Research Papers

Bullying and Its Effects on Depression in Students Aged 9 to 18 Years of Age

Introduction

“Bullying in schools is a problem that has received widespread attention in recent years” (p. 593), and with good cause when you consider the link between it and symptoms of depression (Conners-Burrow, Johnson, Whiteside-Mansell, McKelvey, & Gargus, 2009). Throughout this paper we will be discussing just that, and diving into the vulnerability of bullying and its link to the diagnosis of depression, in youth between the ages of 9 to 18 years of age. To really explore this topic we will be summarizing and comparing/contrasting three research articles that work to explore this topic in a unique way. These articles include: 1) Adults Matter: Protecting Children from the Negative Impacts of Bullying (Conners-Burrow et al., 2009), 2) High School Bullying as a Risk for Later Depression and Suicidality (Klomek, Kleinman, Altschuler, Marrocco, Amakawa, & Gould, 2011), and 3) School Bullying, Cyberbullying, or Both: Correlates of Teen Suicidality in the 2011 CDC Youth Risk Behavior (Messias, Kindrick, & Castro, 2014). It is also important to understand the rate at which these things affect youth in Canada so we will be addressing the prevalence of depression, suicide rates, and delinquency (victimization, etc.) in the target group as well. After the three articles are examined, we will uncover some of the treatments that can be associated to this population and aim to provide social support, create positive psychosocial spaces, and to treat/manage the symptoms of depression they may experience.

Just as a point of reference, the term bully is defined by Olweus (1994) as being “repeated behaviour (verbal or physical) that occurs over time in a relationship characterized by an imbalance of power” (as cited in Conners-Burrow et al., 2009, p. 593). A form of depression can be defined as a persistent state of sadness that occurs for extended periods of time and cannot be without symptoms for two months or more at a time (Barlow et al., 2012). There are a variety of symptoms that can be taken on by someone suffering from depression. These symptoms tend to be: helplessness, depressed mood, loss of interest, lack of pleasure, suicidal ideation, and diminished sexual desire (Barlow et al., 2012). Some symptoms that are not limited to depression, and are actually shared with most anxiety disorders include things like: anticipating the worst, irritability, crying, guilt, fatigue, insomnia, etc. (Barlow et al., 2012).

The average age of onset for depression has been decreasing in recent years but is currently sitting at approximately 25 years of age (Barlow et al., 2012). Symptoms of depression vary with the type of disorder and on average a first episode will last anywhere from 6 to 9 months at a time (Barlow et al., 2012). From research it seems that the most reoccurring course of depression can be classified as episodic because the symptoms can disappear just to have them reappear at a later time. Throughout this paper we aim to address the area of involvement with bullying in youth aged 9 to 18 years of age, and the potential for it to develop depressive symptoms in this population.

Prevalence

A survey in 2007 determined that 1 out every 5 middle schools students had at one point in their lives committed an act that would be considered delinquent (Statistics Canada, 2007). The survey also found that individuals were often unaware of these acts and just under 60% of these individuals had reported that their last delinquent act went unrecognized (Statistics Canada, 2007). Delinquent acts is a very broad term however, and it could be speculated that with the amount of delinquent acts occurring unnoticed in the public eye, that some of these could have included peer victimization or bullying in the process.

Further, bullying has been proven to be a risk for suicide in youth, and suicide is considered among the top causes of death in adolescents (Messias et al., 2014). On a similar note, it has been established that the relatively new form of victimization known as “cyberbullying” has emerged as being a higher risk of suicide than the conventional schoolyard bullying (Messias et al., 2014). Approximately 12 percent of females and 5 percent of male youth in Canada have reported to having at least one major depressive episode in adolescents between the ages of 12 to 19 years of age (CAMH, 2014). Additionally, it is thought that approximately 3.2 million Canadian youth in this age group are at risk of developing depression (CAMH, 2014).

