Bullying, psychiatric pathology and suicidal behavior

The effect of mobbing on the development of depression in anesthesia workers: A prospective, multicenter, observational study

BACKGROUND

Mobbing in the workplace is a critical problem affecting healthcare workers' psychological health and performance. However, there is a lack of data on the relationship between mobbing and depression and a lack of regulations to create a decent working environment.

OBJECTIVE

We aimed to determine the frequency of exposure to mobbing and the depression levels that may be related to mobbing among the employees of the Anesthesiology and Reanimation Clinic.

METHODS

In this multi-center cross-sectional study, employees were evaluated with Leymann's Inventory of Psychological Terror scale and the Beck Depression Inventory.

RESULTS

Of the participants, 86.2% stated that they were exposed to mobbing. The presence of mobbing was also associated with the presence of psychological and depressive symptoms.

CONCLUSION

The frequency of mobbing was relatively high among Anesthesiology and Reanimation clinic employees. Mobbing exposure was found to be associated with a high level of depression. Institutional and legal precautions should be taken, and awareness of mobbing should be increased to eliminate mobbing and its consequences on healthcare workers.

Parental support and bullying bystander behaviors in Chinese adolescents: Longitudinal mediation through social harmony

Objectives

Bullying in schools is a serious concern worldwide. The active defending or passive bystanding behaviors of bullying bystanders significantly contributes to the prevention of bullying. Relevant studies have increasingly adopted a social-ecological system approach in bullying research. However, the role of parental factors (microsystem) and cultural value (macrosystem) factors in adolescents' bullying behaviors in non-western culture contexts is unclear. Social harmony, which is closely related to social behavior, is a core value in Chinese culture. Exploring the role of social harmony in bullying bystanders in China could enhance our understanding of bullying, and enrich the diversity of the literature. This study aimed to examine the mediation effects of social harmony on the associations between parental support and the bullying bystanders among Chinese adolescents.

Materials and methods

The participants comprised 445 Chinese adolescents (mean age = 14.41, SD = 0.51) from Beijing City, China. A 17-month, two-point longitudinal study was conducted. Parental support, social harmony, and the behavior of bullying bystanders were evaluated at two time points. The hypothesized mediation model was examined using a structural equation modeling approach using bootstrapping techniques.

Results

The results showed that social harmony partly mediated the positive relationship between adolescents' parental support and active defending behaviors, and fully mediated the negative relationship between adolescents' parental support and passive bystanding behaviors.

Conclusion

These results highlight the importance of studying parental and cultural values in research on bullying bystanders.

Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables

OBJECTIVE

To study the prevalence and the type of childhood trauma (CT) in a first-episode psychosis (FEP) cohort and in a healthy control (HC) sample. To study which clinical and sociodemographic variables in the onset of the FEP are related to having suffered some traumatic experience in childhood.

METHOD

100 FEP patients and 94 HC participated in the study. The Childhood Traumatic Questionnaire (CTQ) was used to evaluate CT. The Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance (PSP), the Suicide Risk Scale of Plutchik (SRSP), and the Perceived Stress Scale (PSS) were also administered.

RESULTS

61% of FEP patients and 17% of HC reported having experienced some kind of CT. FEP showed more CT than controls in all subscales, except in sexual abuse. The most frequent CT was emotional abuse. For the FEP group, younger age, more years of education, have a first-degree family history, more positive and negative symptoms, more perceived stress and more personal and social functioning were the variables more influenced by having suffered some kind of CT.

CONCLUSIONS

There is a high prevalence of CT in FEP patients. Having a first-degree family history of mental illness, more positive symptoms, and more perception of stress at the time of hospital admission were related to having suffered CT. More research is needed to find out the best way to detect CT and its role in psychosis to be able to implement interventions to improve the evolution of these patients.

The Association of Bullying and Suicidality: Does it Affect the Pediatric Population?

Over the last few years, bullying has been identified as one of the significant issues in the pediatric population. Reports also found that bullied youth have a higher risk of developing suicidality. Although preventable, suicide remains the leading cause of death in young people. This literature review aims to establish the association of bullying and the suicidality of the pediatric group (0-18 years of age). A PubMed search was conducted to find studies associating bullying and suicidality in the pediatric population. MeSH keyword strategy, along with subheadings, was used to retrieve appropriate literature. A total of 42 articles were included after the careful examination and application of exclusion and inclusion criteria. This study showed a strong association between bullying and suicidality, albeit the presence of some contradictory ideas.

