Role of School Bullying Involvement in Depression, Anxiety, Suicidality, and Low Self-Esteem Among Adolescents With High-Functioning Autism Spectrum Disorder

A preliminary randomized controlled study of the PEERS® program for Taiwanese autistic adolescents: The effectiveness on reducing school bullying and enhancing social function

Individuals with autism spectrum disorder (ASD) often experience lifelong social communication challenges and are more vulnerable to school bullying. Addressing their social difficulties and school bullying requires evidence-based interventions. PEERS® (Program for the Education and Enrichment of Relational Skills) was adapted and translated for Taiwanese adolescents. This randomized controlled study aimed to examine the effectiveness of the Taiwanese version of PEERS® in reducing school bullying and enhancing social function among autistic adolescents. Twenty-one autistic adolescents (mean age 14.29 ± 1.67 years; female n = 733.33%) were randomized to a treatment group (TG, n = 10) or a delayed treatment control group (DTG, n = 11). The outcome measures (school bullying, social challenges, social skills knowledge, and social skills performance) were assessed at baseline, post-treatment, and follow-up. The group and time interaction analyses revealed greater magnitudes of reduction in general school bullying (p < 0.001), victimization (p < 0.001), perpetration (p = 0.012), social challenges (p = 0.001), and peer conflicts (p < 0.001), and improvement in social knowledge (p < 0.001) in the TG group than the DTG group. The findings suggest that the PEERS® program tailored for Taiwanese adolescents is effective in reducing school bullying, decreasing social challenges, and enhancing social skills among autistic adolescents, with very large effect sizes (Cohen's d ranging from 1.19 to 2.88). Consequently, participation in the PEERS® program is recommended for adolescents with social difficulties to improve their social communication and interactions to offset school bullying and other social challenges related to adverse outcomes.

Diurnal cortisol profiles in autistic adolescents and young adults: Associations with social difficulties and internalizing mental health symptoms

Several autism-related characteristics, such as social difficulties, may contribute to high perceived stress and increased exposure to stressful life events in some autistic individuals. Repeated exposure to stress might lead to the dysfunction of the hypothalamic-pituitary-adrenocortical-axis and be a vulnerability factor for developing mental health difficulties. Previous studies show contradictory findings on salivary cortisol in autism. In the current study, we investigated diurnal cortisol profiles in autistic adolescents and young adults, as well as their associations with social difficulties, stress exposure, and mental health symptoms. Autistic (n = 48, Mage = 17.6) and nonautistic (n = 51, Mage = 18.4) participants collected salivary cortisol at home six times a day for 2 days. Social difficulties, exposure to stressful life events/bullying, and mental health symptoms were assessed with questionnaires and clinical interviews. Similar diurnal cortisol slopes (DCS) and cortisol awakening responses were observed between the groups, but autistic participants showed higher total cortisol output (AUCG, area under the curve with respect to ground) during the day (b = 19.09, p = 0.009). In the autistic group, more severe social difficulties were associated with flatter DCS (b = 0.01, p = 0.007). Finally, cortisol alterations were associated with self-reported mental health symptoms, especially in autistic females in analyses uncorrected for multiple comparisons. In conclusion, our results do not indicate autism-related group-level alterations in most diurnal cortisol measures, but autistic youth showed higher total cortisol (AUCG) compared with nonautistic peers. More detailed investigation of interindividual variability in cortisol profiles within autistic people might give us important insights into vulnerability to developing stress-related mental health difficulties.