Because the reported rates of delinquency are so high in Canadian youth (Stats Canada, 2007), one can suspect that these youth will act out in ways that could potentially victimize one another. That being said, bullying and cyberbullying have been linked to high rates of suicide in children (Messias et al., 2014), and with 3.2 million youth in Canada that are susceptible to developing depression (CAMH, 2014), eliminating risk factors that can add to this susceptibility (e.g. bullying) seems like the logical next step. It is highly likely that this topic is of the upmost importance to the Child and Youth Care (CYC) community in Canada, because the prevalence of depression, delinquency (victimization, etc.), and suicide attempts in youth between the ages of 9 to 18 are so high (CAMH, 2014; Messias et al., 2014; Statistics Canada, 2007). By not implementing programs and studies to examine the extent of damage that bullying and peer victimization can have on youth in Canada, and the overall development of depressive symptoms, we may be putting their lives at risk in the long-run. As a future CYC worker I truly feel that to give up on our youth, is to throw away our future.

Researched Articles

As was mentioned in the introduction, this section will summarize three research articles then compare and contrast the differences and similarities within them. To reiterate, the three articles to be presented on are: (1) Adults Matter: Protecting Children from the Negative Impacts of Bullying (Conners-Burrow et al., 2009), (2) High School Bullying as a Risk for Later Depression and Suicidality (Klomek et al, 2011), and (3) School Bullying, Cyberbullying, or Both: Correlates of Teen Suicidality in the 2011 CDC Youth Risk Behavior (Messias et al., 2014). To make matters easier, the articles listed above will be classified and pinpointed using their corresponding numbers from the list. For example if I want to summarize the Adults Matter: Protecting Children from the Negative Impacts of Bullying (Conners-Burrows, 2009), I would refer to it as “Article 1”; and so on. The idea behind this section is to access the information from a variety of studies so that we can grasp a thorough understanding of how depression affects youth between the ages of 9-18 who are involved in bullying in some way.    

Article 1 Summary

            In this study Conners-Burrow et al. (2009) assess how varying levels of adult support can protect children involved in bullying from potentially forming depressive symptoms. Throughout the study the authors aim to explore two research questions. The first one being how parental support can affect depressive symptoms; and the second being, to which level can the teachers support the youth involved in bullying from developing symptoms of depression, if they are not receiving any support at home. To address these questions Conners-Burrow et al. (2009) used quantitative, cross-sectional designs in the form of surveys to evaluate 977 students from ages 9 to 16 (grades 5 to 11) and separated them into four different “bully classifications”.

These classifications highlighted the role each student took in bullying and included: a not involved group (no involvement in bullying), a pure victim group (children maltreated by peers), a pure bully group (children that abuse others but are not bullied themselves), and a bully-victim group (children that mistreat others but are also victimized themselves), (Conners-Burrow, 2009). They also note the fact that bully groups tend to have a variety of friends, victim groups tend to have minimal friends, and bully-victim groups tend to be less accepted by their peers to begin with (Conners-Burrow et al., 2009). This helps to understand the level of support they get from peers outside of their households.

To gather information on how levels of parental support effect depressive symptoms in children involved in bullying, they surveyed their population in three different key areas: 1) levels of bullying, 2) levels of depression, and 3) levels of support (Conners-Burrow et al., 2009). To measure the levels of bullying they used the Olweus Bully Survey, which also determined which bully classification they fell into (Conners-Burrow et al., 2009). This survey asks 40 closed questions with the intent of identifying the “measurement of various forms of exposure to bullying/harassment, bullying others, where bullying occurs, and probully or provictim attitudes” (Conners-Burrow et al., 2009, p. 596).

Their levels of depression are measured using the Children’s Depression Inventory-Short Form which is a ten question scale that evaluates the severity in symptoms of depression and is widely used because of its readability (it uses a grade 1 reading level), (Conners-Burrow et al., 2009). Finally, levels of support are measured on the Child and Adolescent Social Support Survey (Conners-Burrow et al., 2009). This 60 item survey “is designed to measure perceived social support from five sources: parents, teachers, classmates, close friends, and people in school” (p. 597), and uses a 6-point scale that ranges from “never” to “always” to address the questions (Conners-Burrow et al., 2009).

To reach their results, Conners-Burrow et al. (2009) examined how levels of depression, parental support, and teacher support measured up to individuals across the four bully classifications. Results showed that levels of depression were much higher in children that experienced bullying (pure victims, pure bullies, and victim-bullies), than they were in those that did not (the uninvolved group), (Conners-Burrow et al., 2009). In terms of support, uninvolved children reported the highest level of support than those involved with bullying, and the group considered most at risk was the bully-victim group which almost half (46.9%) of the individuals showed high levels of depressive symptoms (Conners-Burrow et al., 2009).

