parents, siblings) to reduce bullying and improve mental health.

The Epidemiology of Psychosis in Indigenous Populations in Cape York and the Torres Strait

BACKGROUND

The treated prevalence of psychotic disorders in remote communities of Cape York and the Torres Strait, Australia, has been shown to be elevated compared with the Australian population. Our study used a unique dataset to assess treated incidence and prevalence of psychotic disorders and mortality over a 23-year period in the adult Indigenous population of this region.

METHODS

Data was collated from a clinical database that contains complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients who received treatment for a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Deaths Registry. We calculated 12-month treated prevalence and incidence for each calendar year. Mortality rates were compared to the overall and Indigenous population death rates in Queensland.

FINDINGS

Between 1992 and 2015, 424 patients were treated for psychosis - an age-standardised 12-month prevalence of 1·7% in 2015, approximately two times higher in men than women, and three times higher in Aboriginal versus Torres Strait Islander populations. The highest treated prevalence was observed in 2015 in Aboriginal men (4.0%). A range of psychotic disorders were detected, including many substance-induced cases (n = 93) and schizophrenia (n = 252). The age-standardised 12-month incidence rate over the study period was 3.61 per 1000 person-years for women and 4.23 per 1000 person-years for men. Treated prevalence increased throughout the study period, largely attributable to increases in incidence of schizophrenia and schizoaffective disorder - in contrast, the incidence and prevalence of bipolar and mood disorders remained low and stable. Increased mortality risk compared to the Queensland Indigenous population (SMR = 1.9; 95% CI 1.4-2.6) was attributable to the elevated risk shown in the Aboriginal population in our study (SMR = 2.6; 95% CI 1.8-3.7).

INTERPRETATION

Our results show extremely high prevalence rates of psychosis; increasing prevalence over time; differences in the distribution of psychosis between Aboriginal and Torres Strait Islander populations; and increased mortality risk for Aboriginal people living with psychosis in this region. These observations strongly suggest an aetiological role of environmental and neurodevelopmental factors, and the contribution of social factors to vulnerability and premature mortality.

ROLE OF THE FUNDING SOURCE

This study was funded by Queensland Health who are the custodians of this database. The funder had no role in study design, data analysis, data interpretation, writing of the report, or submission for publication. All authors had full access to all the study data. The corresponding author had final responsibility for the decision to submit for publication. FJC is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1138488).

Association of birth order with adolescent mental health and suicide attempts: a population-based longitudinal study

Previous cohort studies have observed higher birth order to be associated with increased risk of suicidal behaviour. However, the mechanisms underlying this association are unclear. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we used multivariable logistic regression models and mediation analysis to investigate the associations of birth order with adolescent suicide attempts and psychiatric disorder. We investigated whether the number of maternal depressive episodes and father absence mediated the associations found. In fully adjusted models (n = 2571), higher birth order was associated with an increased risk of both suicide attempts (OR = 1.42, CI = 1.10-1.84) and psychiatric disorder (OR = 1.29, CI = 0.99-1.69). Maternal depression and father absence only partially mediated (8%; 12%) these associations. Whilst maternal depression and paternal absence partially mediated the associations between birth order, and suicidal behaviour and psychiatric disorder, other pathways may account for much of these associations. Future studies should investigate alternative mediating pathways.