Enduring effects of adolescent ketamine exposure on cocaine- and sucrose-induced reward in male and female C57BL/6 mice

Ketamine has shown promising antidepressant efficacy for adolescent treatment-resistant depression. However, the potential enduring consequences of ketamine exposure have not been thoroughly evaluated. Thus, we examined if juvenile ketamine treatment results in long-lasting changes for the rewarding properties of sucrose and cocaine in adulthood, across three separate experiments. In Experiment 1, adolescent male and female C57BL/6 mice received ketamine (20 mg/kg) for 15 consecutive days (Postnatal Day [PD] 35-49). Twenty-one days later (PD70; adulthood) we examined their behavioral responsivity to sucrose (1%) on a two-bottle choice design, or cocaine (0, 5, 10 mg/kg) using the conditioned place preference (CPP) test. We found that juvenile ketamine-pretreatment increased preference for sucrose and environments paired with cocaine in male, but not female, adult mice. This long-term outcome was not observed when male and female mice received ketamine as adults (PD70-84) and tested for sucrose and cocaine preference 21-days later (Experiment 2). Similarly, in Experiment 3, no long-lasting differences in these measures were observed when adolescent male mice were exposed to concomitant ketamine and social stressors (PD35-44), namely the social defeat or vicarious defeat stress paradigms-procedures that mediated a depression-related phenotype (along with a ketamine antidepressant-like response). Collectively, we demonstrate that in the absence of physical or psychological stress, adolescent ketamine exposure increases later life preference for the rewarding properties of sucrose and cocaine in a sex- and age-specific manner. As such, this preclinical work provides awareness for the potential long-term behavioral consequences associated with juvenile ketamine exposure.

Bullying and childhood trauma events as predictive factors of suicidal behavior in borderline personality disorder: Preliminary findings

Traumas in childhood could present a significant association with suicidal behavior in BPD. The aim of the report is to study the link between a traumatic childhood involving school bullying and the different forms and degrees of suicidal behavior in BPD. A cross-sectional study was carried out on a sample of 109 BPD patients. It is divided into two groups whether or not there is a history of suicidal behavior. The clinical variables are compared with Chi square and Student's T tests. Traumatic childhood history and bullying, in particular, showed a statistically significant association with the incidence of suicidal behaviors.

Chronic Psychosocial Stress Causes Increased Anxiety-Like Behavior and Alters Endocannabinoid Levels in the Brain of C57Bl/6J Mice

Introduction: Chronic stress causes a variety of physiological and behavioral alterations, including social impairments, altered endocrine function, and an increased risk for psychiatric disorders. Thereby, social stress is one of the most effective stressful stimuli among mammals and considered to be one of the major risk factors for the onset and progression of neuropsychiatric diseases. For analyzing the effects of social stress in mice, the resident/intruder paradigm of social defeat is a widely used model. Although the chronic social defeat stress model has been extensively studied, little is known about the effects of repeated or chronic social defeat stress on the endocannabinoid system (ECS). The present study aimed to understand the effects of chronic social stress on anxiety behavior and the levels of endocannabinoids (ECs) and two N-acylethanolamines (NAEs) in different brain regions of mice. Materials and Methods: Two-month-old, male C57Bl/6J mice were exposed to chronic psychosocial stress for 3 weeks. The effects of stress on anxiety behavior were measured using the light-dark box and hole board test. The EC levels of 2-arachidonoyl glycerol (2-AG) and anandamide (N-arachidonoylethanolamine [AEA]), as well as the levels of two NAEs (oleoylethanolamide [OEA] and palmitoylethanolamide), were analyzed by liquid chromatography-tandem mass spectrometry in the hippocampus, cerebellum, and cortex. Results: In comparison with control mice (n=12), mice exposed to social defeat stress (n=11) showed increased anxiety behaviors in the light-dark box and hole board test and gained significantly more weight during the experimental period. Additionally, chronic social stress induced differential alterations in the brain levels of 2-AG and AEA. More precisely, 2-AG levels were higher in the cortex and cerebellum, whereas reduced AEA levels were found in the hippocampus. Furthermore, we observed lower OEA levels in the hippocampus. Conclusion: The current study confirms that the ECS plays an essential role in stress responses, whereby its modulation seems to be brain region dependent.

