Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries

Exploring the Mediating Role of Self-Regulation in Bullying Victimization and Depressive Symptoms among Adolescents: A Cross-Regional and Gender Analysis

This study explores the mediating role of self-regulation in the relationship between bullying victimization and depressive symptoms among adolescents, considering the moderating effects of gender and region. A cross-sectional analysis was conducted with 3984 adolescents aged 12-18 from the United Kingdom, Hong Kong, Taiwan, and the Netherlands. Data were collected via an online survey administered through Qualtrics. The survey included validated measures such as the Illinois Bullying Scale (IBS) to measure bullying victimization, the Adolescent Self-Regulatory Inventory (ASRI) to measure self-regulation, and the Patient Health Questionnaire (PHQ) to measure depression. The SPSS macro PROCESS was employed for data analysis, with model 4 used for testing the mediating effects of self-regulation and model 1 for assessing the moderating effects of gender and region. The results demonstrated significant associations between bullying victimization, self-regulation, and depressive symptoms. Self-regulation mediated the positive association between bullying victimization and depression, with notable variations across genders and regions. Specifically, male students in Hong Kong exhibited an increased susceptibility to depression when subjected to bullying. These findings underscore the protective role of self-regulation in mitigating the adverse effects of bullying victimization on adolescent mental health. Implications for interventions and prevention strategies targeting adolescent depression are discussed.

Factors associated with health-related quality of life among people with visual impairments living in nursing homes in Armenia: a cross-sectional study

PURPOSE

The study aimed to examine the effect of visual impairment (VI), eye diseases, and other risk factors on health-related quality of life (HRQoL) in nursing home residents in Armenia.

METHODS

This cross-sectional study administered an interviewer-administered structured questionnaire to collect information about socio-demographics, chronic diseases, HRQoL, smoking, receiving and giving instrumental/emotional social support, and sleeping disorders among 313 nursing home residents. An ophthalmic examination of the participants was conducted.

RESULTS

The mean age was 72.5 years, ranging from 45.5 to 91.4. Women constituted 50% of the sample. The prevalence of normal vision by presenting visual acuity with available correction was 55.3%, while VI and blindness were present in 40.8% and 3.9%, respectively. Uncorrected refractive error (URE) was found in 20% of participants. The mean HRQoL score was 51.3, ranging from 7.9 to 95.0. In the adjusted analysis, having at least one chronic non-communicable disease, sleeping disorders, eye diseases, URE, VI, blindness, and giving instrumental social support were associated with HRQoL.

CONCLUSIONS

Regular eye care services could improve the eye health and HRQoL of nursing home residents. Interventions addressing vision loss and chronic non-communicable diseases could enhance the functioning and overall well-being of the target population.

Basic moral sensitivity, moral disengagement, and defender self-efficacy as predictors of students' self-reported bystander behaviors over a school year: a growth curve analysis

Though school children tend to view peer victimization as morally wrong most do not to intervene on the victim's behalf and some instead choose to aid the victimizer. The aim of this longitudinal study was to investigate how students' defending and pro-aggressive bystander behaviors evolved over the course of one school year and their association to basic moral sensitivity, moral disengagement, and defender self-efficacy. Three-hundred-fifty-three upper elementary school students (55% girls; 9.9-12.9 years of age) each completed self-report surveys at three points during one school year. Results from latent growth curve models showed that pro-aggressive bystander behavior remained stable over the year, whereas defending behavior decreased. Moreover, students who exhibited greater basic moral sensitivity were both less likely to be pro-aggressive and simultaneously more likely to defend. Students with defender self-efficacy were not only associated with more defending behavior at baseline but also were also less likely to decrease in defender behavior over time. Conversely, students reporting a higher degree of moral disengagement were linked to more pro-aggressive behavior, particularly when also reporting lower basic moral sensitivity. These short-term longitudinal results add important insight into the change in bystander behavior over time and how it relates to students' sense of morality. The results also highlight the practical necessity for schools to nurture students' sense of morality and prosocial behavior in their efforts to curb peer victimization.

The healthy context paradox: a cross-country analysis of the association between bullying victimisation and adolescent mental health

Bullying victimisation is an increasing global health problem among adolescents and is associated with short- and long-term adverse mental health outcomes. Investigating whether associations with mental health vary across national contexts and why, can provide insights into mechanisms underlying those associations and inform policy. We used data from 479,685 adolescents participating in the 2018 Program for International Student Assessment (PISA) cross-sectional survey and examined whether the associations between bullying victimisation, psychological distress and life satisfaction vary across 63 countries. We further tested the modifying role of country-level factors - bullying prevalence, income inequality and national wealth, by implementing multilevel cross-country analyses. We found significant associations between bullying victimisation, increased psychological distress (β = 0.181; 95%CI: 0.178, 0.184) and decreased life satisfaction (β = -0.158; 95%CI: -0.162, -0.155). Associations between bullying victimisation, psychological distress and life satisfaction among adolescents were consistent across countries in terms of direction but effect sizes varied substantially. The effects ranged from β = 0.08 in the Philippines to β = 0.40 in South Korea for psychological distress and from β = -0.05 in the Philippines to β = -0.36 in the United Kingdom for life satisfaction. In addition, consistent with the "healthy context paradox" effect, associations between bullying and mental health were larger in countries where the prevalence of bullying was lower, as well as in higher-income countries. Interventions aiming to reduce bullying victimisation should aim to provide additional targeted support for those who still experience bullying after the intervention.

A short-term longitudinal study on the development of moral disengagement among schoolchildren: the role of collective moral disengagement, authoritative teaching, and student-teacher relationship quality

The aim of this study was to examine whether collective moral disengagement and authoritative teaching at the classroom level, and student-teacher relationship quality at the individual level, predicted individual moral disengagement among pre-adolescent students 1 year later. In this short-term longitudinal study, 1,373 students from 108 classrooms answered a web-based questionnaire on tablets during school, once in fifth grade (T1) and once in sixth grade (T2). The results showed, after controlling for T1 moral disengagement, gender, and immigrant background, that students with better student-teacher relationship quality at T1 were more inclined to score lower on moral disengagement at T2, whereas students in classrooms with higher levels of collective moral disengagement at T1 were more inclined to score higher on moral disengagement at T2. In addition, both collective moral disengagement and authoritative teaching were found to moderate the associations between student-teacher relationship quality at T1 and moral disengagement at T2. These findings underscore the importance of fostering positive relationships between students and teachers, as well as minimizing collective moral disengagement in classrooms. These measures may prevent the potential escalation of moral disengagement in a negative direction.

