Objective
To assess whether being bullied between 7 and 10 years of age is directly associated with self-harm in late adolescence when controlling for previous exposure to an adverse family environment (domestic violence, maladaptive parenting); concurrent internalizing and externalizing behavior; and subsequent psychopathology (borderline personality disorder and depression symptoms).
Method
A total of 4,810 children and adolescents in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort were assessed to ascertain bullying exposure (between 7 and 10 years of age) and self-harm at 16 to 17 years.
Results
A total of 16.5% of 16- to 17-year-olds reported self-harm in the previous year. Being bullied was associated with an increased risk of self-harm directly, and indirectly via depression symptoms in early adolescence. The association between an adverse family environment (exposure to maladaptive parenting and domestic violence) and self-harm was partially mediated by being bullied.
Conclusions
Being bullied during childhood increases the risk of self-harm in late adolescence via several distinct pathways, for example, by increasing the risk of depression and by exacerbating the effects of exposure to an adverse family environment; as well as in the absence of these risk exposures. Health practitioners evaluating self-harm should be aware that being bullied is an important potential risk factor.
Self-harm is a widespread problem, with a self-reported prevalence of 14% to 17% among adolescents and young adults in the United States.1 and 2 It results in a large number of presentations to hospitals, leading to high economic cost.3 Typical self-harm behaviors include cutting, burning, or swallowing pills.4 and 5 Self-harm may be used to relieve tension or to communicate stress, and, in the most extreme cases, may represent acts with suicidal intent.6 Delineating the developmental antecedents of self-harm and highlighting at-risk groups is important, as single episodes often lead to a repetition of such behavior,7 and self-harm is a key predictor of completed suicide.8
Results
Prevalence of Being Bullied and Self-Harm
A total of 905 participants (18.8%; male, 180; female, 725) reported self-harm at any point in the past,4 and 792 (16.5%; male, 162; female, 630) reported harming themselves in the previous year. Of these 792 individuals, 306 (38.6%) harmed themselves once, 286 (36.1%) 2 to 5 times; 80 (10.1%) 6 to 10 times, and 120 (15.2%) more than 10 times. Although 579 adolescents (74.7%; male, 118; female, 461) self-harmed without an intention to die, 213 (26.9%; male, 44; female, 169) wanted to die. Cutting (n = 489; 61.8%) was the most commonly reported method of self-harm (details in Kidger et al. 4). According to child report, 38% of children were bullied at 8 years and 22.9% at 10 years. According to mother report, 16% of children were bullied at 7 years, 20.5% at 8 years, and 21.5% at 9 years. According to teacher report, 8.7% of children were bullied at 7 years and 12.3% at 10 years. The relative prevalence according to informant is congruent with previous findings, suggesting that some instances of being bullied may go unnoticed by teachers. 22 Among the 792 children who self-harmed, 514 (66%) were victims of bullying, according to child, mother, or teacher report. This yielded a Population-Attributable Fraction (PAF) of 19.9% (95% confidence interval = 12.3%–26.8%), indicating that if bullying could have been eliminated while other exposures remained constant, 20% of self-harm cases could potentially have been prevented.