Association between Facial Emotion Recognition and Bullying Involvement among Adolescents with High-Functioning Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by impaired social interaction, communication and restricted and repetitive behavior. Few studies have focused on the effect of facial emotion recognition on bullying involvement among individuals with ASD. The aim of this study was to examine the association between facial emotion recognition and different types of bullying involvement in adolescents with high-functioning ASD. We recruited 138 adolescents aged 11 to 18 years with high-functioning ASD. The adolescents’ experiences of bullying involvement were measured using the Chinese version of the School Bullying Experience Questionnaire. Their facial emotion recognition was measured using the Facial Emotion Recognition Task (which measures six emotional expressions and four degrees of emotional intensity). Logistic regression analysis was used to examine the association between facial emotion recognition and different types of bullying involvement. After controlling for the effects of age, gender, depression, anxiety, inattention, hyperactivity/impulsivity and opposition, we observed that bullying perpetrators performed significantly better on rating the intensity of emotion in the Facial Emotion Recognition Task; bullying victims performed significantly worse on ranking the intensity of facial emotion. The results of this study support the different deficits of facial emotion recognition in various types of bullying involvement among adolescents with high-functioning ASD. The different directions of association between bully involvement and facial emotion recognition must be considered when developing prevention and intervention programs.

Workplace victimization risk and protective factors for suicidal behavior among active duty military personnel

BACKGROUND

Workplace victimization is a potential risk factor for suicidal behaviors (SB) among military personnel that has been largely overlooked. This paper examines both the impact of workplace victimization on reported SB and several potential protective factors associated with such suicidal behaviors in a large sample of active duty soldiers.

METHODS

A case-control study was conducted with 71 soldiers who reported SB in the past 12 months, each matched on sociodemographic characteristics to two others without reported suicidal behaviors. A multiple regression model was estimated to assess the effects of risk and protective factors while controlling for other variables.

RESULTS

SB was associated with several aspects of victimization, mental health and substance abuse conditions, pain, impulsivity, stressors, negative life events, work-family conflict, active coping behaviors and positive military-related factors. Controlling for other variables, those with SB were more likely to have sought mental health or substance abuse services, to be depressed, anxious, impulsive, and less resilient than non-SB personnel.

LIMITATIONS

Study limitations included the use of retrospective self-report data, absence of some known SB predictors, and a population restricted to active duty Army personnel.

CONCLUSIONS

SB among active duty personnel is associated with victimization since joining the military and is protected by resiliency. These findings suggest that in addition to the usual mental health factors, these additional predictors should be accounted for in SB intervention and prevention planning for active duty personnel.

The influence of deployment stress and life stress on Post-Traumatic Stress Disorder (PTSD) diagnosis among military personnel

There is increasing recognition that traumatic stress encountered throughout life, including those prior to military service, can put individuals at increased risk for developing Posttraumatic Stress Disorder (PTSD). The purpose of this study was to examine the association of both traumatic stress encountered during deployment, and traumatic stress over one's lifetime on probable PTSD diagnosis. Probable PTSD diagnosis was compared between military personnel deployed in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF; N = 21,499) and those who have recently enlisted (N = 55,814), using data obtained from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Probable PTSD diagnosis was assessed using the PTSD Checklist. The effect of exposure to multiple types (i.e. diversity) of traumatic stress and the total quantity (i.e. cumulative) of traumatic stress on probable PTSD diagnosis was also compared. Military personnel who had been deployed experienced higher rates of PTSD symptoms than new soldiers. Diversity of lifetime traumatic stress predicted probable PTSD diagnosis in both groups, whereas cumulative lifetime traumatic stress only predicted probable PTSD for those who had been deployed. For deployed soldiers, having been exposed to various types of traumatic stress during deployment predicted probable PTSD diagnosis, but cumulative deployment-related traumatic stress did not. Similarly, the total quantity of traumatic stress (i.e. cumulative lifetime traumatic stress) did not predict probable PTSD diagnosis among new soldiers. Together, traumatic stress over one's lifetime is a predictor of probable PTSD for veterans, as much as traumatic stress encountered during war. Clinicians treating military personnel with PTSD should be aware of the impact of traumatic stress beyond what occurs during war.