The meditating role of sleep in the longitudinal associations between peer victimization and internalizing symptoms: A cross-lagged panel analysis

Adolescence is a time of heightened vulnerability for both peer victimization (PV) and internalizing symptoms. While the positive association between them is well established, there is little understanding of the mechanisms underpinning this relationship. To address this gap, the current study aimed to investigate sleep hygiene and school night sleep duration as individual and sequential mediators of the relationship between PV and both depressive and social anxiety symptoms during pre- to mid-adolescence. The study drew upon a community sample of 528 Australian youth aged 10-12 years at baseline (M age = 11.19, SD = .55; 51.1% boys) and data were collected over five annual measurement occasions. Direct and indirect longitudinal and bidirectional associations were examined using cross-lagged panel analysis. There was no evidence of sequential mediation through both sleep hygiene and sleep duration to depression and social anxiety. Instead, the findings show that sleep hygiene mediated the prospective association between PV and both depressive and social anxiety symptoms, and between PV and sleep duration. Overall, sleep hygiene represents a modifiable transdiagnostic factor that can be targeted to break the cycle of PV, inadequate sleep, and internalizing symptoms.

Bullying at School, Cyberbullying, and Loneliness: National Representative Study of Adolescents in Denmark

AIMS

The aim was to examine how loneliness was associated with bullying victimization at school and online.

METHODS

We used data from the Danish arm of the international Health Behavior in School-aged Children (HBSC) study from 2022. The study population was a nationally representative sample of 11-15-year-olds who completed the internationally standardized HBSC questionnaire at school, n = 5382. Multilevel logistic regression was applied to study the associations between bullying victimization and loneliness.

RESULTS

The prevalence of reporting loneliness often or very often was 9.0%; 6.3% of the sample experienced habitual bullying victimization at school, and 4.8% incurred cyberbullying. There was a strong and graded association between loneliness and bullying victimization at school and cyberbullying. The associations were significant for boys and girls, and the association between exposure to bullying at school and loneliness was steeper for boys than girls. The gradients were steeper for physical bullying than for cyberbullying. Students exposed to habitual bullying in both contexts had an adjusted OR (95% CI) of 11.21 (6.99-17.98) for loneliness.

CONCLUSION

Exposure to bullying at school and cyberbullying are strongly associated with loneliness. It is important to reduce bullying at school and on the internet and to promote effective interventions to reduce continuing loneliness.

Bullying, Peer Victimization, and Quality of Life in Pediatric Hearing Loss Patients: A Pilot Study

OBJECTIVE

The primary objective of this pilot study is to describe the impacts of bullying and peer victimization (BPV) in children with hearing loss.

STUDY DESIGN

Prospective clinical survey study.

METHODS

This pilot study enrolled children between 8 and 18 years who were administered validated surveys at an outpatient clinic between July 2020 and March 2022. Surveys included health-related quality of life questionnaires (PedsQL and EQ-5D-Y), along with bullying and peer victimization questionnaires ("My Life in School" and the multidimensional peer victimization scale). Responses were scored with multivariate analysis. Clinical histories and active ICD-10 codes were also collected.

RESULTS

About 105 patients were recruited with a mean age of 13.1 years (SD = 3.15) and hearing loss (n = 30) among the top otolaryngological diagnoses. When surveying patients with hearing loss, 50.0% (n = 15) actively used a hearing aid device. Children (ages 8-12 years) with hearing loss reported a significantly lower psychosocial health-related quality of life than their peers without hearing loss (P = .007), though this was not the case for adolescents (ages 13-18 years) with hearing loss (P = .099). These trends did not change significantly before or after students resumed in-person classes. Children who wore hearing aids did not report a different BPV level than their peers.

CONCLUSION

In this small sample of school-aged children, any hearing loss, even with mild severity, was associated with diminished health-related quality of life; however, this was unrelated to hearing aid use. Wearing a hearing aid did not appear to be linked to higher bullying and peer victimization rates. Along with further studies on BPV with larger sample sizes, the findings in this study may help physicians counsel parents and children on the psychosocial aspects of hearing loss treatment and guide care decisions.

LEVEL OF EVIDENCE

3.

Sexual victimisation, peer victimisation, and mental health outcomes among adolescents in Burkina Faso: a prospective cohort study

BACKGROUND

Sexual victimisation and peer victimisation are pervasive and increase risk for mental illness. Longitudinal studies that compare their unique and cumulative effects are scarce and have been done predominantly in high-income countries. The aims of this study were to examine the prevalence, prospective associations, and gender differences in sexual and peer victimisation and mental health in a low-income, African setting.

METHODS

In this prospective cohort study, data were obtained from the 2017 ARISE Adolescent Health Study, a population-representative, two-wave, prospective study of adolescents (aged 12-20 years) from Burkina Faso. A random sample of adolescents was drawn from ten villages, selected to capture the five main ethnic groups, and from one of the seven sectors of Nouna town, Burkina Faso, at two timepoints: Nov 12 to Dec 27, 2017, and Nov 15 to Dec 20, 2018. Standardised interviews were conducted in French or a local language by trained researchers. We measured victimisation exposure as sexual victimisation, peer victimisation, and polyvictimisation, using lifetime frequency of exposure, and we measured mental health symptoms and disorders using the Kutcher Adolescent Depression Scale, the Primary Care Post-Traumatic Stress Disorder screen IV and 5, and a question on lifetime self-harm and number of incidents in the past year. We calculated prevalence of victimisation and mental health symptoms and disorders at the two timepoints, and we used lifetime victimisation at the first timepoint to predict mental health at the second timepoint using logistic and negative binomial regressions. Gender differences were examined using interaction terms.

FINDINGS

Of 2544 eligible adolescents, 1644 participated at time 1 and 1291 participated at time 2. The final sample with data at both timepoints included 1160 adolescents aged 12-20 years (mean 15·1, SE 0·2), of whom 469 (40·4%) were girls and 691 (59·6%) were boys. The majority ethnic group was Dafin (626 [39·1%]), followed by Bwaba (327 [20·5%]), Mossi (289 [16·0%]), Samo (206 [13·0%]), Peulh (166 [9·7%]), and other (30 [1·6%]). After survey weight adjustment, sexual victimisation (weighted percentages, time 1, 256 [13·8%] of 1620; time 2, 93 [7·2%] of 1264) and peer victimisation (weighted percentages, time 1, 453 [29·9%] of 1620; time 2, 272 [21·9%] of 1264) were common, whereas polyvictimisation was more rare (weighted percentages, time 1, 116 [6·6%] of 1620; time 2, 76 [5·7%] of 1264). Longitudinally, sexual victimisation was associated with probable clinical disorder (adjusted odds ratio 2·59, 95% CI 1·15-5·84), depressive symptoms (adjusted incidence rate ratio [aIRR] 1·39, 95% CI 1·12-1·72), and symptoms of post-traumatic stress disorder (aIRR 2·34, 1·31-4·16). Peer victimisation was associated with symptoms of post-traumatic stress disorder (aIRR 1·89, 1·13-3·17) and polyvictimisation was associated with depressive symptoms (aIRR 1·34, 1·01-1·77). Girls reported more sexual victimisation (weighted percentages, 130 [17·3%] of 681 vs 126 [11·4%] of 939), boys reported more peer victimisation (weighted percentages, 290 [33·1%] of 939 vs 163 [25·2%] of 681), and there was a significant interaction between lifetime victimisation and gender for probable clinical disorder (F [degrees of freedom 7, sample 376] 2·16; p=0·030).

