تاثیر زورگویی دوران کودکی در میان مردان مبتلا به HIV مثبت: ارتباط روانی و عوامل خطرساز

Abstract Objectives While some studies have examined the deleterious effects of childhood bullying on adults, no studies to date have focused on the effects of bullying on Persons Living with HIV (PLH), a particularly at-risk population. PLH experience higher rates of childhood and adulthood physical and sexual abuse than the population at large, and experience of childhood abuse appears to be predictive of sexual and other risk behaviors in this population. Thus it remains critical to examine rates of childhood bullying and correlates of bullying in adult PLH. Methods A sample of 171 HIV-positive men over 18 years of age were recruited from the San Francisco Bay Area. All participants reported experiencing symptoms of traumatic stress. The participants were recruited as part of a larger study assessing a group intervention for individuals with HIV and symptoms of trauma. Self-report questionnaires were administered to assess participants’ exposure to bullying in childhood and trauma symptoms in adulthood.

Introduction Bullying is a common and pernicious experience for American youth, with 24–29% of individuals reporting having experienced some bullying before age 18 (Seals & Young, 2003). Research into the psychological impact of childhood bullying has shown that exposure to bullying can lead to mood disorders such as depression and anxiety (e.g., McCabe, Miller, Laugesen, Antony, & Young, 2010), higher rates of suicidality (Klomek et al., 2009), and symptoms of posttraumatic stress disorder (PTSD; e.g., Capaccioli, 2010 and Crosby et al., 2010), both in childhood and in adulthood. Despite decades of research attention, recent media coverage of the tragic effects of bullying in high school and college-aged men make clear the need for further studies examining correlates of bullying in at-risk populations. While some studies of bullying have focused specifically on at-risk populations, including lesbian, gay, and bisexual (LGB) or sexual minority individuals (e.g., Birkett, Espelage, & Koenig, 2009), very few studies have examined the relationship between people living with HIV (PLH) and the long-term mental health effects of childhood bullying. Given the link between mental health and disease progression in PLH (Leserman, 2008), this topic is of relevance both from a psychological and from a public health standpoint. Thus, the current study examines the impact of exposure to bullying in childhood on trauma symptoms in a sample of HIV-positive adult men. Bullying and mental health Previous research has shown that childhood bullying has lasting effects on mental health. Self-report of having been bullied in childhood was shown as a risk factor for later depression (Klomek et al., 2008), as well as a decrease in levels of life satisfaction (Chen & Wei, 2011.) Similarly, adults who report being victims of childhood bullying are twice as likely to attempt suicide (Meltzer, Vostanis, Ford, Bebbington, & Dennis, 2011). Research has also looked at differences in the long term effects of bullying on LGB or sexual minority youth versus heterosexual youth, finding that sexual minority youth are at greater risk of being bullied (Berlan, Corliss, Field, Goodman, & Austin, 2010) and that these sexual minority youth are more likely to develop symptoms of PTSD (Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). PLH report high levels of exposure to traumatic stress (Gore-Felton and Koopman, 2002 and Kimerling et al., 1999), including childhood traumas such as sexual and physical abuse (Kalichman et al., 2002, Martinez et al., 2002, Martinez et al., 2009 and Welles et al., 2009). Exposure to traumatic stress, particularly childhood traumatic stress, is related to sexual and other risk behavior that may facilitate transmission of HIV (Briere and Runtz, 1987, Cavanaugh and Classen, 2009, Gore-Felton et al., 2006, Gore-Felton and Koopman, 2002, Holmes, 1997, Kalichman et al., 2002, Sachs-Ericsson et al., 2009 and Welles et al., 2009) and as such is important to assess when developing interventions to reduce HIV transmission rates. It is unknown, to date, how experience of childhood bullying may contribute to rates of trauma among PLH; similarly, no studies to date have specifically examined the relationship between bullying and risk and health outcomes among PLH, a population where both mental and physical health outcomes are of paramount concern. Bullying and physical health Only over the past decade has research begun to examine the effects of childhood bullying on physical health outcomes. In one recent study, Rigby (2001) showed a significant association between childhood victimization and high levels of enduring physical distress, including somatic and physical complaints. It is important to note that these complaints had a delayed onset, beginning on average 3 years after the start of victimization. Similarly, Haavet, Straand, Saugstad, and Grunfeld (2004) found that common illnesses in adolescence such as hay fever, eczema, asthma, headache, neck or shoulder pain, sore throat, and lower respiratory tract infection were significantly associated with negative life experiences including being bullied at school. In a meta-analysis of recent studies, risk for psychosomatic problems was found to be significantly higher among those victimized by bullying (Gini & Pozzoli, 2009). Among studies examining adult health consequences of being bullied as children, adults who reported childhood bully victimization have been found to experience significantly poorer physical health, including lower health-related quality of life in their adulthood when compared to those who had not been bullied (Allison, Roeger, & Reinfeld-Kirkman, 2009). In examining workplace bullying, Hansen, Hogh, and Persson (2011) found that adults who reported frequent bully victimization also reported poorer mental health and had a 24.8% lower salivary cortisol concentration (one of the primary stress hormones linked to health problems and disease progression) compared with those not bullied, indicating physiological consequences as a result of bullying. Similarly, in a study of health predictors and sickness absence among hospital staff, victims of bullying were shown to have higher body mass and prevalence of chronic disease, and their rates of medically- and self-certified periods of sickness absence were higher than those of non-bullied staff members (Kivimaki, Elovainio, & Vahtera, 2000). Tuckey, Dollard, Saebel, and Berry Narelle (2010) also looked at health problems in the workplace and found significant effects associated with exposure to workplace bullying and poor cardiovascular health. However, no literature to date has studied the enduring physical health consequences of childhood bullying in the specific context of HIV. Bullying and risk behavior A primary concern in HIV-positive populations is prediction of risk behavior, including substance use and sexual risk behavior. Accurately modeling predictors of these risk behaviors can inform efforts to reduce the spread of HIV infection and to improve the quality of life and health outcomes of PLH. Existing literature suggests that bullying during childhood is predictive of subsequent risk behavior as an adult. These risk behaviors can take the form of increased daily heavy smoking (Niemelä et al., 2010), abuse of alcohol (Topper, Castellanos-Ryan, Mackie, & Conrod, 2010) and other forms of substance abuse (Luk, Wang, & Simons-Morton, 2010). Some studies have revealed more nuanced outcomes of childhood bullying, indicating that the type of bullying experienced has an impact on the type of risk behavior individuals endorse. One study found physical victimization to be significantly related to cigarette and alcohol use while relational victimization was related to all categories of drug use (cigarette and alcohol use as well as alcohol and marijuana abuse; Sullivan, Farrell, & Kliewer, 2006). Additionally, gender differences have also been identified: physical victimization was more strongly related to aggression and delinquent behaviors among boys than girls, while relational victimization was more strongly related to physical aggression and marijuana use among girls, but more strongly related to relational aggression among boys (Sullivan et al., 2006). Specifically among sexual minorities, victims of bullying showed higher rates of substance use disorders in adulthood (Hughes et al., 2010 and Mays and Cochran, 2001). In addition to risky substance use, early and frequent peer victimization predicted externalizing behaviors such as rage reactions, road rage, excessive spending, and binge eating (Sansone, Lam, & Wiederman, 2010). While it is evident that bullying increases the risk on those who experience it as a child, little is known about the impact of bullying on individuals living with HIV. The current study The current study extends the existing literature on the psychosocial correlates of bullying by examining the prevalence of childhood bullying in a sample of adult men living with HIV, looking at both heterosexual and sexual minority identified men. We then determine associations among experience of childhood bullying, mental and physical health in adulthood, and endorsement of risk behavior. Finally, we examine the contribution of bullying to report of trauma symptoms in adulthood, over and above other forms of trauma