Bullying Victimization is Associated with Heightened Rates of Anxiety and Depression Among Autistic and ADHD Youth: National Survey of Children's Health 2016-2020

Autistic youth and youth with ADHD have heightened rates of bullying victimization, anxiety, and depression. The purpose of this research is to use nationally representative US data to 1) estimate the prevalence of anxiety and depression among bullied neurodivergent youth and 2) investigate whether the association between bullying victimization and anxiety or depression is significantly greater among autistic youth and youth with ADHD. For this research, we used five years of data (2016-2020) from the nationally representative National Survey of Children's Health (NSCH), youth ages 12-17 years (n = 71,973). Data were analyzed with R and the R survey package to estimate average marginal percentages, risk differences, and additive interactions as recommended by STROBE guidelines. The study identified heightened anxiety and depression among bullied autistic or ADHD youth. Results also showed that the increase in the rate of anxiety or depression associated with bullying victimization was significantly greater among autistic youth and youth with ADHD relative to non-autistic non-ADHD youth; interactions were significant among both male and female youth. Autistic youth, youth with ADHD, and youth with co-occurring autism and ADHD are particularly vulnerable to bullying victimization and associated depression and anxiety. Future research is needed to understand why the association between bullying victimization and depression/anxiety is significantly greater among autistic and non-autistic ADHD youth. Recommendations include exploring school-wide anti-stigma initiatives to stop the reciprocal bullying-anxiety/depression cycle, routine bullying and mental health screening of autistic and ADHD youth, and clinical management of bullied autistic and ADHD youth with anxiety or depression.

Korean autistic persons facing systemic stigmatization from middle education schools: daily survival on the edge as a puppet

Introduction

Korean autistic persons who have endured an integrated secondary education system have been exposed to school bullying, causing trauma and stigma to them. It also blocks them from entering a tertiary education system and a decent work, resulting in a lower quality of life. However, research on how it affects autistic persons has not yet been conducted in Korea.

Methods

Fourteen adult autistic persons in the Republic of Korea participated in the semi-structured focused group interviews. Their conversations were analyzed through qualitative coding.

Results

The interview results show the rare voice of Korean autistic people. Although interviewees experienced physical, verbal, and sexual violence against them during the secondary education period, they could not get substantial assistance from schools and society. Interviewees agreed that bullying is inherent in the secondary education system of Korea, even in Korean culture. They experienced the cause of bullying being attributed to them as victims rather than perpetrators, and impunity is given to the bullying assailants. Early analyses of this article confirm that such experiences are combined with the sociocultural climate of elitism, meritocracy, and authoritarianism in the Republic of Korea.

Conclusion

The study confirmed that the autistic person's bullying experience does not come from the social inability of autistic people but the "profound" competition and discriminative atmosphere of the society. The result urges further studies on the bullying experience of East Asian autistic persons and the construction of Korean intervention strategies to prevent school violence against Koreans with disabilities, especially autistic pupils.

Traditional bullying, cyberbullying, and quality of life among adolescents in 35 countries: Do cultural values matter?

RATIONALE

Substantial evidence indicates that involvement in school bullying has been linked to lower quality of life (QoL). Yet there is little information elucidating the link between bullying involvement and QoL in different cultures.

OBJECTIVE

This study investigated the associations between different types of bullying involvement and QoL among adolescents. The moderating roles of cultural values in the relationship between bullying involvement and QoL were examined.

METHODS

This study included representative samples from 35 countries (N = 184,017) using data from the 2017/2018 Health Behavior in School-Aged Children (HBSC) survey and the new 2023 World Cultural Map Scores from the World Values Survey Wave 7 (2017/2021). Multilevel mixed-effects analysis was employed to examine individual-level and country-level effects simultaneously.

RESULTS

All types of bullying involvement were associated with lower QoL, with being a victim having the lowest QoL. Adolescents in societies that prioritize higher self-expression values exhibited a reduced propensity to engage in school bullying. In countries with higher self-expression values, there was a more pronounced negative association between bullying involvement and QoL. Traditional/Secular-rational values had no significant and consistent moderating effect on the association between bullying involvement and QoL. Those results were quite similar for both traditional bullying and cyberbullying.

CONCLUSION

These findings imply that cultural values are closely intertwined with adolescent bullying and quality of life. Therefore, prevention and intervention programs should pay more attention to addressing bullying and promoting the QoL of adolescents according to various cultural values.