To address the first research question, lower levels of depressive symptoms were recorded by the children in all four bully classifications when parental support was high opposed to being low, but appears to aid the bully-victim group the most (Conners-Burrow et al., 2009). The second research question showed promising results as well, and it was reported that three of the four bully classifications benefitted from high teacher support; the only exception being the victim group (Conners-Burrow et al., 2009). Although there were a few limitations, the study showed the power that social support from teachers and parents can have over the manifestations of depressive symptoms in children between the ages of 9 to 18 years of age, and how this intervention could “help to protect even the most at-risk children” out there (Conners-Burrow et al., 2009, p. 603).

Article 2 Summary

            Because of the amount of research backing the development of depressive symptoms in young children, Klomek et al. (2011) attempt to fill what they refer to as a “gap in knowledge” (p. 503), by assessing the prevalence of depressive symptoms in high school students that reported frequent bullying, but that do not have pre-existing symptoms of anything to begin with. The research question that Klomek et al. (2011) hopes to answer throughout this study is whether or not bullying in this age group (13 to 18) is cause for depressive symptoms, suicidal ideation (thoughts of suicide), or suicide attempts (acts meant to harm oneself) later on in the lives of otherwise healthy individuals (Barlow et al., 2012).

This study uses a quantitative, longitudinal design in the form of surveys/questionnaires to examine a total of 2 342 high school students from the fall of 2002 all the way through to the summer of 2004 (Klomek et al., 2011). Further, the target group is either listed as being a bully, a victim, or both a bully and a victim (Klomek et al., 2011). They also identify three groups that they target among the larger population: an at-risk bully group (individuals that had been a part of bullying behaviors) that was made up 96 students, a bully only group (individuals that experienced bullying but had not displayed symptoms of a previous condition) which included 236 students of various ages, and an at-risk only group (individuals that have a history of depressive symptoms but has not been part of bullying behaviors) which accounted for 317 individuals (Klomek et al., 2011).

To test their hypothesis the team used a variety of different surveys and questionnaires to obtain information from all of the areas they found relevant for this study (Klomek et al., 2011). The surveys/questionnaires covered six areas, they included: (1) the Beck Depression Inventory (BDI), (2) the Suicidal Ideation Questionnaire (SIQ), (3) the Suicide Attempt History (SAH), (4) the Drug Use Screening Inventory (DUSI), (5) the Columbia Impairment Scale (CIS), and last but not least (6) the Bullying/Bullied Experiences (Klomek et al., 2011). The BDI asks 21 questions that are aimed at assessing a large number of components for depression and uses a 0 to 3 scale that ranges from not present, to severe. The SIQ is a 15 item questionnaire that measures the occurrence of specific suicidal ideations on a 7 point scale that ranges “from 0 (I never had this thought) to 6 (This thought was in my mind almost every day)”, (Klomek et al., 2011, p. 506).

The SAH asks seven questions regarding the amount of times the youth have tried to commit suicide both recently and in their life time (Klomek et al., 2011). Klomek et al. (2011) uses the DUSI as a method to screen the youth to assess their levels of alcohol and/or drug abuse and how it affects their schooling or levels of aggression. The CIS uses a 13 piece scale that gauges the severity of functional impairment and also taps into “four major areas of functioning: interpersonal relationships, school/work, certain broad areas of psychopathology (general behaviour or mood), and use of leisure time” (Klomek et al., 2011). Lastly, Klomek et al. (2011) assesses Bullying/Bullied Experiences by asking multiple questions concerning the prevalence of bullying at school and away from school. It uses 5 point scale that begins at 0 and goes to 4 and answers range from “not at all” to “most days” (Klomek et al., 2011). These methods were repeated for the follow-up portion of this study (Klomek et al., 2011).

In order to achieve their results they compared the outcomes of their research methods from the group at large to the smaller groups and they made note of which comprised of the “bully only”, the “at-risk bully” and the “at risk only” groups (Klomek et al., 2011). Klomek et al. (2011) found that the “at-risk bully group” had a significantly higher chance than the “bully only group” to report the development of depressive symptoms and pretty much everything else they were tested for. Further, the individuals with prior conditions were found to have higher symptoms of depression than any of the other target groups as well. Overall the group found that bullying in the absence of previous conditions did not tend to lead to symptoms of depression in the future, but if they did have a pre-standing disorder than the symptoms they developed became far worse.