INTERPRETATION

Sexual and peer victimisation were common in the study setting and increased risk for mental health problems. Adolescent girls who have been sexually victimised are especially at risk of mental health problems. Interventions targeting sexual and peer violence in low-income settings are needed.

FUNDING

Alexander von Humboldt Foundation, the Wellcome Trust, Fondation Botnar, and Harvard TH Chan School of Public Health.

Recognizing the Frequency of Exposure to Cyberbullying in Children: The Results of the National HBSC Study in Serbia

Nowadays, children are able to enrich their reality via the Internet. Unfortunately, this may increase their risk of becoming victims of cyberbullying. We analyzed the health characteristics and risk behavior of two cohorts of children in Serbia; those who reported being exposed to cyberbullying and those who did not. The statistical differences and logistic regression models were applied to the data on 3267 students collected from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). Children exposed to cyberbullying reported having the following health problems on a daily basis: headache (18.5%), back pain (19.5%), depression (21.6%), irritability or bad mood (17.7%), nervousness (16.0%), sleep problems (16.1%), and dizziness (21.2%). As for the different types of risk behavior, cigarette smoking ranging from six to nine days ever was the most prevalent (26.9%). It was followed closely by getting drunk more than 10 times ever (24.1%). Compared to non-victims, victims were found to be at a higher risk of perceived back pain (OR = 2.27), depression (OR = 1.43), irritability or bad mood (OR = 2.07), nervousness (OR = 2.23), and dizziness (OR = 2.43) as well as being injured once or twice (OR = 1.98) or three or more times (OR = 4.09). Victims were associated with further risk factors: having smoked more than five cigarettes ever in life (OR = 1.73) and having gotten drunk two to three times (OR = 1.71) or four or more times (OR = 1.65). As the number of school-age children using social media continues to rise, we must prioritize educating them about self-help and community resources for addressing related health issues with greater speed and intensity. The findings from Serbia suggest that while children may be aware of their health issues, they may be unaware of their link to cyberbullying, which could hinder their ability to address these issues promptly. The respondents' attention to the health implications of cyberbullying could be increased by reformulating the survey questions used in the HBSC study.

Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study

Frequent and increasing use of over-the-counter analgesics (OTCA) is a public health concern. Pain conditions and psychological distress are related to frequent OTCA use, and as exposure to potentially traumatic events (PTE) in childhood appears to increase risk of experiencing such symptoms, we aimed to assess childhood PTEs and related symptoms in adolescence as predictors for frequent OTCA use in young adulthood. Prospective population survey data were used (n = 2947, 59.1% female, 10-13 years follow-up). Exposure to PTEs, symptoms of post-traumatic stress, anxiety and depression, musculoskeletal pain and headache were assessed in adolescence (13-19 years). Use of OTCA was assessed in young adulthood (22-32 years) and use of OTCA to treat musculoskeletal pain and headache served as separate outcomes in ordinal logistic regression analyses. Overall, exposure to childhood PTEs, particularly direct interpersonal violence, was significantly and consistently related to more frequent use of OTCA to treat musculoskeletal pain and headaches in young adulthood. Adjusting for psychological symptoms and pain attenuated associations, indicating that these symptoms are of importance for the relationship between traumatic events and OTCA use. These findings emphasize the need to address symptomatology and underlying causes at an early age.

Recurrent headache, stomachache, and backpain among adolescents: association with exposure to bullying and parents' socioeconomic status

OBJECTIVES

Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain.

METHODS

Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738.

RESULTS

The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11).

CONCLUSIONS

Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.

Association of Bullying Victimization With Suicide Ideation and Attempt Among School-Going Adolescents in Post-conflict Liberia: Findings From the Global School-Based Health Survey

Background School-based bullying is a global problem that negatively impacts the victims' and perpetrators' health and well-being. There is a paucity of data regarding bullying in schools and its association with suicide behaviors among adolescents in Liberia. Objective The study investigated the impact of bullying victimization on suicidal thoughts and suicide attempts among adolescents in Liberia. It aimed to provide insights into the consequences of bullying victimization on adolescents' mental health regarding their thoughts of self-harm and suicide attempts. Methods The study utilized data from the 2017 Liberia Global School-based Health Survey (GSHS) to analyze information on 2744 students between the ages of 11 and 18 years, with 52.4% being males. Prevalence rates of bullying victimization and suicide behaviors were calculated using descriptive statistics. Multiple logistic regressions were used to model the relationship between being bullied and experiencing suicidal behaviors (ideation and attempts). Results Among the 2744 adolescents examined, 20% experienced suicidal thoughts, with about 30% of the adolescents reporting suicide attempts at some point in the year preceding the survey. Within 30 days prior to the survey, the prevalence of bullying victimization was 50%, with 44.9% experiencing frequent victimization (3 or more days). Bullying victimization was significantly linked to increased odds of suicidal ideation with planning (aOR: 1.86; P < 0.001), at least a suicide attempt (aOR: 2.16; P < 0.001), and multiple attempts at suicide (aOR: 2.67; P < 0.001). We also observed that a greater number of days bullied was dose-dependently associated with higher odds for suicide ideation and attempts. Conclusion These findings support and extend those from other developing countries, highlighting the association between school-based bullying and suicidal behaviors. The relatively high prevalence of bullying among adolescents in Liberia underscores the importance of implementing effective anti-bullying policies and suicide prevention strategies in schools.

Socioeconomic Differences in the Association Between Bullying Behaviors and Mental Health in Canadian Adolescents

BACKGROUND

Bullying and poverty are each associated with poor health in adolescents. We examined socioeconomic differences in the association of bullying and health.

METHODS

The 2017/2018 Canadian Health Behaviour of School-aged Children study surveyed 21,750 youth (9-18 years). We used linear regression models to investigate interactive effects of bullying involvement (traditional and cyberbullying) and socioeconomic position (SEP) on self-reported life satisfaction, psychological symptoms, and physical symptoms.

RESULTS

Involvement in either form of bullying, as a perpetrator or a target, was associated with worse health and well-being compared to uninvolved youths. Associations of victimization via conventional bullying with low life satisfaction (b = -.33 [-.61, .05]), more psychological symptoms (b = .83 [.27, 1.38]), and more somatic symptoms (b = .56 [.14, .98]) were stronger at lower SEP.

