Suicidality, internalizing problems and externalizing problems among adolescent bullies, victims and bully-victims

Highlights

• This study examined adolescent victims, bullies, and bully-victims in Australia.

• Victims reported more internalizing problems than uninvolved students and bullies.

• Bullies reported more externalizing problems than uninvolved students and victims.

• Bully-victims had the highest suicidality, internalizing and externalizing problems.

Abstract

Objective

The aim of this study is to compare suicidality, internalizing problems and externalizing problems among adolescent victims, bullies and bully-victims.

Method

This study examined bullying involvement among a subset of the baseline sample of the Climate and Preventure study, a trial of a comprehensive substance use prevention intervention for adolescents in 2012. The sample included 1588 Year 7–9 students in New South Wales and Victoria, Australia.

Results

Victims, bullies and bully-victims had more problems than uninvolved students. Students with internalizing problems were more likely to be a victim than a bully. Some externalizing problems (alcohol and tobacco use) were associated with increased odds of being a bully, but not others (cannabis use and conduct/hyperactivity symptoms). Suicidal ideation, internalizing problems and some externalizing problems increased the odds of being a bully-victim compared to being a bully or a victim.

Conclusion

Early intervention for adolescents frequently involved in bullying may reduce the onset of substance use and other mental disorders. It would be advisable for bullying interventions to include a focus on substance use and mental health problems. A reduction in these chronic and detrimental problems among adolescents could potentially lead to a concomitant reduction in bullying involvement.

Introduction

Bullying is a major issue affecting the health and wellbeing of young people worldwide, with international rates of bullying in the range of 10% to 50% (Currie et al., 2012). Bullying has been associated with concurrent and long-term consequences, such as emotional and behavioural problems, physical health problems, and academic difficulties (Gini and Pozzoli, 2009, Kumpulainen et al., 2001, Hawker and Boulton, 2000, Due et al., 2005, Nansel et al., 2001, Rigby, 2003, Bond et al., 2001, Arseneault et al., 2010). Bullying during adolescence is of particular importance, due to the significant role of peer relationships in development (Perren et al., 2010, Steinberg and Morris, 2001). Adolescence is also the period of onset for many substance use and other mental disorders, and therefore is a key time to focus preventive efforts (Kaltiala-Heino et al., 1999).

The bullying literature typically reports externalizing problems among bullies and internalizing problems among victims (Ivarsson et al., 2005, Hawker and Boulton, 2000, Reijntjes et al., 2010, Hodges and Perry, 1999, Cook et al., 2010, Luukkonen et al., 2010a, Luukkonen et al., 2010b, Sourander et al., 2000, Kumpulainen and Räsänen, 2000, Menesini et al., 2009, Arseneault et al., 2008, Solberg and Olweus, 2003, Ttofi et al., 2011, Kaltiala-Heino et al., 2000). Internalizing problems refer to turning distress inwards, such as mood and anxiety disorders, while externalizing problems refer to expressing distress outwards, such as attention deficit hyperactivity disorder, conduct disorder and substance use disorders (Cosgrove et al., 2011, Krueger, 1999, Krueger and Markon, 2011). However, the internalizing-victim and externalizing-bully dichotomy may be an over-simplification, with evidence of internalizing problems among bullies and externalizing problems among victims (Juvonen et al., 2003, Sourander et al., 2000, Ivarsson et al., 2005, Coolidge et al., 2004, Mitchell et al., 2007, Swearer et al., 2001, Moore et al., 2014, Reijntjes et al., 2011, Archimi and Kuntsche, 2014, Kaltiala-Heino et al., 2000). Cook et al. (2010) conducted a meta-analysis of predictors of bullying victimization and perpetration among school-aged children. They found that, while ‘externalizing behaviour’ was a predictor of being a victim, it was a stronger predictor of being a bully, and while ‘internalizing behaviour’ was a predictor of being a bully, it was a stronger predictor of being a victim.

A further complication in the association between bullying and internalizing and externalizing problems, is the often overlooked group involved in both bullying victimization and perpetration, known as ‘bully-victims’. While bully-victims have not received as much attention as victims or bullies, it appears that bully-victims may experience a more severe combination of internalizing and externalizing problems than ‘pure’ victims or bullies (Nansel et al., 2001, Cook et al., 2010, Haynie et al., 2001, Ivarsson et al., 2005, Sourander et al., 2007, Kumpulainen and Räsänen, 2000, Forero et al., 1999, Copeland et al., 2013, Burk et al., 2011, Schwartz, 2000, Klomek et al., 2011). The co-occurrence of internalizing and externalizing problems has been found to heighten the risk for adverse outcomes (Vander Stoep et al., 2011, Wolff and Ollendick, 2006); one highly concerning outcome that has been found to be particularly high among bully-victims is suicide (McKenna et al., 2011, Espelage and Holt, 2013, Copeland et al., 2013, Borowsky et al., 2013, Ivarsson et al., 2005).

While many longitudinal studies have been conducted to examine predictors and consequences of bullying, few studies have compared concurrent problems among bullies, victims and bully-victims within the same study. Studies on concurrent problems among adolescents involved in bullying tend to be limited to one bullying subtype, and/or a limited number of problems. While such studies are able to show that internalizing problems are high among victims, and externalizing problems are high among bullies, they are not able to determine whether such problems are more strongly associated with one group than the other. Greater clarity is needed in identifying the particular problems among bullying subtypes, to inform preventive interventions for bullying and related harms. Current bullying interventions tend to be whole-of-school programmes aimed at reducing the prevalence of bullying within a school. Reviews of such interventions have found significant variability in their effectiveness, and they rarely assess mental health or substance use outcomes (Barbero et al., 2012, Smith, 2011, Ttofi and Farrington, 2011).

The current study seeks to address the gaps in the literature as described above by comparing a range of concurrent problems among frequent victims, bullies and bully-victims. In addition, this study aims to assess whether bully-victims may be in particular need of intervention. Specifically, this study proposes the following hypotheses:

• Suicidal ideation, internalizing problems and externalizing problems will be more strongly associated with victim, bully and bully-victim status than uninvolved status;

• Internalizing problems will be more strongly associated with victim status than bully status;

• Externalizing problems will be more strongly associated with bully status than victim status;

• Suicidal ideation, internalizing problems and externalizing problems will be more strongly associated with bully-victim status than bully or victim status.

This study will also assess which of the problems present the highest risk for each bullying subtype.