Bullying, depression, and suicidal ideation in Finnish adolescents: school survey

British Medical Journal,  August 7, 1999  by Riittakerttu Kaltiala-Heino,  Matti Rimpela,  Mauri Marttunen,  Arja Rimpela,  Paivi Rantanen

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Depression was measured using a modified, 13 item version of the Beck depression inventory[13 14] which had been validated in Finnish.[15] The Beck inventory has been shown to be a valid measure for detecting depression among adolescents.[16] It has good psychometric properties in this population.[17] Students who scored from 0 to 7 were classed as having no depression or mild depression, and those who had scores of 8 to 39 were classed as having moderate to severe depression.[13]

One of the items on the inventory asks about thoughts of self harm. We classed the students as having severe suicidal ideation if they chose either "I have definite plans about committing suicide" or "I would kill myself if I had the chance."

The sociodemographic variables evaluated were age, sex, years since moving to current area, educational level attained by parents, whether one or both parents had been unemployed during the past 12 months, and family structure (whether the adolescent was living with both parents, with one parent, with a step-parent, or apart from the parents). School performance was measured using the child's grade point average; perceived lack of social support from parents, friends, and teachers were used as independent variables. Grade point average and perceived social support have been shown to be determinants of depression in the sample studied (unpublished data). Age and grade point average were analysed as continuous variables, others were dichotomised.

Incomplete responses to the Beck inventory occurred more often among boys (7.8% (698/8948) v 5.5% (481/8695), P [is less than] 0.0001). The item most frequently unanswered was the item about suicidal ideation which was omitted by 4.9% (438/8948) of boys and 3.7% (322/8695) of girls.

Associations between bullying and depression (dichotomous variables) and severe suicidal ideation were tested using [Chi square]. Multivariate associations were tested with logistic regression using depression and severe suicidal ideation as dependent variables. The models were fitted using a stepwise forward method starting from an empty model. When using depression as a dependent variable, sex, age, and involvement in bullying (being bullied or being a bully) were tested first. Other variables were added later. When severe suicidal ideation was used as a dependent variable, logistic regression was carried out in three steps. Firstly, sex, age, and involvement in bullying were analysed. Secondly, depressive symptoms (defined as the total score of items on the Beck inventory excluding those on suicidal ideation) were added to the analysis. Finally, the other independent variables were included.

Results

Five per cent (373/8196) of the girls and 6% (464/8214) of the boys had been bullied weekly during the current school term. Two per cent (196/8196) of the girls and 9% (705/8214) of the boys reported that they had bullied others at least weekly (table 1).

Table 1 Involvement in bullying by sex. Values are numbers (percentages)