CONCLUSION

Socioeconomic disadvantage intensifies the association between bullying victimization and poor health. The intersections of victimization and poverty pose a significant health risk to adolescents.

Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study

OBJECTIVE

Frequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain.

DESIGN

A cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA.

SETTING AND PARTICIPANTS

All 10 608 adolescents aged 13-19 years in a region of Norway were invited in this school-based survey, participation rate was 76%.

OUTCOME MEASURE

Frequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses.

RESULTS

Trauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose-response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed.

CONCLUSION

Trauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.

Association of bullying victimization with suicidal ideation and suicide attempt among school students: A school-based study in Zhejiang Province, China

BACKGROUND

Evidence of associations between type-specific bullying victimization and suicidal ideation and suicide attempt among adolescents is scant. This study examined these associations among middle and high school students in China.

METHODS

A cross-sectional study of 27,030 students with mean age of 15.7 ± 1.7 years, including 13,946 boys and 13,084 girls, was carried out between April and June 2022.

RESULTS

The prevalence of suicidal ideation and attempt was 19.7 % and 2.9 %, respectively. 30.0 % (95%CI: 28.8-31.1) of students reported being bullied (i.e., bullying victimization) in the past 30 days, and the corresponding figs. (95%CI) for verbal bullying, relational bullying, property-related bullying, physical bullying, and cyberbullying were 11.0 % (10.4-11.7), 2.8 % (2.5-3.0), 1.9 % (1.7-2.2), and 5.7 % (5.3-6.0), respectively. After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, compared to those who reported not being bullied in the past 30 days, the odds ratios (95%CI) for suicidal ideation and suicide attempt among students who reported being bullied were 1.75 (1.60-1.90) and 2.01 (1.63-2.52), respectively. The corresponding odds ratios (95%CI) for verbal bullying were 1.77 (1.61-1.93) and 2.09 (1.67-2.61), respectively, for relational bullying were 1.77 (1.57-2.00) and 2.31 (1.79-2.98), respectively, for property-related bullying were 1.88 (1.48-2.37) and 2.44 (1.60-3.70), respectively, for physical bullying were 1.79 (1.30-2.47) and 2.86 (1.67-4.90), respectively, and for cyberbullying were 2.02 (1.71-2.39) and 2.83 (2.08-3.84), respectively.

CONCLUSION

All types of bullying victimization are strongly associated with both suicidal ideation and suicide attempt among middle and high school students.

Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging

Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.

School bullying victimization and post-traumatic stress symptoms in adolescents: the mediating roles of feelings of insecurity and self-disclosure

BACKGROUND

Posttraumatic stress symptoms (PTSSs) is known to be a typical problem for school bullying victims. However, the underlying mechanism between school bullying victimization and PTSSs remains unknown. This study examined the mediating roles of feelings of insecurity and self-disclosure in the relationship between school bullying victimization and PTSSs in adolescents.

METHODS

Self-report questionnaires were used to assess 5013 adolescents; 443 of them with school bullying experiences were selected to carry out this study.

RESULTS

The results found that school bullying victimization was directly related to more PTSSs, indirectly associated with more PTSSs through feelings of insecurity, and through the path from feelings of insecurity to self-disclosure. However, school bullying victimization did not exert an indirect effect on PTSSs through one step effect of self-disclosure.

CONCLUSIONS

These findings indicated that feelings of insecurity and self-disclosure mediated the relationship between school bullying victimization and PTSSs. The psychological service should reduce adolescents' feelings of insecurity and give them more chances to disclose their bullying experiences.

Geographical variations in the prevalence of traditional and cyberbullying and its additive role in psychological and somatic health complaints among adolescents in 38 European countries

OBJECTIVES

To explore geographical variations in the prevalence of traditional and cyberbullying and their individual and additive role on psychological and somatic health issues of adolescents.

METHODS

We used cross-sectional data from 188,003 adolescents (50.9% females; mean age 13.6 years) from the nationally representative Health Behaviour in School-aged Children 2014 survey in 38 European countries. Multivariable linear regression analyses were conducted to explore the role of bullying on health outcomes whilst meta-analyses were conducted to generate pooled regression coefficients.

RESULTS

Overall, the prevalence of traditional bullying was 26.9%, ranges from 8.8% in Armenia to 49.7% in Latvia, and cyberbullying was 15.8%, ranges from 5.8% in Greece to 38.3% in Greenland. 1 in 10 (8.4%) adolescents reported experiencing both forms of bullying, with the prevalence ranging from 2.5% (Greece) to 21.0% (Greenland). Meta-analytic estimates suggest a significant role of both traditional and cyberbullying in poor somatic and psychological health issues. The additive effect of both forms of bullying was more prominent on psychological health issues (β 0.70, 95% CI 0.66-0.74) than on somatic health issues (β 0.50, 95% CI 0.47-0.53). These associations varied across countries.

CONCLUSION

The prevalence of traditional and cyberbullying varied significantly across European countries while their individual and additive links with an increased risk of poor psychological and somatic health issues remain common in majority countries. To ensure both forms of bullying are prevented, a multifaceted approach and particular attention to mental health issues in bullying victims are needed in countries with high prevalence of bullying.

The severe impact of the COVID-19 pandemic on bullying victimization, mental health indicators and quality of life

Children and adolescents have been severely affected by the COVID-19 pandemic. The aim of this study was to explore the prevalence of traditional and digital bullying and mental health problems a year into the pandemic. Further, how anxiety level, loneliness, and self-perceived school functioning have influenced the quality of life. A comprehensive questionnaire was administered (N = 1239) in the city of Tromsø and compared to a similar data collection (N = 972) conducted in the same schools in 2017. The main findings were increased prevalence in bullying, more mental health problems and significantly reduced quality of life compared to before the pandemic. Implications and the importance of implementing anti-bullying and psychosocial measures after the pandemic are discussed.

Bullying Victimization and Quality of Life among Chinese Adolescents: An Integrative Analysis of Internet Addiction and Social Withdrawal

Bullying victimization has been proven to be a direct predictor of adolescents' quality of life, whereas elaborate mechanisms remain inconclusive. This study aims to explore the mediating pathway of Internet addiction and social withdrawal on the relationship between bullying victimization and quality of life among Chinese adolescents. This study used the cross-sectional data collected by self-reported questionnaires, including multidimensional peer-victimization scale, youth quality of life instrument-short form, prolonged social withdrawal questionnaire, and compulsive Internet use scale. A total of 1278 participants from four junior middle schools and two high schools participated in the questionnaire survey. SPSS 25.0 and Amos 25.0 were adopted to analyze the data. The results indicated that bullying victimization was directly and indirectly associated with adolescents' quality of life. Internet addiction and social withdrawal partially mediated the relationship between bullying victimization and quality of life among adolescents. The current study demonstrated the underlying pathway of how bullying victimization affected adolescents' quality of life, which could provide an intervention perspective for governments and social workers to improve adolescents' quality of life by controlling Internet addiction and social withdrawal.

Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats

BACKGROUND

While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.

OBJECTIVE

To examine caregiver: (1) rates of disclosure of their child's exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.

METHODS

Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016-2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.

RESULTS

PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p <0.05). This difference was accentuated for children identified as black and/or male (p <0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.

CONCLUSION

While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.

TRIAL REGISTRATION

Clinical trial registry: NCT04182906.

Bullying victimization and depressive symptoms in Chinese adolescents: A moderated mediation model of self-esteem and friendship intimacy

BACKGROUND

Depression is a major mental disorder and poses a serious threat to public health. Bullying victimization is identified as one of the major risk factors for depression in adolescence. Understanding the mechanism that explain why bullying victimization leads to depression, and identifying protective factors that could alleviate the negative effects of bullying victimization are pivotal to developing effective intervention programs.

METHODS

A sample of Chinese adolescents in junior high schools (N = 458, 50.58 % girls, M age = 11.63 years at T1) was followed for three years. The data on depression, bullying victimization, self-esteem, and friendship intimacy were collected from adolescents' self-report.

RESULTS

After controlling related variables, T1 bullying victimization positively predicted T3 depressive symptoms. T2 self-esteem mediated the link between T1 bullying victimization and T3 depressive symptoms when T1 friendship intimacy was low. More specifically, only for youth who reported low friendship intimacy, bullying victimization would lead to a lower level of self-esteem, which in turn, was associated with a higher level of depression.

LIMITATIONS

The study only considered the roles of self-esteem as the mediator and friendship intimacy as the moderator. All measures were based on self-report.

CONCLUSIONS

The results highlighted the role of friendship intimacy and self-esteem in the longitudinal relation between bullying victimization and depressive symptoms. The results suggest that intervention programs aiming at reducing victimized adolescents' depressive symptoms should consider the buffering effect of friendship intimacy.

Association of single child family with subjective health complaints in children and adolescents

The number of single-child families has been increasing across developing countries during the last decades. We aimed to examine the association between being a single child (SC) and subjective health complaints (SHCs) in Iranian children and adolescents. This study was conducted as a part of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V). This national survey included a total of 14,400 students 7-18 years and their parents from rural and urban areas in 30 provinces of Iran. Data on demographic characteristics, lifestyle variables, and SHCs were measured using the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS). Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of being an SC with SHCs. Data on 14,151 participants were available for this study, of whom 7.7% (1092) were SCs. The most frequent SHCs were irritability (37.1%, 95%CI: 36.3-37.9%), feeling nervous 32.5%, 95% CI: (31.7-33.3%), and headache 24.3%, 95%CI: (23.6-25.0% ). In the multivariate model, being an SC significantly increased the odds of dizziness [adjusted OR (95% CI): 1.37(1.08-1.72)] and backache complaint [1.22(1.01-1.47)]. The association of being an SC with other SHCs (feeling low, irritability, feeling nervous, difficulty in getting to sleep, headache, stomachache) was not statistically significant (p value > 0.05). Our results suggest that being an SC may be associated with higher odds of dizziness and backache complaints.

Cyberbullying Among Adolescents with Chronic Illnesses in Thailand: Prevalence and Relationship with Health-Risk Behaviors

BACKGROUND

The use of social media may enhance the quality of life in adolescents living with chronic illnesses but may increase the risk of cyberbullying.

OBJECTIVE

The aim of this study was to estimate the prevalence of cyberbullying among adolescents with chronic illnesses and relationship with health-risk behaviors.

METHODS

This is an online survey of randomly recruited adolescents aged 11 to 18 years with chronic illness managed at Siriraj Hospital, Thailand, during 2019 to 2020. Participants were asked to respond anonymously to validated online questionnaires to evaluate health-risk behaviors, experience with cyberbullying, and depression-screening questions.

RESULTS

Three hundred forty-one participants with a mean age of 15.02 ± 2.17 years (interquartile range 12.8, 17.2) responded. Reported risk behaviors included sexual activity in 42 participants (12.3%) with almost half (47.6%) having practiced unsafe sex. Alcohol drinking and polysubstance use were also found in 8.5% and 1.2%, respectively. 38 (11.1%) felt depressed within the previous 2-week period. 56 (16.4%) had been a cyberbully victim. Among the victims, 25 (44.6%) were also cyberbullies themselves. Chronically ill adolescents were more likely to be a victim of cyberbullying if they knew someone who had also been a victim (adjusted odds ratio [aOR] 5.25 [95% confidence interval [CI] = 1.80-15.29], p < 0.001) or had a positive depression screening (aOR 6.182 [95% CI = 2.41-15.85], p < 0.001). Underlying diseases, age, sex, risky behaviors, and time spent online were not associated with being cyberbullied.

CONCLUSION

Thai adolescents with chronic illness were similar to their healthy peers regarding health-risk behaviors and the likelihood of being a victim of cyberbullying. Screening for risky behaviors, evidence of depression, and online activity during routine medical visits was an opportunity to prevent cyberbullying.

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

School assets and bullying in Chinese youth: A multiple mediation model of intentional self-regulation and internet gaming disorder

Bullying is a severe social problem affecting young people all over the world. Previous studies suggested that engagement in bullying had massive effects on teenagers' physical and psychological development. It is critical and necessary to investigate the antecedents and underlying mechanisms of this phenomenon among young generations. The present study, based on the positive youth development perspective and the developmental assets theory, attempts to explore the positive factors in the school subsystem that could effectively prevent adolescents from bullying, as well as the multiple mediation effects of intentional self-regulation (ISR) and internet gaming disorder (IGD). In this study, we adopted a two-wave design and recruited a sample of 768 Chinese adolescents using a randomized cluster sampling method in the post-pandemic era. The results revealed that T1 school assets significantly and negatively predicted T2 adolescent bullying. Furthermore, T2 ISR and T2 IGD mediated the association between T1 school assets and T2 bullying separately and sequentially. Overall, school resources play a protective role in adolescent development and could effectively prevent them from negative outcomes. These current findings contribute to the literature by providing a further understanding of the direct and indirect protective effects of school assets on adolescent bullying. Moreover, practitioners could also benefit from these findings in preventing and intervening in bullying in the school subsystem.

Do Spiritual Health Connections Protect Adolescents When They Are Bullied: A National Study of 12,593 Young Canadians

It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health-the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11-15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of "connections to self" (i.e., a sense of meaning/purpose or joy and happiness in one's life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26-2.12] and 1.25 [1.06-1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered.