Discrimination and Harassment Experiences of Autistic College Students and Their Neurotypical Peers: Risk and Protective Factors

This study examines autistic and non-autistic college students' experiences of discrimination and harassment and identifies protective and risk factors. A nationwide survey was used to match autistic students (N = 290) and non-autistic students (N = 290) on co-occurring diagnoses and demographic characteristics. Multiple regression and interaction analysis revealed that faculty support was protective against discrimination and harassment regardless of autism status. Habits of mind was particularly protective for autistic students against harassment. Any student who engaged in school-facilitated events was more likely to experience discrimination and harassment, but the risk was heightened for autistic students. Findings highlight the importance of faculty support in fostering positive interpersonal experiences on campus, and demonstrate the need to address deeper college campus issues with respect to neurodiversity.

A mixed method examination: how stigma experienced by autistic adults relates to metrics of social identity and social functioning

A recent meta-analysis reveals almost half of autistic individuals experience some form of victimization in their lifetime, including bullying and other forms of stigma. Research among caregivers of autistic individuals demonstrates that stigma can have a long-lasting impact on other aspects of a social identity, such as self-esteem, but less research has specifically examined this among autistic adults themselves, in spite of research suggesting these are likely constructs that contribute to the internalization of stigma and subsequent mental health consequences. The current study used a mixed method approach to assess the relation between stigma and several components of social identity and social functioning. More specifically, among 45 autistic young adults, three dimensions of self-reported stigma (discrimination, disclosure, and positive aspects) were examined in relation to self-esteem, self-efficacy, social satisfaction and adaptive social functioning. Quantitative analyses revealed higher reported discriminative and disclosure stigma were significantly associated with lower self-efficacy. Increased experience with all types of stigma were associated with lower social satisfaction. Greater reported disclosure stigma was also associated with lower self-esteem. Qualitative interviewing among eight autistic young adults helped to better understand the nature of stigma and the impact of these experiences. Thematic analysis of the qualitative data revealed that all of the participants experienced stigma in the form of exclusion or isolation and that a majority also experienced verbal bullying. Many of the negative interactions came from educators, peers, and family members. Most participants indicated that these stigmatizing interactions directly contributed to decreased social satisfaction, diminished self-efficacy, and lowered self-esteem. A greater understanding of the negative consequences of stigma can inform efforts to increase awareness and acceptance of autism.

A longitudinal study of the mental health of autistic children and adolescents and their parents during COVID-19: Part 1, quantitative findings

LAY ABSTRACT

Autistic children and adolescents, and their parents/carers, tend to experience more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. The rapid change in society as a result of the COVID-19 pandemic is likely to have disproportionately affected autistic young people and their parents/carers. We investigated how the mental health of autistic young people, and their parents/carers, developed during the first lockdown in the United Kingdom and how it changed once schools fully reopened for face-to-face teaching approximately 6 months later. Parents/carers completed online standardised questionnaires about their own and their child's mental health at four time points between March 2020 and October 2020. We found that, throughout this period, autistic young people experienced more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. Anxiety levels decreased as lockdown progressed and schools reopened for face-to-face teaching but only for those with other special educational needs and disabilities. For autistic young people, both anxiety and depression symptoms remained high throughout. There were no differences in the mental health of parents/carers of autistic children compared to those with other special educational needs and disabilities. These findings suggest that the mental health of autistic children and adolescents is likely to have been disproportionately affected during and after the first lockdown in the United Kingdom. In the second part of this article (Asbury & Toseeb, 2022), we attempt to explain these trends using qualitative data provided by parents during the same period.

Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression

Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

Psychological Resilience May Be Related to Students' Responses to Victims of School Bullying: A Cross-Sectional Study of Chinese Grade 3-5 Primary School Students

BACKGROUND

School bullying is a major public health problem with a large impact on children's health. There is an increasing number of cases of school bullying reported in China. Studies have shown that the health consequences of different ways of responding to school bullying may be quite different and that psychological resilience is also closely related to aggressive behaviors. However, there has been little research on whether individuals with different psychological resilience levels respond differently.

OBJECTIVE

To explore the relationship between responses to school bullying and psychological resilience, which may provide new ideas and strategies to better prevent and intervene in school bullying.

