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Industry: Email Alert RSS FeedBullying, 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
Discussion
Methodological considerations
This study provides a good opportunity to assess cross sectional relations between being bullied or being a bully, self reported depression, and severe suicidal ideation. The sample is large and representative of the mid-adolescent population in Finland. More than 99% of children and adolescents aged 7 to 16 attend primary and secondary school. The participation rate for the survey was high. However, psychological problems, depression, and experiences of being a bully or being bullied may be more common among those pupils who were absent. Therefore, the prevalences of bullying, depression, and severe suicidal ideation detected in this study are likely to be underestimates.
The 13 item Beck inventory measures the respondent's own perception of her or his depressive symptoms but it is not a diagnostic instrument for depressive disorders. Because the inventory measures a psychological state we could not assess the duration of depressive symptoms. However, severe depressive symptoms in adolescents are likely to be comparatively persistent.[18] To avoid bias due to normal mood changes in adolescence, we dichotomised the depression score to moderately or severely depressed versus no depression or mildly depressed. In the multivariate analyses that studied the association between bullying and severe suicidal ideation, we used depressive symptoms as a total score but we excluded the item on suicidal ideation.
Transient death wishes and non-specific suicidal ideation have been reported to be comparatively common during adolescence.[19] Therefore, only responses indicating severe suicidal ideation with an intent were included in the analyses.
Bullying and mental health
Depression and severe suicidal ideation are strongly linked to being bullied or to acting as a bully. Even an infrequent involvement in bullying (being bullied or being a bully) increases the likelihood of severe suicidal ideation, independent of depression.
Being bullied frequently is likely to be a considerable source of stress. Depression among those who were frequently bullied might be expected. However, adolescents who are depressed may also attract negative attention from their peers. Previous research suggests that compared with their peers, those who are bullied are more introverted, less assertive, and are overinvolved in their families.[20] Victims also tend to be rejected by peers.[9 21] Depression could thus be both a result of and a reason for being bullied. A longitudinal design is necessary to study causality. However, in this study severe suicidal ideation was increased among those who were bullied regardless of whether they were depressed. This emphasises the stressful nature of being bullied and highlights the importance of taking action to stop bullying.
Although the association between being a bully and depression has not received attention in previous research, bullies have been shown to have certain mental health problems. Being a bully has been associated with juvenile delinquency, alcohol misuse, violence in adulthood, and criminal behaviour.[20 22] The social background of bullies also suggests that they are vulnerable to psychiatric morbidity. Being a bully has been associated with rejection by peers and social isolation.[1 9] In bullies' families, more emotional distance between family members, a lack of warmth, and inconsistent discipline for children has been noted.[20] Bullies thus need support for normal development to proceed, and any interventions should also recognise the role of depressive disorders in the background of their behaviour.
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