 Article 3 Summary

            In this study Messias et al. (2014) works to examine the link between students that report cyberbullying, school bullying, or both and their potential for developing depression or suicidal behaviours. The group “hypothesized that subjects reporting school bullying, cyberbullying, or both, are at a higher risk for reporting 2-week sadness, as a proxy for depression, and of endorsing suicide related items” (Messias et al., 2014). This study used a quantitative, cross-sectional design and examined 15 425 students aged 13 to 18 (Messias et al., 2014).

To do this they measured the extent of exposure these individuals had to the various forms of bullying and evaluated there mental capacity for symptoms of depression (Messias et al., 2014). To measure the levels and types of bullying faced by the youth in this study Messias et al. (2014) asked close ended questions that probed the students to assess their own levels of bullying experience in the last twelve months (Messias et al., 2014). Some of the classifications that were located as a result of this quiz were in some way due to the overlap between school bullying and cyber bullying (Messias et al., 2014). They consist of: no bullying, cyberbullying victimization only (being bullied online), school victimization only (being bullied just at school), and finally victimization in cyberbullying and school bullying both (being bullied both online and at school), (Messias et al., 2014). To evaluate the individual’s mental capacity they asked close ended questions that were similar to: how often they felt depressed and how long had these symptoms lasted (Messias et al., 2014). These types of questions were aimed at searching for things like: suicidal ideation, suicide attempts, whether the individual needs treatment from severe suicide attempts, whether they had a suicide plan laid out or not, and if they experienced 2-week sadness (Messias et al., 2014).

In order to come to their results they used adjusted odds ratios to apply their findings from the methods laid out above to areas of race and gender. By doing this, Messias et al. (2014) found that males experience higher ratios of school bullying than females (12.2% to 9.2%), and that women were much more likely to experience cyberbullying than men were (22.0% to 10.8%), (Messias et al., 2014). Further, females were also much more likely to report depressive symptoms afterwards (Messias et al., 2014). In sum, individuals that experienced both forms of bullying had the highest frequency of depressive symptoms at 27.3% (Messias et al., 2014). Cyberbullying alone came in a close second on the list with 13.7% of individuals developing symptoms of depression and it ranked slightly higher than school bullying, which was reported to have caused symptoms in 12.9% of the individuals under that classification (Messias et al., 2014).

Comparing and Contrasting

All three of the articles discussed above chose to use a quantitative type of data collection and is no doubt due to the vast populations being considered in each study (Conners-Burrow et al., 2009; Klomek et al., 2011; Messias et al., 2014). However, only two of the three articles went with a cross-sectional design; article 1 and article 3 (Conners-Burrow et al., 2009; Messias et al., 2014). Article 2 decided to use a longitudinal design which is typically more beneficial in the long run because of its capability to measure both cause and affect relationships (Klomek et al., 2011), opposed to just the cause. Similarly, 2 of the three articles focused on high school students (Klomek et al., 2011; Messias et al., 2014), whereas article 1 chose to begin a little bit younger and covered the age range of 9 to 18 years of age (Conners-Burrow et al., 2009). All three of the articles chose to use the same research method as well (interviews/questionnaires) but assessed different aspects in the process (Conners-Burrow et al., 2009; Klomek et al., 2011; Messias et al., 2014).

They all assessed the areas of bullying and depression (Conners-Burrow et al., 2009; Klomek et al., 2011; Messias et al., 2014), but only Article 2 and 3 assessed the levels of suicidal ideations and suicide attempts in youth involved with bullying (Klomek et al., 2011; Messias et al., 2014). That being said, all of the articles have one feature that is specific to their study. Article 1 varied in a sense that it assessed levels of social support in youth who were involved with bullying (Conners-Burrow et al., 2009). Article 2 differed in assessment because it took into consideration the impacts that drug use could have on depressive symptoms in people involved with bullying in schools (Klomek et al., 2011). Lastly, Article 3 was the only study to look into cyber bullying and how it affected the production of depressive symptoms in this population (Messias et al., 2014).