METHODS

A random sample of 5425 primary school students aged 7-14 years were recruited in Luzhou, China. All students completed a questionnaire anonymously. The statistical significance of differences between groups was tested using the χ² test or t test. Binary logistic regression was conducted to explore the relationship between responses and psychological resilience.

RESULTS

Over two-thirds of primary school students in this study reported experiencing bullying in the past year. The rate of positive responses among victims was 69.10% (2596/3757, 95% CI: 67.62~70.58%). There was a positive relationship between psychological resilience and positive responses. This relationship was observed for all victims (OR = 1.605, 95% CI: 1.254~2.055), especially male victims (OR = 2.300, 95% CI: 1.624~3.259).

CONCLUSIONS

There was a positive relationship between primary school bullying responses and psychological resilience among victims, with differences by sex. Therefore, increasing students' level of psychological resilience, possibly by improving their responses, is important for preventing school bullying. Meanwhile, effective interventions for school bullying should be developed from multiple perspectives, particularly sex, bullying roles, and psychological resilience.

Factors and experiences that influence school mobility for autistic students: A systematic review

BACKGROUND

Autistic students are reported to move schools at a high rate, but little is understood about why this is happening. What is known is that the effects of school mobility can negatively impact both short- and long-term outcomes, particularly the child's learning, behaviours, mental health and school retention.

AIMS

The aim of this systematic review was to synthesize the research on factors and experiences which influence the family's decision to move their autistic child to another school.

METHODS

A protocol was registered with PROPERO (ID: CRD4202120794). Searches were conducted with ERIC, Scopus and Web of Science and seven studies were identified.

RESULTS

The studies focused on three main types of mobility: mainstream-to-mainstream school moves, moving between mainstream and segregated schools, and moving between mainstream and homeschool. Parents' concerns for their child's learning, social experiences and mental health, as well as their own interactions with their child's school, influenced the decision to leave. Whilst there were similarities across the studies for reasons to move, there were also differences based upon the settings between which students moved.

CONCLUSION

The findings highlight the need for further research across all school mobility types to better understand the reasons underpinning high rates of school mobility for autistic students.

A Scoping Review of Autism and the Way It Changes the Presentation of Suicidal Thoughts and Behavior Compared to the General Population

Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior; and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people; 2. The presentation of suicidality in autistic people, including (a) risk of suicidality; (b) gender, age, employment and education; (c) co-occurring psychiatric conditions; (d) autism traits and social communication; (e) intellectual disability; and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.

Bullying experiences and mothers’ responses to bullying of children with autism spectrum disorder

Despite the fact that children with disabilities generally have been shown to be at a greater risk of bullying, which include physical attacks and threats, being picked on and teased and verbal abuse, there is still a need to understand bullying of children with autism spectrum disorder (ASD) and the strategies used by parents to support them in tackling this issue. This study aims to investigate the type and level of occurrence of bullying and parental support for children aged five with ASD who suffer from bullying. This study used both quantitative and qualitative analysis; a questionnaire, distributed to mothers of children with ASD, adopted from the Bullying for ASD Survey developed by Chen and Schwartz (Focus Autism Other Dev Disabil 27(4):200–212, 2012) measured types and frequency of bullying and parental support. An open-ended question was added to the survey to enable parents to write about the ways in which their child was bullied and the ways in which they supported their child. The results showed that while children suffered from all types of bullying, especially being picked on, being excluded and called names. Parental support showed a higher prevalence of involving peers and teachers for the prevention of bullying as well as avoiding strategies which included avoiding bullies and none of the mothers encouraged their children to stand up to bullies.

