Guest Editorial
Don’t Let Anyone Bully You Into Thinking Bullying Is Not Important!
Ellen L Lipman, MSc, MD, FRCPC1
Bullying, a form of interpersonal violence, is emerging as an important public health issue. There was a time when bullying might have been viewed as a normal developmental experience for school children. However, a more precise definition of bullying, as well as information about its prevalence and associated difficulties, has caused this view to shift substantially.
Bullying is characterized by repeated physical or verbal interactions that are meant to be hostile, cause distress, and involve a power differential between bully and victim (1). While certain characteristics of bullying distinguish it from other forms of aggressive behaviour (for example, its repetitive nature and power differential), bullying can occur in many forms across the lifespan, from playground interactions to dating violence, workplace harassment, and elder abuse. This In Review series focuses on bullying occurring in childhood and adolescence.
Bullying during childhood and adolescence is a common problem: it occurs frequently, and it is universal. It is common for young people to experience bullying. In a 2002 school-based sample of Canadian children aged 11 to 15 years, about one-third of the boys and one-quarter of the girls reported that they had been bullied in the last 6 weeks (2). Greater proportions of boys and girls reported bullying others in the same time period. Cases of severe bullying can result in death (3,4). These rare cases capture headlines and raise public concern, but they clearly represent only the tip of the iceberg in terms of all the bullying that occurs within homes, peer groups, schools, and communities.
Being either a bully or a victim of bullying is associated with increased risk of a broad range of difficulties. Problems in the emotional, behavioural, and social realms—including depressed mood and suicidal ideation—have all been associated with victimization (5–7). Similarly, children and adolescents who bully also have an increased risk of associated emotional and behavioural problems (6). Ongoing research is investigating the extent to which being a bully or a victim represents a causal risk factor (8) for these varied difficulties (9,10).
In this series on bullying, we are fortunate to have 3 linked review articles from distinguished authorities in the field. Their papers help to advance our understanding of the nature, consequences, and management of bullying. The authors come from distant parts of the world—Canada, England, and Australia—which again reinforces that bullying is ubiquitous.
Dr Wendy Craig (Queen’s University, Kingston, Ontario) and Dr Debra Pepler (York University, Toronto, Ontario) represent the Canadian contingent. Their subject is “Identifying and Targeting Risk for Involvement in Bullying and Victimization” (11). These authors emphasize the importance of a developmental perspective on bullying, since patterns of peer interactions learned in childhood generalize to other relationships throughout the lifespan. To adequately assess and address the problem, the nature of bullying must be clearly specified, including understanding sex and developmental differences, risk and protective factors, prevalence, and associated problems.
Dr Kenneth Rigby (University of South Australia, Adelaide, South Australia) has written about “Consequences of Bullying in Schools” (12). Dr Rigby presents studies with various designs examining several outcome variables. In his paper, he works to move beyond difficulties associated cross-sectionally with bullying or victimization to increase our understanding of the causal impact of bullying on emotional and behavioural difficulties.
Dr Peter Smith and Dr Katerina Ananiadou (Goldsmiths College, University of London, London, UK), together with Professor Helen Cowie (University of Surrey, Guildford, Surrey), have written about “Interventions to Reduce School Bullying” (13). They present interventions targeted at various levels (that is, school, classroom, and individual) and evaluate school-based interventions from around the world.
Many of us see children and families with behavioural difficulties such as aggression, and we must often recommend ways to assist children who are either victims or perpetrators of bullying. As a clinician-scientist working in child psychiatry, and as a researcher with an interest in effective, evidence- based interventions, I want to emphasize 2 major points. First, it is crucial to recognize the importance of rigourous methodology in research on bullying. This is a recurrent theme in the 3 reviews. The prevalence of bullying and victimization in the community will vary, depending on how questions are specified and what time period is designated. Studies of the morbidity associated with bullying depend on how bullying is conceptualized (for example, as direct vs relational aggression) and the consequences examined. The research methodology employed (for example, prospective studies vs retrospective or cross-sectional studies) determines the understanding of causality. Clear definitions, consensus where possible, and rigorous study design will all contribute to increasing our understanding of bullying and victimization. Second, it is important to think about how to intervene to reduce the burden of suffering associated with bullying. Clearly, being a bully or a victim is common among children and adolescents. These individuals have associated impairments that may persist, and there are substantial costs associated with bullying and victimization in the multiple domains (that is, in the school system, the health care system, and the judicial system). Therefore, successful interventions have great potential. While a child who has been bullied and who presents with depressed mood or suicidal ideation may receive treatment in a mental health clinic, most antibullying interventions are appropriately aimed at a broader, non–clinic-based system. The success of interventions depends on the type, length, and comprehensiveness of the program; on the age and sex of participants; and on program support by researchers—again highlighting the need for sound and clear methodology. Moving to provide interventions in the broader community (for example, school- or community-based treatments) and evaluating these programs using effectiveness trials (14,15) is an important direction for future research.