Another thing that was rather interesting is that all of the articles split bullying into classifications that were very similar (Conners-Burrow et al., 2009; Klomek et al., 2011; Messias et al., 2014). The only major differences that come to mind are from article 2 when they create target populations out of the larger group, and pinpoint the individuals who were susceptible to depression before the onset on bullying, victimization, or both (Klomek et al., 2011). Finally, the overall goals of the studies showed both similarities and differences across the three articles discussed throughout this section. For example, all three articles work to discuss the link between bullying and symptoms of depression in youth that fall between the ages of 9 to 18 years-of-age (the vulnerability, diagnosis, and population), (Conners-Burrow et al., 2009; Klomek et al., 2011; Messias et al., 2014).

However, similar to the methods of research, each article works towards their goal in a unique way. Article 1 uses this criterion to discover if social factors such as parental support and teacher support can help to prevent the manifestation of depressive symptoms for people involved in bullying (Conners-Burrow et al., 2009). However, Article 2 works to assess symptoms of depression in youth who have experienced or taken part in some sort of bullying and must not have any pre-existing conditions to begin with (Klomek et al., 2011). Last but not least, Article 3 assesses gender and ethnic contributions to these symptoms of depression, and also takes into consideration the relatively new form of bullying known as cyberbullying (Messias et al., 2014). By summarizing, comparing, and contrasting these articles we now have a better understanding of the research that has taken place in this given area of study.

Treatments

Social Support

One form of treatment that can be applied specifically to my vulnerability, diagnosis, and population, is that of social support (Conners-Burrow al., 2009). Conners-Burrows (2009) found that social support (both parental and teacher) was beneficial for all groups that took place in his study regardless of whether they had been connected to bullying in some way or not, but was considered to be most effective in the more at-risk groups such as the bully-victim group; which presented the highest risk for developing symptoms of depression. This method of treatment can not only act to limit the negative impacts of bullying in children, but can also be used as an intervention strategy aimed at decreasing the levels of bullying behaviours in this age group as well (Conners-Burrow al., 2009).

In this study Conners-Borrow et al. (2009) measure effective social support as parents doing one or more of the following things for their children: helping them problem solve tough scenarios, offering up advice when they are out of options of their own, listening to them, and basically just showing that you care about them. This technique can be very favourable for the parents or other adults that feel incapable of helping the youth in their lives that are struggling with the connection to bullying and/or symptoms of depression, and Conners-Burrow et al. (2009) ensure adults that “by engaging in these behaviours, parents and teachers may be able to help protect even the most at-risk children and adolescents from experiencing depressive symptoms” (p. 603).

Increased Psychosocial Climate

However, the baseline vulnerability of depression has been proven in many cases to stem from bullying factors in youth between the ages of 9 to 18 (Conners-Burrow et al. 2009; Messias et al., 2014). Because the level of negative impacts bullying can have on a child’s well-being are so apparent, it can be speculated that it would be beneficial to note some ways in which bullying can be limited in school settings to help avoid the negative outcomes associated to it (the harm reduction model). In a study done by Low and Ryzin (2014) to moderate the effects of school climate on bully prevention efforts, this duo found that school climate was instrumental in assisting to change behaviors around bullying. Specifically, they found that the faculty reported a decline in the amount of students that approached them with inquires about bullying when there was a higher level of positivity in the psychosocial climate (Low & Ryzin, 2014).

Psychosocial methods concentrate on not only psychological influences, but factors concerning social and cultural impacts as well (Barlow et al., 2012). Staff in this study reported that a positive change in the psychosocial climate resulted in improvements in student outcomes such as “lower levels of bullying perpetration and higher levels of positive bystander behaviour” (Low & Ryzin, 2014, p. 313-314). Therefore, by improving school climates we can also act to reduce bullying in schools (Low & Ryzin, 2014), which, according to research, would also reduce the manifestations of depressive symptoms in children between the ages of 9 to 18 (Conners-Burrow et al., 2009; Messias et al., 2014).

Depression

Sometimes, however, when children develop symptoms of depression, bullying can be overlooked as a cause (Klomek et al., 2011), and treatment may be aimed at subduing the depressive symptoms alone. Under the biological paradigm, depression could be treated with antidepressant medications such as: selective serotonin reuptake inhibitors (SSRIs), which alter levels of serotonin in the brain, and serotonin and norepinephrine reuptake inhibitors (SNRIs), which increase the availability of positive neurotransmitters in the brain (Web M.D, n.d.).