Results Prevalence of bullying and other forms of trauma Bullying was commonly reported by men in the current sample, with 90.1% (n = 154) of the sample endorsing having experienced some level of bullying before age 18 and 21.1% (n = 36) of the sample endorsing having experienced all 11 assessed forms of bullying “more than once.” The most commonly reported form of bullying was being called names, endorsed by 85.4% (n = 146) of the sample, followed by being sworn at, endorsed by 83.0% (n = 142) of the sample, and being made fun of “because of the way you are,” also endorsed by 83.0% (n = 142) of the sample. Less commonly reported forms of bullying included being beaten up, endorsed by 51.5% (n = 88) of the sample, and being kicked, endorsed by 53.2% (n = 91) of the sample. Scores on the Bullying Questionnaire were higher among MSM (M = 13.82) than among MSW (M = 11.10; t = −2.08, p = .03). Examining specific types of bullying experienced at least once, MSM were more likely to endorse having been punched (χ2 = 17.68, p < .01), hurt physically (χ2 = 8.07, p = .01), beaten up (χ2 = 8.47, p = .01), called names (χ2 = 14.00, p < .01), and made fun of “because of who [they] are” (χ2 = 19.74, p < .01), while they were children or adolescents. Other forms of childhood trauma were also commonly reported by men in the current sample, with men reporting an average of 2.56 (range = 0–15, standard deviation = 2.72) types of trauma experienced before age 18. Number of types of trauma experienced did not differ between MSM (M = 2.52) and MSW (M = 2.47; p > .05). Psychosocial correlates of bullying Having been bullied in childhood was significantly (p < .05) and positively associated with several psychosocial factors and outcomes, including self-report of total number of traumatic experiences in childhood (r = .33), trauma symptoms (r = .23), dissociation symptoms (r = .21), state (r = .24) and trait (r = .31) anger, depression (r = .19) and suicidal ideation (r = .20). Having been bullied in childhood was significantly (p < .05) and negatively associated with quality of life factors, including physical (r = −.20) and emotional (r = −.19) well-being. Finally, having been bullied was significantly (p < .05) and positively associated with a risk factor, namely methamphetamine use in adulthood (r = .25). Having been bullied was not significantly associated with functional well-being, HIV symptom severity, unprotected sexual encounters, alcohol use, or cigarette use (all p > .05). See Table 2 for further details.