Weekday sleep duration and morning tiredness are independent covariates of breakfast skipping in adolescents

BACKGROUND/OBJECTIVES

Although regular breakfast consumption is associated with various health benefits, many adolescents skip this meal, particularly those with shorter sleep durations. In order to better understand the association between sleep duration and breakfast consumption among youth, we analyzed the association between weekday morning tiredness and daily breakfast consumption in adolescents, and explored the mediating role of morning tiredness in the association between sleep duration and daily breakfast consumption on weekdays.

SUBJECTS/METHODS

The "Health Behaviour in School-aged Children" survey conducted in 2018 in French-speaking Belgian schools provided data (n = 8444 11-20-year-old adolescents) on bed- and wake-up times, and on the frequency of breakfast consumption and morning tiredness on weekdays. Multivariable logistic regressions and mediation analyses assessed the association, on weekdays, of morning tiredness (≥4 school mornings a week vs. less) and sleep duration (hours), with daily breakfast consumption, and the mediating role of morning tiredness.

RESULTS

Feeling tired ≥4 school mornings a week was associated with lower odds of daily breakfast consumption on weekdays (aOR = 0.77 (95% CI 0.69-0.86)). In turn, on weekdays, sleep duration was positively associated with daily breakfast consumption (aOR = 1.29 (95% CI 1.23-1.36)), even after adjustment for morning tiredness (aOR = 1.28 (95% CI 1.21-1.35)). Morning tiredness only explained 4.9% of the association between sleep duration and daily breakfast consumption.

CONCLUSION

Our findings suggest that in adolescents, sleep duration and morning tiredness are independent correlates of daily breakfast consumption on weekdays.

Bullying, Mental Health, and the Moderating Role of Supportive Adults: A Cross-National Analysis of Adolescents in 45 Countries

Objectives: Relationships with supportive adults during adolescence may be a protective factor that lowers the risks associated with bullying. The current study aimed to examine the moderating role of supportive adults in the associations between bullying involvement (in-person and cyber) and mental health problems (psychological symptoms and low life satisfaction).

Methods: Data from 45 countries and regions taking part in the 2017/18 Health Behaviour in School-Aged Children study (N = 230,757) were used. Multivariable Poisson regression models were used to estimate relative risks of bullying on mental health. Effect estimates were compared across the number of supportive adults to examine a possible cumulative protective effect of relationships with supportive adults.

Results: Bullying involvement was consistently associated with poor mental health across the 45 countries. Risk of mental health problems associated with bullying involvement was greatest among students reporting relationships with multiple supportive adults. This was true for all indicators of bullying involvement.

Conclusion: Bullying remains a prevalent and harmful experience for youth worldwide. Merely having supportive adults is not sufficient in protecting youth from experiencing the mental health risks associated with bullying.

Bullying and lifetime asthma among children and adolescents in the United States

PURPOSE

To examine the association of experiencing bullying within the past year with the prevalence of lifetime childhood asthma in US children and adolescents; and whether this associations vary with sex of the child and select socioeconomic indicators.

METHODS

We performed secondary analysis of data from the 2018 National Survey of Children's Health participants aged 6 to 17 years (n=19,766). We used log-binomial regression to examine the association between bullying and lifetime childhood asthma before and after controlling for select covariates. We also tested interactions of bullying with sex and select socioeconomic indicators.

RESULTS

Children who experience bullying have a significantly increased probability of having asthma in adjusted analyses. The probability of childhood asthma increased with the frequency of bullying with PRs starting at 1.28 (95%CI:1.06, 1.55) for children bullied 1-2 times per year to 1.59 (95%:1.22, 2.09) for those being bullied at least 4 times per month. This association did not differ with sex of the child and select socioeconomic indicators.

CONCLUSION

We found that children who experienced bullying had a greater probability of having asthma relative to those who never experienced bullying. These finding highlight the impact of psychosocial stressors on asthma as a nontraditional trigger in children with asthma.

Prevalence of Bullying and its Co-occurrence with Aggression and Mental Health Problems among Greek Adolescents Attending Urban Schools

BACKGROUND

Bullying is one widespread violence type that threatens adolescent's well-being in family, school, and neighborhood. This study aimed to estimate the percentages of the last 12 months bullying behaviors- types among Greek adolescents, and to identify the associations between these behaviors and adolescents' aggression and mental health- behavioral problems.

STUDY DESIGN

A cross-sectional study.

METHODS

The sample consisted of 1934 adolescents, attending the second grade of 45 randomly selected public and private high schools and senior high schools, of the Greater Athens Metropolitan Area. Bullying involvement was examined by four questions, evaluating the occurrence and type of bullying. The Buss and Perry Questionnaire and Strength and Difficulties Questionnaire were administrated in order to estimate adolescents' aggression and mental health-behavioral problems, respectively. Information about adolescents' individual and family characteristics was also collected.

RESULTS

Overall, 18.4% of participants reported bullying involvement at school, as a victim (11.0%), a bully (5.0%), or both (2.4%), while verbal bullying was the most common type. Compared to uninvolved participants, victims were significantly more likely to report emotional symptoms and peer problems, bullies were more likely to report physical aggression, and bully-victims physical aggression, hostility, and lower prosocial behavior.

CONCLUSIONS

Approximately one out of five adolescents were involved in bullying in the past year at school, reporting aggressive behaviors, emotional problems, and/or social difficulties. Further longitudinal research would increase understanding of the mechanisms of bullying involvement and may lead to preventative interventions promoting positive peer interactions in schools.

Chronic Pain in Schoolchildren and its Association With Psychological Wellbeing Before and During the COVID-19 Pandemic

PURPOSE

The current longitudinal observational study aimed to explore how chronic pain among schoolchildren changed before and during the COVID-19 pandemic, and how changes in chronic pain were related to changes in psychological wellbeing and COVID-19-related experiences.

METHODS

Data were collected from N = 777 German schoolchildren (aged 9-17 years) at two assessments before and one assessment during the COVID-19 pandemic lockdown. Participants self-reported chronic pain experience, anxiety, depression, and quality of life across all assessments; and COVID-19-related experiences at the last assessment. Trajectories of anxiety, depression, and quality of life as well as COVID-19-related experiences were analyzed separately for groups of stable chronic pain trajectories compared to chronic pain trajectories that changed during the pandemic.

RESULTS

Chronic pain prevalence was lowest at the assessment during the COVID-19 pandemic (22.8% vs. 29.2% and 29.9% before the pandemic). However, 4.6% experienced new chronic pain onset during the COVID-19 pandemic. This was preceded by heightened depression and anxiety, as well as lowered quality of life scores. These students were also more likely to describe time with their family during the COVID-19 pandemic as tense compared to students who did not develop chronic pain. During the COVID-19 pandemic boys were more likely to recover from ongoing chronic pain than girls.

