Abstract
Background
Few studies have compared the risks of mental health problems among the adolescents with different levels and different types of bullying involvement experiences.
Method
Bullying involvement in 6,406 adolescents was determined through use of the Chinese version of the School Bullying Experience Questionnaire. Data were collected regarding the mental health problems, including depression, suicidality, insomnia, general anxiety, social phobia, alcohol abuse, inattention, and hyperactivity/impulsivity. The association between experiences of bullying involvement and mental health problems was examined. The risk of mental health problems was compared among those with different levels/types of bullying involvement.
1. Introduction
One important reason to evaluate young people's experiences of bullying and being victimized by perpetrators is their significant association with a range of mental health problems [1]. Youths who are bullied have been found to have significant risk of depression [2], [3] and [4], anxiety [2] and [5], suicidal ideation and attempts [6], and attention-deficit/hyperactivity disorder (ADHD) [7]. Bullying has also been found to be associated with ADHD [7], alcohol use disorder [8], depression [4] and suicidal ideation and attempts [6]. It is important for mental health professionals, educators, and parents to increase their awareness of mental health problems in adolescents involved in school bullying.
Bullying behaviors can involve physical acts, verbal utterances, social exclusion, property theft, or other behaviors [9]. The nature of bullying and victimization in adolescents is heterogeneous. Research has identified various classes of victim [10]. Meanwhile, bullying behavior may serve different social functions and, depending on these functions, perpetrators differ in their skills, status, and social behavior [11]. Age [12], sex [12], and residential background variations [13] have been identified among those suffering from different types of bullying. These results of previous studies raise important issues that need further examination: Does increased co-occurrence of bullying-involvement experiences cause greater risk for mental health problems? Also, do different types of bullying-involvement experiences have different associations with mental health problems? A previous study found that increased co-occurrence of victimization types put adolescents at greater risk for poorer physical and psychological outcomes, including more severe depression and more frequent medically-attended injuries and medicine use [10]. In addition, different types of bullying victimization could result in independent and cumulative effects on psychological trauma symptoms [12]. However, it is not known whether there are differences in the risk of mental health problems among adolescents who perpetrated different levels and types of bullying on peers.
Another issue needing further examination is whether perpetrator-victims, who are individuals who are involved in bullying others and who also are victims of bullying, have a higher risk of comorbid mental health problems than pure victims and pure perpetrators. Some research considered perpetrator-victims, defined as individuals who bully others but also are bullied themselves, as a distinct group and the most troubled among all individuals involved with bullying [14]. Compared with pure perpetrators and victims, the perpetrator-victims were found to have the greatest risk of externalizing behavioral problems [15], psychological and psychosomatic symptoms [16], referrals to psychiatric services [17], suicidal ideation [3], school and interpersonal dysfunction [4] and [5], and alcohol use [4]. Thus, it has been proposed that perpetrator-victims could particularly benefit from early identification and intervention [18]. However, some researchers have found no differences between perpetrator-victims and pure perpetrators/pure victims. For example, a previous study showed that the perpetrator-victims' level of risk-taking behaviors do not significantly exceed those of the bullying group, and that their increased suicidal ideation is similar to that in the victim group [19]. Further study is needed to compare the risks of mental health problems among perpetrator-victims, pure perpetrators and pure victims.
This study had three major aims. First, we examined the association of various school bullying involvement experiences with a range of mental health problems. Second, we compared the risk of mental health problems among adolescents with different levels of bullying or victimization (victim of both passive and active bullying vs. victim of only passive or active bullying, and perpetrator of both passive and active bullying vs. perpetrator of only passive or active bullying). Third, we compared the risk of mental health problems among adolescents with different types of bullying or victimization (victim of only passive bullying vs. victim of only active bullying, perpetrator of only passive bullying vs. perpetrator of only active bullying, perpetrator-victims vs. pure victims, perpetrator-victims vs. pure perpetrators, and pure victims vs. pure perpetrators). We hypothesized that any type of bullying involvement experiences would be significantly associated with mental health problems. We also hypothesized that adolescents with increased co-occurrence of bullying or victimization would have increased risk of mental health problems, as well as that the risk of mental health problems among the adolescents with different types of bullying or victimization would vary.