Why should psychiatrists treating children and adolescents care about bullying when much of the necessary prevention and intervention work related to it may seem outside the traditional psychiatric role of assessing, consulting, and treating children and families? The paucity of evidence-based treatments in child psychiatry, particularly in clinic (vs research-based) therapy (15), and small numbers of child psychiatric practitioners (16) are 2 major reasons. The lack of evidence-based treatment and practitioners both argue for child psychiatrists’ adopting an advocacy role and supporting broader non–clinic-based programming, using multidisciplinary resources.
This editorial’s title, while tongue-in-cheek, reflects the fact that bullying is detrimental to both victim and bully. I hope this series of review articles will contribute to your understanding of the importance of bullying and victimization in your role as a clinician, researcher, teacher, child advocate, and (or) parent.
Funding and Support
Dr Lipman is supported by an Ontario Mental Health Foundation Intermediate Research Fellowship.
References
1. Olweus D. Bully/victim problems among school children: some basic facts and effects of a school-based intervention program. In: Pepler D, Rubin K, editors. The development and treatment of childhood aggression. Hillsdale (NJ): Erlbaum; 1991. p 411–8.
2. Craig WM, Yossi H. Bullying and fighting: results from the World Health Organization health and behaviour survey of school-aged children. Geneva: World Health Organization. Forthcoming.
3. Canadian Broadcasting Corporation. Bullies. March 13–14, 2001. www.cbc.ca/national/news/bully.
4. British Broadcasting Corporation. UK. Hanged choirboy was bullied. November 4, 1998. news.bbc.co.uk/l/hi/uk/207889.stm.
5. Hawker DSJ, Boulton MJ. Twenty years’ research on peer victimisation and psychosocial maladjustment: a meta-analytic review of cross-sectional studies.
J Child Psychol Psychiatry 2000; 41:441–55.
6. Salmon G, Smith DM. Bullying in schools: self-reported anxiety, depression and self-esteem in secondary school children. BMJ 1998;317:924–5.
7. Kaltiala-Heino R, Rimpelä M, Marttunen M, Rimpelä A, Rantanen P. Bullying, depression and suicidal ideation in Finnish adolescents: school survey. BMJ 1999;319:348–51.
8. Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ.
Coming to terms with terms of risk. Arch Gen Psychiatry 1997;54:337–43.
9. Bond B, Carlin JB, Thomas L, Rubin K, Patton G. Does bullying cause emotional problems? A prospective study of young teenagers. BMJ 2001;323:480–4.
10. Rigby K. Peer victimisation at school and the health of secondary school students. Br J Educ Psychol 1999;69:95–104.
11. Craig W, Pepler D. Identifying and targeting risk for involvement in bullying and victimization. Can J Psychiatry 2003;48:577–82.
12. Rigby K. Consequences of bullying in schools. Can J Psychiatry 2003;48:583–90.
13. Smith P, Ananiadou K, Cowie H. Interventions to reduce school bullying. Can J Psychiatry 2003;48:591–9.
14. Streiner DL. The 2 “Es” of research: efficacy and effectiveness trials. Can J Psychiatry 2002;47:552–6.
15. Weisz JR, Donenberg GR, Hans SS, Kauneckis D. Child and adolescent psychotherapy outcomes in experiments versus clinics: why the disparity? J Abnormal Child Psychol 1995;23:83–106.
16. Canadian Academy of Child Psychiatry. Physician Resource Committee. Child psychiatry in Canada, position statement. Ottawa: Canadian Academy of Child Psychiatry; 2002.
Author(s)
1. Associate Professor, Division of Child Psychiatry, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario; Offord Centre for Child Studies, Hamilton, Ontario.
Address for correspondence: Dr EL Lipman, Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5
e-mail: lipmane@mcmaster.ca
ERRATUM: Vol. 48, No. 7, August 2003, article entitled Implementing Quality Management in Psychiatry. We have noted an error in Figure 2 (p 470).
“Estimated Psychometric Properties,” should read “Established Psychometric Properties.”
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