Next, Cognitive Behavioural Therapy (CBT) seems to be the most widely accepted therapy for the treatment of depression. In a study done by Wiles and colleagues where they examined 469 patients from various age groups, they found that exactly half of the patients (50%) experienced a reduction in depressive symptoms (as cited in Otto & Wisniewski, 2013). Otto and Wisniewski (2013) also find that CBT can act as a “first-line alternative… for antidepressant discontinuation, with retention of benefit over time” (p. 353). Another effective form of treatment for depression is psychotherapy (Web M.D, n.d.). Psychotherapy works to create coping strategies in order to change behaviours and attitudes that accompany depression (Web M.D, n.d.). When depression becomes severe and won’t respond to other forms of treatment, doctors can resort to electroconvulsive therapy (ECT), (Web M.D, n.d.). ECT stimulates portions of the brain that are not otherwise active and is very effective in treating high levels of depression.

In sum, treating depression and bullying together in children through the use of increased social support proves to be the most effective form of treatment (Conners-Burrow et al., 2009), highlighted in this paper. Although, treating the underlying cause of bullying by creating a more positive psychosocial space (Low & Van Ryzin, 2014), and treating the overall condition of depression in various ways (Web M.D, n.d.), may also prove to be effective in this population as well.

Conclusion/Summary

In conclusion, it can be seen that bullying can in fact have a negative impact on youth between the ages of 9 to 18 years of age, and act to promote symptoms of depression in this target sample as well. Depression is a large concern for this age group- as we seen in the introduction- because the target population is within the parameters for the average age of onset (Barlow et al., 2012), and are constantly being exposed to risk factors such as bullying (Conners-Burrow et al., 2009; Messias et al., 2014). This writer hopes that the reader was able to get a grasp on how prevalent this disorder is even right here in Canada, and to understand the level of importance there is for follow up studies and increased monitoring in this area of study as well. Also, it was discovered that there are a variety of different treatment options for youth in this target sample that can help to eliminate or suppress some of the negative risk factors people in this demographic face on a daily basis. Moving forward toward my thesis, I feel that this would be an area of interest for me because the risk assessment of this population seems to point toward the need for future attention.

References

Barlow, D. W., David H., Durand, V. Mark, Stewart, Sherry H. (2012) Abnormal Psychology an Integrative Approach. (3rd Canadian Edition) Nelson Publishing. ISBN-13: 978-0-17-650219-5 ISBN-10: 0-17-650219-X.

Center for Addiction and Mental Health (CAMH). (2014). Fast Facts about Mental Illness: Canadian Mental Health Association. Retrieved November 18, 2014, from http://www.cmha.ca/media/fast-facts-about-mental-illness/#.VG4fdovF9cg

Conners-Burrow, N. A., Johnson, D. L., Whiteside-Mansell, L., McKelvey, L., & Gargus, R. A. (2009). Adults matter: Protecting children from the negative impacts of bullying. Psychology in The Schools46(7), 593-604. doi:10.1002/pits.20400

Klomek, A. B., Kleinman, M., Altschuler, E., Marrocco, F., Amakawa, L., & Gould, M. S. (2011). High school bullying as a risk for later depression and suicidality. The American Association of Suicidality41(5), 501-516.

Low, S., & Van Ryzin, M. (2014). The moderating effects of school climate on bullying prevention efforts. School Psychology Quarterly, 29(3), 306-319. Retrieved from http://dx.doi.org/10.1037/spq0000073.

Messias, E., Kindrick, K., & Castro, J. (2014). School bullying, cyberbullying, or both: Correlates of teen suicidality in the 2011 CDC youth risk behavior survey. Comprehensive Psychiatry55, 1063-1068. Retrieved from www.sciencedirect.com.

Otto, M. W., & Wisniewski, S. R. (2013). CBT for treatment resistant depression. The Lancet, 381(98), 352-353. Retrieved from http://dx.doi.org/10.1016/ S0140-6736(12)61844-3

Statistics Canada. (2007). Statistics Canada: Canada’s national statistical agency. Retrieved from http://www.statcan.gc.ca/start-debut-eng.html

Web M.D. (n.d.). Depression Treatment Options — MAOIs, SSRIs, and More. Retrieved from http://www.webmd.com/depression/guide/depression-treatment-options.

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