Childhood bullying 'casts shadow' over adult life

“Bullying is bad for your health,” the Daily Mail reports. The story comes from research which found that victims of childhood bullying had a higher risk of poor health, poverty and problems with social relationships in adulthood.

The study, which followed more than 1,400 participants from childhood to young adulthood, looked at three groups involved in bullying:

• victims only – who reported being bullied but never bullying others
• bullies only – who bullied, but had never been bullied themselves
• bully-victims – who had been victims of bullying and also bullied others

They found that “bully-victims” seemed to be the most vulnerable group, being six times more likely to have a serious illness, smoke regularly or develop a psychiatric disorder in adulthood.

“Bullies only” were at no increased risk of problems in adulthood, once other risk factors had been taken into account.

This large study addresses an important issue – whether the damaging effects of bullying last into adulthood.

The study cannot prove that being bullied causes problems in adulthood. It is possible for example, that involvement in bullying is a marker for a pre-existing problem which would also lead to difficulties in adulthood, such as psychiatric problems or family dysfunction.

Still, this was a well-conducted study carried out over a lengthy period and its findings should be taken seriously.

Where did the story come from?

The study was carried out by researchers from the University of Warwick, UK  and Duke University in the US. It was funded by the by the National Institute of Mental Health, the National Institute on Drug Abuse, the Brain & Behavior Research Foundation, the William T. Grant Foundation, all in the US, and the UK Economic and Social Research Council.

The study was published in the peer-reviewed journal Psychological Science. Due to the study’s topicality, it was covered widely and for the most part fairly, in the media.

What kind of research was this?

This was a prospective cohort study which followed more than 1,400 participants from childhood into young adulthood.

Its aim was to assess whether involvement in childhood bullying had any effects on areas in adult life such as:

• health
• wealth
• social relationships
• educational achievements
• involvement in risky or illegal behaviours

Cohort studies enable researchers to follow large groups of people for lengthy periods and are useful to look at associations between behaviour (in this case, involvement in bullying) and later outcomes.

Their main limitation is whether they are able to take account of all the other factors (called confounders) which might affect those outcomes. This means cohort studies can never prove cause and effect, only highlight associations.

The researchers point out that being bullied or bullying others is a relatively common experience in childhood and adolescence. While the damaging effects of involvement in bullying in childhood are recognised, they say that this is the first study to investigate how it might affect adult life.

What did the research involve?

In 1993, the researchers recruited a random sample of three groups of children aged 9, 11 or 13 years, from 11 counties in North Carolina, 80% agreed to participate. Each child, or their caregiver, was assessed annually by structured interview, until the age of 16. Each participant was interviewed again at ages 19, 21, and 24 to 26 years. Of the 1,420 children, 89.6% were followed up into young adulthood.

At each assessment between 9 and 16 years old, children and their parents reported on whether the child had been bullied or teased, or had bullied others in the three months before the interview.

Those who had been involved in bullying were then asked for further details such as how often bullying had occurred and where (the focus in the current study was peer bullying at school, rather than for example, sibling bullying at home).

Definitions of bullying and the questions used in the interview were taken from a validated child and adolescent psychiatric assessment. Frequency of bullying and its onset were also assessed.

The definition of being bullied used in the study is that the child is a particular object of repeated mockery, physical attacks, or threats by peers or siblings.

The definition of bullying is where a child repeatedly engages in deliberate actions aimed at causing distress to another or attempts to force another to do something against his or her will by using threats, violence, or intimidation.

To assess bullying involvement, interviewers asked questions such as:

• “Do you get teased or bullied at all by your siblings or friends and peers?”
• “Is that more than other children?”
• “Are other boys and girls mean to you?”
• “Do you ever do things to upset other people on purpose or try to hurt them on purpose?”
• “Do you ever try to get other people into trouble on purpose?”
• “Have you ever forced someone to do something s/he didn’t want to do by threatening or hurting him/her?”
• “Do you ever pick on anyone?”