ASD Symptoms, Social Skills, and Comorbidity: Predictors of Bullying Perpetration

Children with ASD are more likely to be involved in bullying compared to typically developing peers; however, studies rarely examine bullying perpetration and the contributing factors among this population. The primary aim of this study was to examine the extent to which parent-reported ASD symptoms, social skills, and comorbid externalizing and internalizing symptoms predicted bullying perpetration in a sample of 390 children with ASD without intellectual disability. Findings from hierarchical regression analyses indicated that social skill deficits, externalizing symptoms (i.e., hyperactivity, aggression, and conduct problems), and depressive symptoms were associated with higher likelihood of bullying perpetration, while severity of ASD symptoms and anxiety were not significant predictors. Further research is needed to better understand bullying perpetration among children with ASD.

The relevance of the interpersonal theory of suicide for predicting past-year and lifetime suicidality in autistic adults

Background

While there are known risk factors for suicidality in autistic adults, these are often unconnected from theoretical frameworks that might explain why risk is elevated and guide clinical interventions. The present study investigated the relevance of constructs from the Interpersonal Theory of Suicide (ITS), including perceived burdensomeness, thwarted belongingness and acquired capability for suicide, and explored mechanisms through which certain risk factors (relationship status, age at diagnosis) might elevate suicide risk.

Methods

Autistic adults (n = 314) completed an online study including measures of depression, anxiety and constructs from the ITS. Linear and multinomial regression analysis disentangled contributions of ITS variables from effects of depression and anxiety for past-year suicide ideation, past-year and lifetime suicide attempts. Mediation analyses examined associations between risk factors and these suicide outcomes via mechanisms proposed by the ITS.

Results

Past-year suicide ideation was associated with burdensomeness, mental rehearsal of suicide plans (a facet of acquired capability), and depression. Greater feelings of burdensomeness, and reduced fear of death, marked out participants who had attempted suicide in comparison to those who had experienced suicide ideation in the past year. Relationship status was indirectly associated with past-year suicide ideation via the mediators of depression and burdensomeness, and was associated with past-year attempts via its effect on ideation. Age at diagnosis was unrelated to any variables.

Limitations

Cross-sectional research is insensitive to causality and temporal dynamics, which is likely why interaction hypotheses from the ITS were unsupported. Normative measures may be invalid in autistic samples. There was no control group. The autistic sample was unrepresentative of the whole population, particularly autistic people with intellectual disabilities, ethnic/racial minorities, and gender minorities.

Conclusions

Perceived burdensomeness and acquired capability appear potentially important to suicide in autistic people, and may mediate the effects of some risk factors. Future research should explore the temporal dynamics of suicide trajectories in longitudinal, prospective designs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-022-00495-5.

Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis

Co-occurring anxiety in children on the autism spectrum is associated with greater social challenges, including poorer social skills and relationships, which may influence the severity and presentation of anxiety symptoms, particularly social anxiety. The current study used Bayesian network analytics (Williams & Mulder, 2020) and a multimethod approach to examine (a) how different facets of social functioning relate to one another and to anxiety severity and comorbidity, (b) which facet(s) are most influential and thus may represent optimal targets for intervention, and (c) how social functioning relates to the presentation of social fears in a large treatment-seeking sample of autistic children with anxiety disorders (n = 191, 7-13 years). Results indicated strong associations among measures of social ability (i.e., theory of mind [ToM], social motivation, friendship attainment) and among measures of social integration (i.e., bullying, interpersonal and peer difficulties), with only bullying demonstrating a significant association with anxiety. ToM was the most interconnected variable in the network, and social motivation demonstrated the strongest individual connections with other variables, particularly with other facets of social ability. Socially anxious children with impaired ToM were less likely to express fears of negative evaluation, resulting in a distinct diagnostic presentation of social fears. Findings suggest that social motivation and ToM may represent important targets for intervention for autistic children with co-occurring anxiety. Further, social-cognitive difficulties associated with autism, like ToM, may play a role in distinct manifestations of anxiety in these youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Geographical variations in the association between bullying victimization and sleep loss among adolescents: a population-based study of 91 countries

OBJECTIVE

To examine geographical variations in the association between bullying victimization and sleep loss over worry among adolescents.