Association between bullying and pediatric psychiatric hospitalizations

Objectives:

Bullying is a serious public health issue. We sought to demonstrate an association between bullying victimization and hospital admissions for acute psychiatric problems. We described the demographics and types of bullying in a sample of hospitalized patients in Staten Island, NY, and compared bullying victimization scores with psychiatric versus medical admissions.

Methods:

Patients in grades 3–12 were recruited from the Staten Island University Hospital Inpatient Pediatrics unit and emergency department. Patients completed the validated Olweus Bully/Victim Questionnaire (OBQ) was analyzed to formulate a report of bullying in our sample as well as a sub-score measurement of bullying victimization. Pediatric residents simultaneously documented whether the subject was a medical versus an in-patient psychiatry admission. Statistical analysis was performed to look for an association between the victimization sub-score and a psychiatric indication for admission.

Results:

A total of 185 surveys were analyzed. Peak bullying occurred in 7th and 8th grades. Demographics and types of bullying in our sample were described. A strong association between bullying victimization and hospitalization for in-patient psychiatry was demonstrated. Association between bullying victimization and suicidal ideation, psychiatry, and social work consults was also shown. Concern for an association between hospitalization for psychogenic illness and bullying victimization was also raised.

Conclusions:

There is a significant association between bullying victimization and psychiatric hospital admissions. This raises the specter of the serious consequences of bullying as it is the first study to prospectively link hospital admissions to bullying. Studies using a valid measure of psychogenic illness to look for an association with bullying victimization are needed.

Evaluating social defeat as a model for psychopathology in adult female rodents

Social conflict is a predominant stressor in humans and is associated with increased risk for developing psychological illnesses including depression and anxiety. Overwhelmingly, more women suffer from these disorders, which may be due to increased stress sensitivity. Like humans, rodents experience a myriad of physiological and behavioral sequelae due to prolonged stress exposure. Although the motivation for social conflict may differ between humans and rodents, female rodents may provide an opportunity to explore the underlying mechanisms by which stress confers risk for psychopathology in women. Because most female rodents do not express spontaneous aggression, the majority of basic research examines the physiological and behavioral outcomes of social conflict in male rodents. However, there are instances where female rodents exhibit territorial (California mice and Syrian hamsters) and maternal aggression (rats, mice, and hamsters) creating a venue to examine sex differences in physiology and behavior in response to stress. While many studies rely upon nonsocial behavioral assays (e.g., elevated plus maze, forced swim test) to assess the impact of stress on emotionality, here we primarily focus on behavioral outcomes in social-based assays in rodents. This is critically important given that disruptions in social relationships can be a cause and consequence of neuropsychiatric diseases. Next, we briefly discuss how sex differences in the recruitment of neural circuitry and/or neurochemistry in response to stress may underlie sex differences in neuroendocrine and behavioral stress responses. Finally, the translational value of females in rodent stress models and considerations regarding behavioral interpretations of these models are discussed. © 2016 Wiley Periodicals, Inc.

An acute social defeat stressor in early puberty increases susceptibility to social defeat in adulthood

Syrian hamsters readily display territorial aggression. If they lose even a single agonistic encounter, however, hamsters show striking reductions in aggressive behavior and increases in submissive behavior, a distinct behavioral change that we have previously termed conditioned defeat. This acute social defeat stressor is primarily psychological and is effective in both males and females. Therefore, we maintain that this procedure presents an ideal model for studying behavioral and physiological responses to social stress. Here, we demonstrate that social avoidance following social defeat is a particularly useful dependent measure because of its sensitivity and stability between sexes and across the estrous cycle. In addition, we demonstrate that peripubertal hamsters exposed to a single, 15min social defeat exhibit significantly more social avoidance 24h later when compared with no-defeat controls. Later, defeated and non-defeated hamsters display similar agonistic behavior in adulthood indicating that the peripubertal defeat does not alter adult territorial aggression. After experiencing an additional social defeat in adulthood, however, the hamsters that experienced the pubertal defeat respond to the adult defeat with increased social avoidance when compared with hamsters that were defeated only in adulthood and with no-defeat controls. These data are the first to show that a single social defeat in puberty increases susceptibility to later social defeat in both males and females.