Participants were categorised as:

• victims only (they never indicated that they had bullied others)
• bullies only (they never indicated that they had been a victim of bullying)
• bully-victims (they had indicated that they both bullied others and had been victims of bullying )
• not involved in bullying

When the children had become young adults, they were asked about the following issues.

Health

For example, whether they had been diagnosed with a serious illness, been in a serious accident, or had a positive test result for sexually transmitted disease or whether they smoked. Weight and height measurements were also taken to work out their body mass index (BMI).

Risky or illegal behaviour

For example, they were asked whether they had been involved in fighting, property break ins, frequent drunkenness, frequent use of illegal drugs, frequency of one time sexual encounters with strangers. Official criminal charges were checked from court records.

Wealth, financial and educational status

They were asked about income and family size, whether they had completed high school or college, whether they had work or financial problems.

Social relationships

At the last adult assessment, participants were asked about their marital, parenthood and divorce status; and the quality of relationships with parents, partners and friends.

The researchers also assessed any disadvantages the child might have suffered – which they call “Childhood hardships” – using established risk scales. Hardships included, low socioeconomic status, unstable family structure, maltreatment at home and family dysfunction.

They also assessed psychiatric problems between 9 and 16, using formal diagnostic definitions. Psychiatric problems assessed included anxiety, depression, disruptive behaviour disorders and substance use disorders.

They analysed their results using standard statistical methods. The results were adjusted for both presence of ‘childhood hardships’ and childhood psychiatric disorders.

What were the basic results?

Nearly two thirds (62.5%) of the children said they had not been involved in bullying.

Nearly a quarter (23.6%) said they had been victims only, 7.9% said they had been bullies only and 6.1% had been bully-victims. 
Both bully-victims and bullies were more likely to be male, but victim status did not differ by sex.

Over one third (37.8%) of victims and bully-victims had been chronically bullied (bullied at two or more time points).

Once they had adjusted for childhood hardships and psychiatric problems, the researchers found that both “victims only” and “bully-victims” were at risk of poorer health, poorer finances and poorer social relationships in adulthood, compared to those who had not been involved in bullying.

By contrast “pure bullies” were not at increased risk of poorer outcomes in adulthood.

Those who had been chronically bullied had a higher level of social problems and showed a trend to financial problems, compared to those who were only bullied at one time point.

Bully victims were six times more likely to have a serious illness, smoke regularly or develop a psychiatric disorder as adults, than those who had not been involved in bullying.

How did the researchers interpret the results?

Being bullied is not a harmless rite of passage but throws a “long shadow over affected people’s lives”, say the researchers.

They suggest that being bullied may alter physiological responses to stress or interact with genetic vulnerability.

Interventions in childhood are likely to reduce long-term health and social costs, they argue.

Conclusion

This long term study suggests that victims of bullying, in particular chronic bullying, suffer long term damage which lasts into adulthood. As the authors point out, early monitoring, assessment and interventions are vital to prevent or stop such destructive behaviour.

The study does have some limitations. It relied heavily on children and adults self-reporting in many areas of life, which could affect the reliability of its results. Also, as the authors point out, the findings may not apply to other populations, particularly since American Indians (Native Americans) were overrepresented and African Americans under-represented.

In their analysis the authors tried to take account of other factors in childhood which might influence adult prospects, such as family and psychiatric problems. However, in this type of study it is always possible that both measured and unmeasured confounders might have an effect on outcomes.

This is a complex area and it is possible that involvement in bullying is a marker for a pre-existing condition such as a psychiatric problem which could also damage prospects in adulthood. On the other hand, as the authors point out, it is possible that bullying was caused by psychiatric problems in childhood, a factor that was adjusted for in their analysis. This may have led to an underestimate of the long term effects.

This is a difficult area to research and this study overall provides useful initial insights into the potential prolonged effects of childhood events.