METHODS

We used data from the Global School-based Student Health Survey conducted between 2003 and 2017 in 91 countries across the globe. Sleep loss was categorised as: none/minimum (reported never or rarely sleep loss), moderate (reported sometimes), and severe (reported most of the time or always). We obtained country-specific estimates from multiple multinomial logistic regression analyses and pooled estimates from meta-analyses.

RESULTS

Of 282,036 adolescents 13-17 years of age, 28.1% (male: 25.4%, female: 31.0%) and 8.4% (male: 7.3%, female: 9.5%) of adolescents reported moderate and severe sleep loss respectively. Adolescents who frequently experienced bullying (≥3 per 30 days) reported higher prevalence of severe sleep loss. Meta-analyses showed that increased frequency of bullying victimization is associated with increased odds of sleep loss, with adolescents who experienced bullying for ≥3 days in the past 30 days were 1.65 and 2.65 times more likely than adolescents without being bullied to experience respectively moderate (OR 1.65, 95% CI: 1.59-1.72) and severe (OR 2.65, 95% CI: 2.52-2.79) sleep loss. Irrespective of sex, the association between bullying victimization and sleep loss was significant in all regions, income groups, and in all but a few countries.

CONCLUSIONS

Increased frequency of bullying victimization is positively associated with increased sleep loss among adolescents. Appropriate policies and programmes to stop bullying at school could help downgrade the risk of sleep loss among adolescents.

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

PURPOSE

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

DESIGN

Cross-sectional population-based study.

SETTING

Young Minds Matter, a nationwide survey in Australia.

SUBJECTS

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

MEASURES

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

ANALYSIS

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

RESULTS

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

CONCLUSION

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

Social Anxiety in Victimization and Perpetration of Cyberbullying and Traditional Bullying in Adolescents with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The aims of this study were to examine the role of social anxiety in victimization and perpetration of cyberbullying and traditional bullying in adolescents with ASD and ADHD in Taiwan. A total of 219 adolescents with ASD and 287 adolescents with ADHD aged 11–18 years and their caregivers were recruited from the child psychiatry outpatient clinics into this study. The associations of social anxiety with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results indicated that after the effects of sex, age, and autistic social impairment were controlled, social anxiety increased the risk of being a victim of cyberbullying (Odds Ratios (OR) = 1.048; 95% Confidence Interval (CI): 1.013–1.084), a victim of traditional bullying (OR = 1.066; 95% CI: 1.036–1.097), and a perpetrator of traditional bullying (OR = 1.061; 95% CI: 1.027–1.096) in adolescents with ASD. After the effects of sex, age, and ADHD symptoms were controlled for, social anxiety increased the risk of being a victim of traditional bullying in adolescents with ADHD (OR = 1.067; 95% CI: 1.039–1.096). Social anxiety was significantly associated with several forms of bullying involvement in adolescents with ASD and ADHD and warrants being considered into prevention and intervention programs for bullying involvement.

Direct and Inverse Correlates of Post-Traumatic Stress Disorder among School-Age Autistic Boys

Young people with autism are often bullied at school, a potential direct correlate of Post-Traumatic Stress Disorder (PTSD). This may be compounded by their difficulties in social interaction. Alternately, some of these young people may develop ‘coping strategies’ against bullying that may have an inverse association with PTSD. As a vulnerable population for PTSD, a sample of 71 young males with autism were surveyed for their self-reported experiences of being bullied at school, their coping strategies for dealing with this bullying, and their own evaluations of the severity of two of the key diagnostic criteria for PTSD. Their mothers also provided a rating of the severity of the three major diagnostic criteria for autism for these boys. Over 80% of this sample had been bullied, and there was a significant direct correlation between this and PTSD score, and between their mother-rated severity of the boys’ social interaction difficulties, but also a significant inverse correlation between their coping strategies and PTSD score. There were differences in these relationships according to whether the boys attended elementary or secondary school. These findings hold implications for the identification, assessment and support of autistic youth at risk of PTSD.

Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019

AIMS

Anxiety disorders are widespread across the world. A systematic understanding of the disease burden, temporal trend and risk factors of anxiety disorders provides the essential foundation for targeted public policies on mental health at the national, regional, and global levels.