CONCLUSIONS

Overall, during the COVID-19 pandemic the prevalence of chronic pain decreased. However, stressful situations and pre-existing vulnerabilities in psychological wellbeing can facilitate the development of chronic pain during the pandemic.

Pre-vaccination vulnerability and suspected adverse events following HPV vaccination. A case-control study nested in the Danish national birth cohort

Previous studies have indicated that girls experiencing suspected adverse events (AE) following HPV vaccination were more vulnerable prior to vaccination. However, no study has previously investigated differences in vulnerability using prospectively collected self-reported measures of vulnerability. The objective of this study therefore was to describe the distribution of biological and psychosocial indicators of vulnerability in girls referred to a hospital setting due to suspected adverse events and compare it with a sample of non-referred HPV vaccinated girls. The study was conducted as a case control study based within the Danish National Birth Cohort. Cases were defined as HPV vaccinated girls referred to a hospital setting between 2015 and 2017 due to suspected adverse events (n = 80), and 5 controls were randomly selected from the remaining source population, matched to cases on age at vaccination, region of residence and year of vaccination. The final study population consisted of 480 girls. Prior exposures were based on information gathered from an 11 year follow up of the DNBC and included information on self-rated health, frequent health complaints, medication use, bullying, stressful life events and physical activity. Conditional logistic regression analysis was used to estimate the association between each exposure and referral. The percentage of individuals in the exposed category of each exposure was generally higher for cases than controls. Particularly, the odds of being referred were higher for those with low self-rated health compared to high (OR [95%-CI] 2.43 [1.07-5.5]1), those being bullied (OR 3.19 [1.17-8.73]), and those who had taken medication (OR 2.22 [1.32-3.67]). Overall, these results indicated that girls experiencing suspected AE following HPV vaccination were more vulnerable prior to vaccination.

Adolescent School Bullying and Life Skills: A Systematic Review of the Recent Literature

The health consequences of being involved in bullying and cyberbullying are well described for adolescents, but many questions related to the role played by their life skills remain unanswered. Accordingly, this systematic review aims to provide a clear overview of research on the relationships between bullying involvement as a bully, victim, bully-victim or bystander, and adolescents' life skills. This article systematically reviewed 71 relevant empirical studies that met the inclusion criteria, extracted from the PubMed, PsycINFO, Scopus, Sage, Wiley, and SpringerLink databases. Their main findings were categorized according to the three types of life skills described by the World Health Organization: decision-making/problem-solving skills, interpersonal and communication skills, and self-management skills. Results showed relatively consensual outcomes for communication and interpersonal skills (empathy, moral disengagement) and skills for managing stress (coping strategies). Other decision-making or interpersonal skills, such as executive function or theory of mind, were poorly explored, and require further research, if we are to understand how life skills may be involved in bullying. Taken together, our findings highlight methodological heterogeneity and measurement problems in bullying studies that make their results difficult to interpret. Recommendations for prevention/education health researchers and professionals are provided, emphasizing the importance of considering the sociocognitive development of adolescents in bullying prevention.

Additive and Interactive Effects of Victimization on Adolescent Aggression Across Social Settings

Considering that children and adolescents can face multiple exposures to violence due to their involvement in different socialization domains, this study aimed to analyze additive and interactive effects of physical and verbal victimization by parents, peers, and schoolteachers on adolescent aggression across social settings. With regard to parent-child and teacher-adolescent relationships, physical and verbal forms of aggression were differentiated, whereas aggression by and toward peers was assessed by a composite measure of overt and indirect aggression. Data were drawn from three large secondary school surveys of ninth-grade students within one federal German state conducted in the years 2013, 2015, and 2017. Based on a sample of 8,458 adolescents (mean age = 14.9 years), results provided evidence for additive as well as interactive effects of victimization across settings. Controlling for a range of risk factors associated with victimization and aggression, victimization by parents, peers, and teachers was uniquely related to adolescent aggression across social settings. In addition, three significant interaction effects were identified between different combinations of victimization: Students exposed to earlier parent-to-child physical aggression perpetrated more physical aggression toward parents within the last 12 months if they were also recently victimized by peers. Furthermore, parent-to-child physical aggression exacerbated the positive relationship between teacher-to-adolescent physical aggression and adolescent-to-teacher physical aggression. In contrast, exposure to teacher-to-adolescent verbal aggression reduced the positive link between peer-to-adolescent aggression and aggression toward peers. Findings suggest that intervention should be particularly sensitive toward multiple exposure to violence across socialization contexts, as well as toward the interdependence of cross-setting victimization.

Internet-delivered cognitive processing therapy for individuals with a history of bullying victimization: a randomized controlled trial

The purpose of this randomized controlled trial was to test an internet-delivered version of cognitive processing therapy (CPT) for the psychological distress associated with bullying victimization. The sample comprised 52 adults (i.e. 69.20% women; mean age = 43.37 (SD = 12.47); 3.85% ethnic minority) who self-identified as having a lifetime history of bullying victimization. Participants were randomized into three groups, which received 12 sessions of internet-delivered, therapist-guided, and content-modified version of CPT, 12 sessions of internet-delivered and therapist-guided stress management (SM), or a waitlist. Treatment outcomes included maladaptive trauma appraisals, symptoms of posttraumatic stress disorder (PTSD), depression, general anxiety and stress, social anxiety, and anger. Hierarchical linear modeling was used to analyse the data. Findings indicated that CPT was effective in reducing the strength of maladaptive appraisals related to bullying victimization and symptoms of PTSD compared to the waitlist and SM. SM outperformed CPT and the waitlist in reducing symptoms of depression, general anxiety, and stress. In conclusion, the results of this trial suggest that internet-delivered CPT is effective for the psychological distress and maladaptive appraisals associated with bullying victimization but that adaptions might be needed to target more effectively symptoms of anxiety and depression.

The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain

The development, implementation, and qualitative evaluation of smartphone-based pain management applications may provide an opportunity for more optimal management of pediatric pain in the homesetting. The present mixed-method study was conducted to assess a smartphone-based pain management application regarding the feasibility, adherence, participant satisfaction, and effectiveness on pain intensity and quality of life in adolescents with chronic pain. The study was carried out in the quantitative and qualitative stages using a mixed-method approach. The quantitative stage included 128 adolescents who met the ICD-11 criteria of chronic pain. After random allocation, adolescents allocated to the intervention group received a pain management program through a smartphone-based application. No education was given to the adolescents in the control group. The adolescents were assessed regarding pain intensity and different dimensions of quality of life at pre-intervention, post-intervention, and three-month follow-up. The findings in the quantitative stage were explained by qualitative interviews. The findings of the quantitative stage showed significant improvements in the pain intensity, emotional, social, and school functioning but not in the physical functioning of the adolescents. A high level of adherence (78.12%) and satisfaction (Mean = 26.45, SD = 6.45) with thes martphone-based pain management program was found. Based on the qualitative interviews, adolescents' pain management strategies can be classified in three main categories: physical management, psychological management, and interpersonal resources. The results confirm the positive effect of a smartphone-based pain management program on the pain intensity and different dimensions of quality of life of adolescents with chronic pain. Within the context of chronic pain management, a mobile application incorporating both the psychological and physical management of pain may help adolescents with chronic pain to reduce the negative impacts of pain on their life.

