Bullying and school violence

Clinical Psychiatry News, June, 2007 by Diana Mahoney

News that the college student behind the Virginia tech massacre had been the victim of bullying during middle school and high school was not surprising. In fact, given the available data on common characteristics of perpetrators of school violence, it could almost be expected.

Seung Hui Cho was a socially awkward young man who was mocked throughout high school for his shyness and for the strange way in which he spoke. A 2002 study conducted by the U.S. Secret Service and the U.S. Department of Education regarding 37 incidents of targeted school shootings and school attacks that occurred in the United States from 1974 to 2000--including the 1999 Columbine murders--determined that 71% of the shooters felt bullied, persecuted, or injured by others before the attack (www.secretservice.gov/ntac/ssi_final_report.pdf).

That the majority of youth involved in school shootings have been bullied certainly does not mean that bullying in and of itself causes school violence, but it does drive home the fact that bullying and victimization are important risk factors for dangerous behavior that cannot be ignored, according to Dr. Thomas P. Tarshis, director of the Bay Area Children's Association in Cupertino, Calif. It also highlights the fact that, for as much as we know about bullying and its adverse effects, there are many questions we still can't answer, he said.

"We know from longitudinal studies that higher levels of bullying and victimization are associated with poorer mental health outcomes, but it's impossible to quantify what amount of bullying leads to some of the negative sequelae that have been observed," said Dr. Tarshis. "So, while we know, for instance, that children who score highest on victim and bully scales are most likely to have worse scores on clinical measures of anxiety and depression, we can't say something like, '6 months of consistent teasing is 70% likely to cause a clinical diagnosis of depression.'"

There are a number of reasons for this. "One factor is that some children are much more resilient to traumatic events than others. Thus, a resilient child may be able to tolerate high levels of bullying without any negative consequences, while a child who is not as resilient may have poor mental health outcomes with what may seem like minor infractions," he said.

Another consideration, he noted, is "the lack of a consistent, valid instrument for measuring bullying and victimization in children" in order to develop group norms to explain variance.

To address the latter consideration, Dr. Tarshis and Dr. Lynne C. Huffman of Stanford (Calif.) University developed and tested a simple questionnaire for use in school settings to gather comprehensive information on bullying and victimization. The Peer Interactions in Primary School (PIPS) questionnaire is a single-page survey consisting of 22 multiple-choice questions about direct bullying (physical violence or threat of harm) or indirect bullying (social ostracizing, teasing, dirty looks, or rumor spreading).

With funding from the National Institutes of Health, the investigators administered the PIPS questionnaire to 270 third-through sixth-grade students in California and Arizona. According to the results, nearly 90% of the students experienced some degree of victimization by bullies, and almost 60% participated in some form of bullying. Subsequent analyses of the PIPS questionnaire demonstrated high reliability, strong construct and concurrent validity, and high internal consistency (J. Dev. Behav. Pediatr. 2007;28:125-32).

In addition to being an easy, useful tool for measuring the extent of bullying behaviors in school settings, the PIPS questionnaire may be most valuable in the development, implementation, and analysis of anti-bullying interventions, said Dr. Tarshis.

"Because bullying is so multidimensional--cutting across home, school, and peer relations--it is exceedingly difficult to arrive at interventions that can docu ment clear benefit," he explained. "PIPS could be used as a validated pre- and postmeasure for any manualized intervention or school program hoping to decrease bullying and victimization."

And without question, such help is desperately needed. Even though bullying has been identified as a pressing public health issue and a majority of schools nationwide have taken up the cause, there are few indications that such attention is paying off.

Of more than 300 available bullying interventions identified in a 2004 review of bullying and victimization in the United States ("Bullying in American Schools: A Social-Ecological Perspective on Prevention and Intervention." Espelage DL, Swearer SM, eds. Mahwah, N.J.: Lawrence Erlbaum Associates, 2004), "not one meets the full criteria for recommendation as an evidence-based intervention, and only six have been tested against a control group with positive results," Dr. Tarshis said.

Similarly, a recently published review of 26 studies of school-based interventions found that a lot of them had little impact on bullying outcomes overall (Arch. Pediatr. Adolesc. Med. 2007;161:78-88). "We found that many common methods of dealing with the problem [of bullying], such as classroom discussions, role playing, or detention, are ineffective," said Dr. Rachel Vreeman of Indiana University, Indianapolis, lead author of the study.