METHODS

The estimation of anxiety disorders in the Global Burden of Disease Study 2019 using systematic review was conducted to describe incidence, prevalence and disability-adjusted life years (DALYs) in 204 countries and regions from 1990 to 2019. We calculated the estimated annual percentage change (EAPC) to quantify the temporal trends in anxiety disorders burden by sex, region and age over the past 30 years and analysed the impact of epidemiological and demographic changes on anxiety disorders.

RESULTS

Globally, 45.82 [95% uncertainty interval (UI): 37.14, 55.62] million incident cases of anxiety disorders, 301.39 million (95% UI: 252.63, 356.00) prevalent cases and 28.68 (95% UI: 19.86, 39.32) million DALYs were estimated in 2019. Although the overall age-standardised burden rate of anxiety disorders remained stable over the past three decades, the latest absolute number of anxiety disorders increased by 50% from 1990. We observed huge disparities in both age-standardised burden rate and changing trend of anxiety disorders in sex, country and age. In 2019, 7.07% of the global DALYs due to anxiety disorders were attributable to bullying victimisation, mainly among the population aged 5-39 years, and the proportion increased in almost all countries and territories compared with 1990.

CONCLUSION

Anxiety disorder is still the most common mental illness in the world and has a striking impact on the global burden of disease. Controlling potential risk factors, such as bullying, establishing effective mental health knowledge dissemination and diversifying intervention strategies adapted to specific characteristics will reduce the burden of anxiety disorders.

Trends and sex disparities in school bullying victimization among U.S. youth, 2011-2019

Background

The prevalence of being bullied traditionally among U.S. high school students is expected to reduce to 17.9%, according to Healthy People 2020 Initiatives. We examined trends in traditional victimization and cybervictimization with the latest large-scale time-series data in the United States.

Methods

We analyzed the data from the 2011–2019 national Youth Risk Behavior Survey (YRBS) to access the trends in traditional victimization and cybervictimization among U.S. high school students. We identified the temporal trends using multivariate logistic regression analyses, accounting for survey design features of YRBS. Participants included 72,605 high school students.

Results

The overall prevalence of victimization was 19.74% for traditional bullying and 15.38% for cyberbullying, suggesting that cyberbullying is not a low frequent phenomenon. The prevalence of victimization ranged from 20.19 to 19.04% for traditional victimization and 16.23 to 14.77% for cybervictimization, and the declined trends for the two kinds of bullying victimization were both statistically non-significant. The degree of overlap between the two kinds of bullying victimization was about 60%. Besides, female students reported more traditional victimization and cybervictimization than male peers within each survey cycle.

Conclusions

No declined trends in traditional victimization and cybervictimization were observed during 2011–2019. Female students are more likely to experience school bullying. To achieve the Healthy People 2020 goal on bullying, more work is needed to explore the underlying reasons behind these unchanging trends.

Bullying victimization, mental disorders, suicidality and self-harm among Australian high schoolchildren: Evidence from nationwide data

The effects of bullying on mental health among adolescents are of major public health concern, especially following modern bullying methods that technologically victimize adolescents. However, the independent effects of different forms of bullying (traditional, cyberbullying or both) on different types of mental disorders, suicidality and self-harm are not clear. Using a cross-sectional study design, involving 2166 Australian high schoolchildren (1131 Boys and 1035 Girls) aged 12-17 years, this study examined the associations of bullying victimization (traditional, cyber and both) with mental disorders, suicidality (ideation, plan and attempt) and self-harm. Both bivariate and multivariate analyses were employed to assess the associations. Victims of traditional bullying and cyberbullying incurred a significantly higher risk of major depressive disorder, suicidality and self-harm compared to those who had not encountered such threats. Findings also indicated the need for early identification of bullying victims to prevent the risk of mental disorders, suicidality and self-harm in schoolchildren. Furthermore, this evidence can be utilized to inform decisions regarding the provision of resources to address this important health issue in the context of any developed countries like Australia.