دیدگاه جدید: قربانی زورگویی، خودآسیبی و عوامل مرتبط با آن در پسران نوجوان ایرلندی

Abstract School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n = 1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm.

Introduction Self harm is common among adolescents and a wide range of factors, including school bullying victimisation, are associated with self harm in this group (Evans et al., 2004 and Fergusson et al., 2003). Self harm is a major risk factor for repeated self harm and subsequent suicide (Gunnell et al., 2008 and Tidemalm et al., 2008), and so pathways to self harm among young men are of particular interest. Suicide is the leading cause of death in men aged 15–34 years in Ireland, with suicide rates among young men aged 15–19 in Ireland the third highest in the European Union (Eurostat, 2009). A gender paradox in suicidal behaviour has been described whereby suicide mortality is generally higher among men than women in Western cultures, despite lower prevalence of suicidal ideation and non-fatal suicidal behaviour (Canetto & Sakinofsky, 1998). Trends in Irish suicide are somewhat unique as suicide rates peak in young men, unlike most European countries where rates increase with age (Health Service Executive; National Suicide Review Group and Department of Health and Children, 2005). Rates of hospital-treated self harm also peak in men in the 20–24 years age group and have increased significantly in recent years (National Suicide Research Foundation, 2009). These national trends have led to a media, government and research focus on potential causes and prevention of suicide and self harm in young men (Department of Public Health, 2001). The psychological impact of particularly rapid social change in Ireland over the past three decades has been cited as a potential cause of the increase in suicide and self harm among young men (Cleary and Brannick, 2007 and Smyth et al., 2003). In particular, the doubling of suicide rates in the 1980s and 1990s has been associated with the undermining of traditional institutions and the transition to a wealthy, secular and individualist society. Increasing economic prosperity and personal freedom is generally beneficial, but less so for those with fewer resources at their disposal (Cleary and Brannick, 2007 and Eckersley and Dear, 2002). An Irish study of young men revealed a pessimistic view of Irish life, as 60% believed that “The lot of the average man is getting worse” (Begley, Chambers, Corcoran, & Gallagher, 2003). However, few causal links between indicators of change and male suicide have been identified (Cleary, 2005). The fact that men are disproportionately affected by suicide has been attributed to the fact that men are more reluctant than women to seek help for psychological problems (Cleary, 2005) and consequently have lower rates of diagnosis and treatment of depression (Rutz, von Knorring, Pihlgren, Rihmer, & Walinder, 1995). Canetto and Sakinofsky (1998) also reported evidence for the influence of “cultural scripts” which sometimes make suicide an acceptable course of action for Western men. However, in Ireland attitudes reflecting justification of suicide showed an upward trend in the 1980s and were reversed in the 1990s (Cleary & Brannick, 2007). Bullying victimisation is a common problem among adolescents of both sexes (Kaltiala-Heino et al., 1999, Nansel et al., 2001 and Salmon et al., 1998), with lifetime prevalence of between 10.5% and 29.6% reported in a multi-centre European study (Analitis et al., 2009). An Irish study reported that 15.6% of 12–18 year olds had been bullied at some point (O’Moore, Kirkham, & Smith, 1997). Among adolescents, bullying most often takes place within the school environment (Brunstein Klomek, Marrocco, Kleinman, Schonfeld, & Gould, 2007). Boys more often report both bullying others (Juvonen, Graham, & Schuster, 2003) and being the victim of bullying than girls (Brunstein Klomek et al., 2007, Hazemba et al., 2008 and Salmon et al., 1998). Victims of bullying suffer not only distress but social marginalisation and low status among their peers, while bullies have high social status as rated by their peers and are considered psychologically stronger than victims (Juvonen et al., 2003). Hodges and Perry (1999) described the vicious cycle whereby peer rejection is both an antecedent and a consequence of peer victimisation (Hodges & Perry, 1999). This peer rejection and perceived weakness may be particularly difficult for boys given the associations of failure in the masculine role, and may contribute to the fact that boys are less likely than girls to seek help when they are victimised (Hunter, Boyle, & Warden, 2004). Bullying victimisation warrants attention in the context of self harm among young men because of its association with suicidal ideation (Rigby & Slee, 1999) and deliberate self harm (Barker et al., 2008, Cleary, 2000, Kim et al., 2005 and Mills et al., 2004) as well as with a wide range of mental health problems, such as depression (Brunstein Klomek et al., 2007, Kaltiala-Heino et al., 1999 and Seals and Young, 2003); anxiety (Cleary, 2000), eating disorders (Kaltiala-Heino, Rimpela, Rantanen, & Rimpela, 2000) and poor self esteem (Delfabbro et al., 2006). A Danish longitudinal study reported that boys who were bullied at school were at increased risk of being diagnosed with depression between the ages of 31 and 51 compared with those without the experience of school bullying victimisation (Lund et al., 2009). Such findings suggest that the distress and peer rejection reported as associated with victimisation are precursors of mental health problems and the associated risk of self harm. On the other hand, Hodges and Perry (1999) reported that pre-existing mental health problems contributed to becoming a victim of bullying, which again increased later symptoms. The direction of causality between bullying and mental health problems such as depression, low self esteem and suicidal behaviour can thus be both ways. Nonetheless, theoretical models of the aetiology of self harm such as a life-course model which postulates that the risk of developing suicidal behaviour depends on accumulation of a broad variety of psychological and social risk factors across the lifespan from childhood into adolescence (Fergusson, Woodward, & Horwood, 2000) can inform the study of bullying and its association with poor mental health and self harm. Bullying victimisation can be viewed as one of the negative life events which make an independent contribution to the development of self harm and one which is particularly relevant in childhood and adolescence. To date, a small number of Irish studies have highlighted the mental health problems associated with bullying victimisation (Mills et al., 2004 and O’Moore et al., 1997), but none has looked at a wide range of potential associated risk and protective factors and none has focused specifically on boys. A small-scale cross-sectional Irish study which examined mental health difficulties associated with bullying in adolescents found that those who had been bullied were significantly more likely to be depressed compared to those without this experience. Moreover, they were more likely to report self harm thoughts, to report serious self harm acts and referrals to psychiatric services (Mills et al., 2004). Several centres of the Child and Adolescent Self Harm in Europe (CASE) study, of which this study is part, found no significant associations between bullying and self harm in their multivariate logistic regression models for history of self harm (De Leo and Heller, 2004, Hawton et al., 2002 and Ystgaard et al., 2003), while a Scottish study found an association for both boys and girls (O’Connor, Rasmussen, Miles, & Hawton, 2009). A strong association between school bullying victimisation and self harm among boys (but not among girls) was reported by the Irish centre of the CASE study (McMahon et al., 2010). Given these findings, potential associations between bullying and self harm thoughts and acts in Irish adolescent boys require further investigation. The aims of the present study were: 1) To investigate the prevalence of self-reported school bullying victimisation among boys (hereafter referred to as simply victimisation); 2) To examine associations between bullying and psychological/mental health factors: depression, anxiety, self esteem and impulsivity; 3) To examine associations between victimisation and a broad range of lifestyle and life event factors among adolescent boys; 4) To compare those boys with and without the experience of victimisation in terms of prevalence of self harm; 5) To identify and compare the factors associated with deliberate self harm among boys with a history of victimisation and those without.

Results Prevalence of school bullying victimisation Bullying victimisation in the past year was reported by 4.3% of boys (Table 1). There was a correlation between age and prevalence of reporting bullying in the past year, with prevalence decreasing with increasing age (Spearman’s rho, p = 0.38). Lifetime history of school bullying victimisation was reported by almost one fifth of boys. Table 1. Prevalence of school bullying victimisation among boys. Age No. bullied/n % bullied Bullied in the past year All 80/1870 4.3% 15-year olds 25/420 6.0% 16-year-olds 41/996 4.1% 17-year-olds 14/454 3.1% Bullied lifetime prevalence All 363/1870 19.4% 15-year olds 82/420 19.5% 16-year-olds 190/996 19.1% 17-year-olds 91/454 20.0% Table options Associations between bullying victimisation and psychological factors Lifetime history of victimisation was associated