Enduring Personality Changes after Intense Stressful Event: Case Report

BACKGROUND

World statistical data show that a large number of individuals suffer from posttraumatic stress disorder (PTSD) after exposure to the intense traumatic event. PTSD can have a chronic course with enduring changes in the functioning of the person.

CASE PRESENTATION

Here we report two adult individuals of different gender and education who were exposed to the extremely severe stressful event after which difficulties in psychological functioning developed. The first case we present is a 46-year-old man, with completed high education, divorced, father of two children, who lives with his parents, and is retired. Disorders appeared 20 years ago when he was exposed to extremely severe stressful events in war circumstances that included captivity, torture, and loss of fellow soldiers. The second case is a 50-year-old female patient, with a university degree, professor of art, married, and mother of two children of whom the son died six years ago. She suffered from disorders after the sudden injury of her son that ended with his death.

CONCLUSION

Posttraumatic stress disorder after the intense stress is a risk of development enduring personality changes with serious individual and social consequences.

Molecular Signatures of Psychosocial Stress and Cognition Are Modulated by Chronic Lithium Treatment

Chronic psychosocial stress is an important environmental risk factor of psychiatric diseases such as schizophrenia. Social defeat in rodents has been shown to be associated with maladaptive cellular and behavioral consequences including cognitive impairments. Although gene expression changes upon psychosocial stress have been described, a comprehensive transcriptome profiling study at the global level in precisely defined hippocampal subregions which are associated with learning has been lacking. In this study, we exposed adult C57Bl/6N mice for 3 weeks to "resident-intruder" paradigm and combined laser capture microdissection with microarray analyses to identify transcriptomic signatures of chronic psychosocial stress in dentate gyrus and CA3 subregion of the dorsal hippocampus. At the individual transcript level, we detected subregion specific stress responses whereas gene set enrichment analyses (GSEA) identified several common pathways upregulated upon chronic psychosocial stress related to proteasomal function and energy supply. Behavioral profiling revealed stress-associated impairments most prominent in fear memory formation which was prevented by chronic lithium treatment. Thus, we again microdissected the CA3 region and performed global transcriptome analysis to search for molecular signatures altered by lithium treatment in stressed animals. By combining GSEA with unsupervised clustering, we detected pathways that are regulated by stress and lithium in the CA3 region of the hippocampus including proteasomal components, oxidative phosphorylation, and anti-oxidative mechanisms. Our study thus provides insight into hidden molecular phenotypes of chronic psychosocial stress and lithium treatment and proves a beneficial role for lithium treatment as an agent attenuating negative effects of psychosocial stress on cognition.

Bully, bullied and abused. Associations between violence at home and bullying in childhood

Aims: The aim was to examine experiences of bullying among Swedish adolescents and whether victims and perpetrators were also exposed to violence in the home, with particular focus on how abuse severity affected the risk of exposure to bullying. Methods: A nationally representative sample of pupils aged 14–15 responded to a questionnaire exploring exposure to corporal punishment and other types of violence. Results were analysed using Pearson’s chi-square and multiple logistic regression, adjusting for factors regarding the child, the parents and the families’ socioeconomic status. Results: Among the 3197 respondents, a significant proportion reported at least one incident of either bullying victimisation (girls 36%, boys 26%) or bullying perpetration (girls 24%, boys 36%). Physical and emotional violence in the home, including witnessed intimate partner violence, were significantly associated with both bullying victimisation and bullying perpetration. Odds ratios for exposure to bullying rose with increasing frequency and severity of abuse. Adjusted odds ratios ranged from 1.6 for any event of abuse vs. single episodes of bullying to 20.3 for multiple types of abuse vs. many episodes of bullying. The child’s gender and the presence of a chronic health condition were consistently associated with nearly all levels of abuse and bullying. Conclusions: Bullying experiences are common among youth and are clearly associated with abuse. Frequent bullying, whether as victim or perpetrator, warrants particular vigilance, as it appears to be an indicator of severe violence in the home.

