August 9, 2007 — Bullying and victimization during early school years may identify boys at risk for psychiatric disorders in early adulthood, according to the results of a study reported in the August issue of Pediatrics.”There have been no longitudinal cohort studies that examined the psychiatric outcomes in late adolescence or early adulthood of children who bully or are victimized in childhood,” write Andre Sourander, MD, from Turku University in Finland, and colleagues. “Generally, our knowledge of the continuities and discontinuities of childhood problems to early adulthood was based on a limited number of study cohorts.

However, information about the long-term effects of bullying has considerable public health significance that would justify universal or targeted preventive interventions and research directed at school bullying.” The goal of this study was to evaluate the relationships between bullying and victimization in boys aged 8 years and psychiatric diagnoses 10 to 15 years later.

In 1989, the investigators collected data on 2540 boys who were born in 1981, by administering questionnaires about bullying and victimization to parents, teachers, and to the boys themselves. Military call-up examination and army registry data were used to determine the presence of psychiatric disorders when the participants reached 18 to 23 years of age. Children who engaged in frequent bullying behavior but who were not victims of bullying were more likely to develop antisocial personality, substance abuse, and depressive and anxiety disorders than a reference group, based on univariate logistic regression analysis.

Those who reported frequent victimization-only were more likely to develop anxiety disorder, whereas those who were often both bullies and victims were more likely to develop antisocial personality and anxiety disorder. After adjustment for parental educational level and parent and teacher reports of emotional and behavioral symptoms on the Rutter scales, boys who reported frequent victimization-only were more likely to develop anxiety disorders; those who reported frequent bullying-only were more likely to develop antisocial personality disorder; and those who reported frequent bully-victimization were more likely to develop both anxiety and antisocial personality disorder.

When used as primary screening for high-risk children, information about frequent bullying and victimization identified 28% of those who developed a psychiatric disorder within 10 to 15 years. “Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood,” the authors write. “The school health and educational system has a central role to play in detecting these boys at risk.”Limitations of the study include lack of generalizability to girls, and psychiatric diagnoses not determined through a structured diagnostic interview.”

Proponents of preventing or stopping bullying in schools should consider the provision of individual psychiatric assessments for those involved, and subsequently offering them mental health treatment for their problems,” the authors conclude. “Additional studies that address resilience factors (eg, parental and social support systems and the child’s cognitive and social skills in dealing with bullying behavior) are warranted. Because childhood bullying is a complex behavior with potentially serious consequences, the early identification of children at risk should be a priority for society.”

Pediatrics. 2007;120:397-404.

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