with scores indicating poorer mental health on three of the four psychological scales (Fig. 1), while no significant effects were found for impulsivity. Boys who had been bullied had significantly higher levels of depression and anxiety and poorer self esteem (Mann–Whitney U-test, p < 0.001 for all three scales) than those without this experience. Association between lifetime history of school bullying victimisation and ... Fig. 1. Association between lifetime history of school bullying victimisation and psychological factors for boys. ∗ Higher scores indicate more positive self-esteem. Figure options Associations between victimisation and lifestyle, life event and psychological factors According to univariate analyses, a broad range of factors was associated with lifetime history of victimisation among boys (Table 2). Problems with peers and problems with parents were strongly associated with being a victim of bullying, with the highest odds ratio for difficulty in making or keeping friends (OR 5.64, CI 4.28–7.42). Other relationship problems associated with victimisation were serious arguments or fights with friends, serious fights with parents and problems between parents. Self harming behaviour was associated with victimisation at different levels. Deliberate self harm acts and self harm thoughts in the past year were significantly associated with victimisation. In addition, knowing a friend who had engaged in deliberate self harm was also significantly associated with the experience of victimisation. Boys who had been bullied had significantly higher levels of depressive symptoms and anxiety, and poorer self esteem than those without a history of victimisation, while impulsivity was not associated. Worries about sexual orientation were strongly associated with reporting victimisation, as was serious physical abuse and problems with schoolwork. Of the lifestyle factors examined, heavy drinking (four or more episodes of drunkenness in the past year) was negatively associated with being a victim of bullying (OR 0.72, CI 0.56–0.93) while smoking and drug taking were not associated with victimisation. Social support from a family member or from a friend were both negatively associated with reported bullying victimisation. Table 2. Factors associated with lifetime history of school bullying victimisation among boys. Age-adjusted Odds ratio 95% Confidence interval p-Value Psychological factors Anxietya 1.16 1.13–1.20 <0.001 Depressiona 1.11 1.07–1.15 <0.001 Self esteema 0.88 0.85–0.91 <0.001 Impulsivitya 1.01 0.97–1.05 0.79 Problems with peers Difficulty making/keeping friendsb 5.64 4.28–7.42 <0.001 Serious fights with friendsb 3.00 2.37–3.81 <0.001 Boy/girlfriend problemsb 1.48 1.11–1.97 0.007 Problems with/between parents Serious arguments between parentsb 2.29 1.79–2.94 <0.001 Serious fights with parentsb 1.73 1.37–2.20 <0.001 Parents separated/divorcedb 1.05 0.71–1.53 0.82 Self harm Deliberate self harmb 4.07 2.57–6.44 <0.001 Self harm thoughts in past year 3.33 2.49–4.45 <0.001 Self harm by friendb 2.26 1.66–3.06 <0.001 Self harm by family memberb 1.74 1.18–2.57 0.006 Friend/family member suicideb 1.61 1.13–2.29 0.008 Social support Can talk to a friend about what bothers you 0.61 0.46–0.79 <0.001 Can talk to family member about what bothers you 0.67 0.51–0.88 0.004 Can talk to teacher about what bothers you 1.40 0.99–1.97 0.06 Can talk to someone else about what really bothers you 0.89 0.68–1.17 0.41 Lifestyle factors Heavy drinking 0.72 0.56–0.93 0.012 Smoking 1.22 0.94–1.59 0.14 Drug taking in past year 0.97 0.76–1.23 0.79 Abuse Serious physical abuseb 3.34 1.91–5.82 <0.001 Forced sexual activityb 1.70 0.94–3.08 0.08 Other factors Worries about sexual orientationb 4.25 2.86–6.31 <0.001 Other distressing eventb 2.13 1.59–2.86 <0.001 Problems with schoolworkb 1.64 1.30–2.06 <0.001 Trouble with the policeb 0.88 0.67–1.16 0.37 Not living with both parents 1.01 0.73–1.40 0.94 Experience of illness/death Self/family member serious illnessb 1.72 1.36–2.17 <0.001 Death of someone else closeb 1.66 1.29–2.13 <0.001 Serious illness of close friendb 1.37 1.07–1.76 0.014 Death of family memberb 0.89 0.58–1.39 0.61 a Odds ratio for one point increase in score. b Lifetime history. Table options Multivariate logistic regression was carried out in order to identify the factors independently associated with victimisation among boys. Serious physical abuse (OR 11.22, CI 3.16–39.87), and self esteem (OR 0.81, CI 0.76–0.88) remained in the multivariate model. School bullying victimisation and deliberate self harm We examined the associations between having ever experienced victimisation and deliberate self harm for boys (Table 3). Boys who had experienced victimisation reported more self harm thoughts (χ2 = 70.67, p < 0.001), self harm in the past year (χ2 = 27.42, p < 0.001), and lifetime history of self harm (χ2 = 40.83, p < 0.001) than those without this history. More than one third of those bullied in the past year reported self harm thoughts in the past year. Nearly one in ten boys who had been bullied reported at least one act of self harm in the past year, which is more than four times higher than their peers who had not been bullied. Table 3. School bullying victimisation and deliberate self harm among boys. Not bullied group: Percentage with self harm Bullied group: Percentage with self harm Odds ratio, 95% confidence interval χ2 p-Value Self harm thoughts in past year 10.0% (147/1464) 27.1% (94/347) 3.33 (2.49–4.45) 70.67 p < 0.001 Self harm lifetime 2.9% (42/1442) 10.8% (37/342) 4.07 (2.57–6.44) 27.42 p < 0.001 Self harm past year 1.5% (22/1451) 6.4% (22/346) 4.43 (2.42–8.10) 40.83 p < 0.001 Table options Factors associated with lifetime history of deliberate self harm among boys with and without a history of bullying victimisation We examined associations between self harm and a wide range of psychological, lifestyle and life event factors for boys who had been bullied and those who had not (Table 4). Among boys with a history of victimisation, highest odds ratios for lifetime history of self harm were problems with schoolwork, serious physical abuse, worries about sexual orientation and self harm thoughts in the past year. Among non-bullied boys, highest odds ratios for self harm were self harm by a friend, self harm by a family member, self harm thoughts in the past year and drug taking in the past year. Being able to talk to a family member about what bothers you was negatively associated with self harm among both bullied and non-bullied boys. Table 4. Factors associated with lifetime history of self harm among boys with and without lifetime history of school bullying victimisation. Boys with a lifetime history of school bullying Boys without a lifetime history of school bullying Age-adjusted odds ratio 95% Confidence interval p-Value Age-adjusted odds ratio 95% Confidence interval p-Value Psychological factors Impulsivitya 1.37 1.20–1.55 <0.001 1.27 1.15–1.41 <0.001 Depressiona 1.34 1.21–1.49 <0.001 1.16 1.07–1.26 <0.001 Self esteema 0.75 0.67–0.83 <0.001 0.86 0.79–0.93 <0.001 Anxietya 1.32 1.20–1.45 <0.001 1.26 1.17–1.36 <0.001 Problems with peers Difficulty making/keeping friendsb 4.77 2.26–10.07 <0.001 1.60 0.66–3.88 0.295 Boy/girlfriend problemsb 3.69 1.81–7.50 <0.001 6.10 3.26–11.40 <0.001 Serious fights with friendsb 2.83 1.32–6.07 0.007 3.25 1.75–6.02 <0.001 Problems with/between parents Serious fights with parentsb 5.00 2.32–10.77 <0.001 3.66 1.94–6.88 <0.001 Serious arguments between parentsb 2.93 1.45–5.90 0.003 2.32 1.22–4.43 <0.001 Parents separated/divorcedb 3.06 1.26–7.42 0.014 3.44 1.68–7.03 <0.001 Self harm Self harm thoughts in past year 5.55 2.67–11.56 <0.001 10.01 5.17–19.47 <0.001 Self harm by friendb 4.53 2.20–9.35 <0.001 16.82 8.77–32.24 <0.001 Self harm by family memberb 3.29 1.40–7.73 0.006 10.70 5.41–21.17 <0.001 Friend/family member suicideb 2.30 0.97–5.49 0.059 4.84 2.40–9.75 <0.001 Social support Can talk to teacher about what bothers you 0.61 0.18–2.09 0.43 0.22 0.03–1.62 0.14 Can talk to family member about what bothers you 0.21 0.09–0.46 <0.001 0.41 0.20–0.83 0.013 Can talk to someone else about what bothers you 0.30 0.09–1.02 0.053 0.96 0.44–2.07 0.91 Can talk to a friend about what bothers you 0.66 0.31–1.44 0.300 1.52 0.59–3.94 0.39 Lifestyle factors Drug taking in past year 5.03 2.38–10.60 <0.001 9.35 4.11–21.23 <0.001 Heavy drinking 1.43 0.69–2.95 0.34 4.27 2.13–8.57 <0.001 Smoking 2.15 1.04–4.43 0.04 4.13 2.21–7.75 <0.001 Abuse Serious physical abuseb 6.26 2.39–16.42 <0.001 4.81 1.38–16.78 0.014 Forced sexual activityb 4.75 1.48–15.19 0.009 7.99 3.12–20.49 <0.001 Other factors Problems with schoolworkb 8.65 3.28–22.84 <0.001 3.40 1.79–6.46 <0.001 Worries about sexual orientationb 5.59 2.63–11.88 <0.001 4.70 1.89–11.71 0.001 Trouble with the policeb 3.69 1.81–7.53 <0.001 7.17 3.72–13.79 <0.001 Not living with both parents 2.07 0.91–4.70 0.08 3.69 1.92–7.09 <0.001 Other distressing eventb 2.19 1.04–4.60 0.04 2.99 1.45–6.15 0.003 Experience of illness/death Serious illness of close friendb 1.10 0.53–2.25 0.80 2.76 1.48–5.14 0.001 Death of family memberb 1.22 0.35–4.33 0.75 3.01 1.34–6.67 0.007 Death of someone else closeb 2.07 0.88–4.88 0.10 2.39 1.16–4.89 0.018 Self/family member serious illnessb 1.41 0.71–2.83 0.32 1.42 0.71–2.83 0.32 a Odds ratio for one point increase in score. b Lifetime history. Table options All four psychological scales (depression, anxiety, self esteem and impulsivity) were strongly associated with self harm for both the bullied and the non-bullied groups, with higher odds ratios for self harm for the bullied group on all four scales.