Mental health problems and social resource factors among bullied children in the Nordic countries: a population based cross-sectional study

This study estimated internalising and externalising mental health problems among bullied-, unclear if bullied- and not bullied children aged 4-16 in the Nordic countries, and identified resource factors to bullied children's mental health. Data comes from the cross-sectional NordChild survey 2011 and the Strength and Difficulties Questionnaire, including 6,214 children in the analyses. Mental health problems were most prevalent among children parent-reported as bullied (29.2-44.3 %), followed by children with unclear status if bullied (13.0-25.6 %) and not bullied children (5.3-7.9 %). Externalising problems were more prevalent in all groups except among bullied girls aged 7-16, where internalising problems were more prevalent. Ten potential resource factors to bullied children's mental health were analyzed, finding that (1) children with at least three close friends had higher odds to be mentally healthy than children with fewer close friends and (2) bullied boys had higher odds to be mentally healthy if they regularly practiced sport.

Which adverse effects influence the dropout rate in selective serotonin reuptake inhibitor (SSRI) treatment? Results for 50,824 patients

Background: Nowadays, selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants due to their superior clinical efficacy, effectiveness, tolerability, and safety as compared to tricyclic antidepressants or monoamino oxidase inhibitors. However, despite these advantages SSRIs are still associated with a number of adverse drug reactions, especially in the early stages of treatment, which may lead to premature discontinuation of therapy in some cases. The aim of the present study was to assess the most common adverse drug reactions of SSRIs as well as their impact on dropout rate in a large study population.

Patients and methods: Data for 50,824 patients treated for major depressive disorder with SSRIs for the first time was accessed via the Disease Analyzer database (IMS Health, Germany), providing information on SSRI adverse drug reactions and their influence on premature treatment discontinuation calculated by regression analysis. The presence of certain co-morbidities was also registered.

Results: The mean age was 54.5 ± 19 years, two-thirds of the study population being female. The adverse effects mentioned most frequently were: “discomfort” of the digestive system (10%), sleep disorders (8.6%), and heart rhythm disorders (4%); however, these were of tolerable severity as they did not significantly influence the dropout rate. Contrary to that, somnolence and younger age (≤50 years) in particular increased the chance of premature treatment discontinuation, while patients suffering from cardiovascular risk factors or osteoporosis tended to adhere to the therapy.

Conclusions: Overall, there is high tolerability for early SSRI treatment, whereas the occurrence of somnolence leads to discontinuation.

Risk of psychiatric and neurological diseases in patients with workplace mobbing experience in Germany: a retrospective database analysis

Introduction: The number of mobbing experiences recorded has increased during recent years and it has now been established as global phenomenon among the working population. The goal of our study was to analyze the incidence of certain neurologic and psychiatric diseases as a consequence of mobbing as compared with a control group and to examine the possible influence of previous diseases that occurred within one year before the first mobbing documentation on the incidence of mobbing.

Material & methods: We used a large database (IMS^® Disease Analyzer, Germany) to collect data from general practitioners in Germany from 01/2003 until 12/2012. Based on age, gender, and health insurance, patients with experience of mobbing were matched with a control group of patients who had not reported workplace mobbing and who were being treated by the same physicians. At first, diseases that occurred within one year before the bullying experience took place (“index date”) were noted and compared to a control group of similar composition in terms of gender, age, and health insurance. Subsequently, the prevalence of depression, anxiety, somatoform disorders, and sleep disorders following experiences of mobbing were determined. After adjustment to take into account the odds of bullying, the ratios of these diseases were assessed using a logistic regression model.

Results: The study population consisted of n=2,625 patients and n=2,625 controls, of which 33% were men. The number of cases of bullying documented rose continuously from 2003 to 2011 and remained high in 2012. Those who would later become victims of mobbing demonstrated a considerably higher prevalence of diseases in general – these diseases were not confined to the neurologic-psychiatric spectrum. Following experiences of bullying, depression, anxiety, somatoform disorders, and sleep disorders were significantly more prevalent than in the control group (for all, p<0.05). Similarly, odds ratios (OR) representing the risk of suffering from diseases were higher in affected patients, with the highest value (4.28) for depression and the lowest value for sleep disorders (OR=2.4).

Conclusion: Those who will later become the victims of bullying are more prone to suffer from diseases in general, even before this experience of mobbing has occurred, which underlines the importance of supporting (chronically) ill patients to protect them against bullying. Sequelae of mobbing include, in particular, diseases from the neurologic-psychiatric spectrum.