Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence | Adolescent Medicine | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Lorenz K. On Aggression. London, England: Methuen & Co; 1966
Stassen Berger K. Update on bullying at school: Science forgotten?  Dev Rev. 2007;27(1):90-126Google ScholarCrossref
Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis.  Pediatrics. 2009;123(3):1059-106519255040PubMedGoogle ScholarCrossref
Reijntjes A, Kamphuis JH, Prinzie P, Telch MJ. Peer victimization and internalizing problems in children: a meta-analysis of longitudinal studies.  Child Abuse Negl. 2010;34(4):244-25220304490PubMedGoogle ScholarCrossref
Schreier A, Wolke D, Thomas K,  et al.  Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years.  Arch Gen Psychiatry. 2009;66(5):527-53619414712PubMedGoogle ScholarCrossref
Nakamoto J, Schwartz D. Is peer victimization associated with academic achievement? a meta-analytic review.  Soc Dev. 2010;19(2):221-242Google ScholarCrossref
Brunstein Klomek A, Sourander A, Gould MS. The association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings.  Can J Psychiatry. 2010;55(5):282-28820482954PubMedGoogle Scholar
Kim YS, Leventhal B. Bullying and suicide: a review.  Int J Adolesc Med Health. 2008;20(2):133-15418714552PubMedGoogle ScholarCrossref
Winsper C, Lereya T, Zanarini M, Wolke D. Involvement in bullying and suicide-related behavior at 11 years: a prospective birth cohort study.  J Am Acad Child Adolesc Psychiatry. 2012;51(3):271-28222365463PubMedGoogle ScholarCrossref
Farrington DP, Ttofi MM, Lösel F. School bullying and later criminal offending.  Crim Behav Ment Health. 2011;21(2):77-7921370292PubMedGoogle ScholarCrossref
Ttofi MM, Farrington DP, Lösel F, Loeber R. The predictive efficiency of school bullying versus later offending: a systematic/meta-analytic review of longitudinal studies.  Crim Behav Ment Health. 2011;21(2):80-8921370293PubMedGoogle ScholarCrossref
Arseneault L, Bowes L, Shakoor S. Bullying victimization in youths and mental health problems: ‘much ado about nothing’?  Psychol Med. 2010;40(5):717-72919785920PubMedGoogle ScholarCrossref
Sourander A, Jensen P, Rönning JA,  et al.  What is the early adulthood outcome of boys who bully or are bullied in childhood? the Finnish “From a Boy to a Man” Study.  Pediatrics. 2007;120(2):397-40417671067PubMedGoogle ScholarCrossref
Klomek AB, Sourander A, Kumpulainen K,  et al.  Childhood bullying as a risk for later depression and suicidal ideation among Finnish males.  J Affect Disord. 2008;109(1-2):47-5518221788PubMedGoogle ScholarCrossref
Sourander A, Ronning J, Brunstein-Klomek A,  et al.  Childhood bullying behavior and later psychiatric hospital and psychopharmacologic treatment: findings from the Finnish 1981 Birth Cohort Study.  Arch Gen Psychiatry. 2009;66(9):1005-101219736357PubMedGoogle ScholarCrossref
Klomek AB, Sourander A, Niemelä S,  et al.  Childhood bullying behaviors as a risk for suicide attempts and completed suicides: a population-based birth cohort study.  J Am Acad Child Adolesc Psychiatry. 2009;48(3):254-26119169159PubMedGoogle ScholarCrossref
Rønning JA, Sourander A, Kumpulainen K,  et al.  Cross-informant agreement about bullying and victimization among eight-year-olds: whose information best predicts psychiatric caseness 10-15 years later?  Soc Psychiatry Psychiatr Epidemiol. 2009;44(1):15-2218604618PubMedGoogle ScholarCrossref
Sourander A, Haavisto A, Ronning JA,  et al.  Recognition of psychiatric disorders, and self-perceived problems: a follow-up study from age 8 to age 18.  J Child Psychol Psychiatry. 2005;46(10):1124-113416178937PubMedGoogle ScholarCrossref
Costello EJ, Angold A, Burns BJ,  et al.  The Great Smoky Mountains Study of Youth: goals, design, methods, and the prevalence of DSM-III-R disorders.  Arch Gen Psychiatry. 1996;53(12):1129-11368956679PubMedGoogle ScholarCrossref
Angold A, Costello EJ. The Child and Adolescent Psychiatric Assessment (CAPA).  J Am Acad Child Adolesc Psychiatry. 2000;39(1):39-4810638066PubMedGoogle ScholarCrossref
Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity.  Psychol Bull. 1987;101(2):213-2323562706PubMedGoogle ScholarCrossref
 SAS/STAT Software [computer program]. Version 9. Cary, NC: SAS Institute Inc; 2004
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association; 2000
Angold A, Costello EJ. A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C).  Psychol Med. 1995;25(4):755-7627480452PubMedGoogle ScholarCrossref
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. ed 4. Washington, DC: American Psychiatric Association; 1994
Nakao K, Treas J. The 1989 Socioeconomic Index of Occupations: Construction From the 1989 Occupational Prestige Scores. Chicago, IL: National Opinion Research Center; 1992
Woods S, Wolke D, Nowicki S, Hall L. Emotion recognition abilities and empathy of victims of bullying.  Child Abuse Negl. 2009;33(5):307-31119457555PubMedGoogle ScholarCrossref
Monks CP, Smith PK, Naylor P, Barter C, Ireland JL, Coyne I. Bullying in different contexts: commonalities, differences and the role of theory.  Aggress Violent Behav. 2009;14(2):146-156Google ScholarCrossref
Salmivalli C. Bullying and the peer group: a review.  Aggress Violent Behav. 2010;15(2):112-120Google ScholarCrossref
Juvonen J, Graham S, Schuster MA. Bullying among young adolescents: the strong, the weak, and the troubled.  Pediatrics. 2003;112(6, pat 1):1231-123714654590PubMedGoogle ScholarCrossref
Ouellet-Morin I, Danese A, Bowes L,  et al.  A discordant monozygotic twin design shows blunted cortisol reactivity among bullied children.  J Am Acad Child Adolesc Psychiatry. 2011;50(6):574-58221621141PubMedGoogle ScholarCrossref
Harkness KL, Stewart JG, Wynne-Edwards KE. Cortisol reactivity to social stress in adolescents: role of depression severity and child maltreatment.  Psychoneuroendocrinology. 2011;36(2):173-18120688438PubMedGoogle ScholarCrossref
Shalev I, Moffitt TE, Sugden K,  et al.  Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study [published online April 24, 2012].  Mol PsychiatryGoogle Scholar
Sugden K, Arseneault L, Harrington HL, Moffitt TE, Williams B, Caspi A. Serotonin transporter gene moderates the development of emotional problems among children following bullying victimization.  J Am Acad Child Adolesc Psychiatry. 2010;49(8):830-44020643316PubMedGoogle ScholarCrossref
Reijntjes A, Stegge H, Terwogt MM, Kamphuis JH, Telch MJ. Children's coping with in vivo peer rejection: an experimental investigation.  J Abnorm Child Psychol. 2006;34(6):877-88917111114PubMedGoogle ScholarCrossref
Brunstein Klomek A, Marrocco F, Kleinman M, Schonfeld IS, Gould MS. Bullying, depression, and suicidality in adolescents.  J Am Acad Child Adolesc Psychiatry. 2007;46(1):40-4917195728PubMedGoogle ScholarCrossref
Wolke D, Skew AJ. Bullying among siblings.  Int J Adolesc Med Health. 2012;24(1):17-2522909908PubMedGoogle ScholarCrossref
Crick NR, Ostrov JM, Werner NE. A longitudinal study of relational aggression, physical aggression, and children's social-psychological adjustment.  J Abnorm Child Psychol. 2006;34(2):131-14216741683PubMedGoogle ScholarCrossref
Ttofi MM, Farrington DP. Effectiveness of school-based programs to reduce bullying: a systematic and meta-analytic review.  J Exp Criminol. 2011;7(1):27-56Google ScholarCrossref
Original Article
April 2013

Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence

Author Affiliations

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Center for Developmental Epidemiology, Duke University Medical Center, Durham, North Carolina (Drs Copeland, Angold, and Costello); and Department of Psychology and Division of Mental Health and Well-being, University of Warwick, Coventry, England (Dr Wolke).

JAMA Psychiatry. 2013;70(4):419-426. doi:10.1001/jamapsychiatry.2013.504

Importance Both bullies and victims of bullying are at risk for psychiatric problems in childhood, but it is unclear if this elevated risk extends into early adulthood.

Objective To test whether bullying and/or being bullied in childhood predicts psychiatric problems and suicidality in young adulthood after accounting for childhood psychiatric problems and family hardships.

Design Prospective, population-based study.

Setting Community sample from 11 counties in Western North Carolina.

Participants A total of 1420 participants who had being bullied and bullying assessed 4 to 6 times between the ages of 9 and 16 years. Participants were categorized as bullies only, victims only, bullies and victims (hereafter referred to as bullies/victims), or neither.

Main Outcome Measure Psychiatric outcomes, which included depression, anxiety, antisocial personality disorder, substance use disorders, and suicidality (including recurrent thoughts of death, suicidal ideation, or a suicide attempt), were assessed in young adulthood (19, 21, and 24-26 years) by use of structured diagnostic interviews.

Results Victims and bullies/victims had elevated rates of young adult psychiatric disorders, but also elevated rates of childhood psychiatric disorders and family hardships. After controlling for childhood psychiatric problems or family hardships, we found that victims continued to have a higher prevalence of agoraphobia (odds ratio [OR], 4.6 [95% CI, 1.7-12.5]; P < .01), generalized anxiety (OR, 2.7 [95% CI, 1.1-6.3]; P < .001), and panic disorder (OR, 3.1 [95% CI, 1.5-6.5]; P < .01) and that bullies/victims were at increased risk of young adult depression (OR, 4.8 [95% CI, 1.2-19.4]; P < .05), panic disorder (OR, 14.5 [95% CI, 5.7-36.6]; P < .001), agoraphobia (females only; OR, 26.7 [95% CI, 4.3-52.5]; P < .001), and suicidality (males only; OR, 18.5 [95% CI, 6.2-55.1]; P < .001). Bullies were at risk for antisocial personality disorder only (OR, 4.1 [95% CI, 1.1-15.8]; P < .04).

Conclusions and Relevance The effects of being bullied are direct, pleiotropic, and long-lasting, with the worst effects for those who are both victims and bullies.