The Importance of Pedagogical and Social School Climate to Bullying: A Cross-Sectional Multilevel Study of 94 Swedish Schools

BACKGROUND

Bullying is a public health issue with long-term effects for victims. This study investigated if there was an association between pedagogical and social school climate and student-reported bullying victimization, which dimensions of pedagogical and social school climate were associated with bullying, and if these associations were modified by individual-level social factors.

METHODS

The study had a cross-sectional multilevel design with individual-level data on bullying from 3311 students nested in 94 schools over 3 consecutive school years. School climate was measured with student and teacher questionnaires, aggregated at the school level. The association between school climate and bullying victimization was estimated with multilevel mixed-model logistic regression.

RESULTS

In schools with the most favorable school climate, fewer students reported being bullied. This was especially evident when school climate was measured with the student instrument. Students in schools with favorable climate had an adjusted odds ratio of bullying of 0.74 (95% CI: 0.55-1.00) compared to students in schools with the worst climate. Results from the teacher instrument were in the same direction, but less consistent.

CONCLUSIONS

Improvement in school climate has the potential to affect students both academically, and socially, as well as decrease the prevalence of bullying.

Is bullying in adolescence associated with the development of depressive symptoms in adulthood?: A longitudinal cohort study

BACKGROUND

Being bullied in adolescence is linked to mental health problems like anxiety, depressive- and somatic symptoms and can have negative consequences on both an individual and a societal level. However, evidence regarding the long-term mental health consequences of bullying in adolescence is limited. The aim of this study was to examine whether being bullied at age 15 or 18 was associated with experiencing depressive symptoms at age 28, and to examine whether being bullied at both ages 15 and 18 increased the risk of experiencing depressive symptoms at age 28.

METHODS

A prospective cohort study, which applied data from the West Jutland Cohort Study, was conducted. Bullying and depressive symptoms were measured on the basis of self-reported data from surveys in 2004, 2007 and 2017. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. A total of 1790 participants were included in the study, and analyzed by multiple logistic regressions.

RESULTS

The results showed associations between being bullied at age 15 or 18 and the reporting of depressive symptoms at age 28 when adjusted for potential confounders. An exposure-response relationship was seen in those who were bullied at both ages 15 and 18. This group had the highest risk of developing depressive symptoms at age 28.

CONCLUSIONS

Being bullied in adolescence was associated with developing depressive symptoms in adulthood and there was an exposure-response relationship between being bullied over time and the later reporting of depressive symptoms. The results highlight the need to provide more detailed information to schools and local communities about the negative consequences of bullying. Such increased awareness may help reduce the risk of young people developing depressive symptoms later in life.

Translating Screening into Action: Risk Assessment and Intervention for Bullying in Pediatric Settings

The prevalence and consequences of childhood bullying demand routine screening and intervention in all pediatric health care settings. Although there are many validated screening tools available, there is little guidance on how to assess children at risk and provide interventions based on risk level. Guided by the Screening, Brief Intervention, and Referral to Treatment model for adolescent substance use, we reviewed the literature to identify factors that raise a child's risk level from bullying. In this article, we discuss the five factors identified and propose interventions for differential risk among children. Beyond screening questions and general guidance, a framework for identifying children most at risk of negative outcomes owing to bullying and practical next steps for care is essential. This article outlines such a framework for use by pediatric nurse practitioners and in pediatric care settings at large.

Bullying in adolescents: role, type of violence and determinants

OBJECTIVE

To determine the prevalence of bullying and its determinants among adolescents attending school.

METHOD

An analytical cross-sectional study was conducted with a sample of adolescents, who were selected using a multistage probability sampling, from 20 public educational institutions in a Colombian city, in which a simple and multivariate binomial regression was carried out.

RESULTS

A total of 500 adolescents participated from which 50.4% were women and 53.2% in their middle adolescence. Verbal violence prevailed in 66.5%, followed by physical violence in 32.0% and social bullying in 30.6%. 69.5% of the adolescents have been witnesses, 35.8% victims, and 14.2% aggressors. 80.5% of the aggressors were victims of bullying. In the multivariate analysis, an association was found between being a victim and having disabilities (PR:2.4; CI: 1.6-3.7), verbal aggression in the home (PR: 1.7; CI: 1.2-2.3) and drug abuse (PR: 1.7; CI 1.1-2.8). Being an aggressor was also associated with being a victim (PR: 7.2; CI 3.6-14.3) and alcohol abuse (PR: 2.2; CI: 1.3-3.8).

CONCLUSION

The frequency of bullying observed and the associated determinants demonstrate the persistence of this problem in adolescents and the need to develop a culture of appropriate and inclusive coexistence that goes beyond the school setting.

Parental Reported Bullying among Saudi Schoolchildren: Its Forms, Effect on Academic Abilities, and Associated Sociodemographic, Physical, and Dentofacial Features

Aim

To determine the prevalence of bullying, its forms, and its effect on academic abilities and school attendance, as well as associated sociodemographic, physical, and dentofacial features among Saudi schoolchildren.

Methods

This cross-sectional study recruited a sample of 1131 parents of schoolchildren 8-18 years old and requested them to complete internationally accepted questionnaires for their children. Chi-squared test and logistic regression analysis were used to analyze the data (p < 0.05).

Results

A majority (89.2%) of schoolchildren were bully victims. Physical bullying (48.9%) was the most common form of bullying. The youngest schoolchildren (8-11 years) and those who disliked school classes or neither liked nor hated them, as well as those who were truant from school, were more likely to be victims. In addition, those who had worse grades because of bullying and those who were very often bullied because of good grades or because they showed an interest in school were more likely to be victims. With regard to targeted physical features, teeth were the number one target, followed by the shape of the lips and strength, while tooth shape and color were the most common dentofacial targets, followed by anterior open bite and protruded anterior teeth. Boys and the youngest schoolchildren were more often subjected to bullying because of these features (p < 0.05).

Conclusions

The prevalence of bullying, mainly in a physical form, was high among Saudi schoolchildren, with a negative influence on students' academic abilities. Problems related to teeth, in particular, which can be treated, were targets, mainly for boys and the youngest schoolchildren. More studies are required in Saudi Arabia to explore the issue further among schoolchildren themselves.