Posted by Phillipa on May 21, 2009, at 12:42:09
Seems bullied kids are the topic being discussed frequently. Hopefully this is another study. Phillipa
Bullied Kids More Likely to Become Psychotic
May 13, 2009 Children who are bullied are more likely to develop psychotic symptoms in early adolescence and there is a dose effect, with repeated bullying associated with greater risk.In the first prospective study to examine the relationship between childhood bullying and psychotic symptoms in early adolescence, investigators at the University of Warwick, in Coventry, the United Kingdom, found the risk for psychotic symptoms nearly doubled among children who were victims of bullying at age 8 or 10 years, independent of other psychiatric illness, family adversity, or the child's IQ, and increased nearly 4-fold when victimization was chronic or severe.
Study coauthor Dieter Wolke, PhD, told Medscape Psychiatry the findings have clear clinical implications.
"If children present with physical or mental health problems, also explore their peer relationships. Being victimized, in particular chronically or severely, can make you ill," Dr. Wolke, told Medscape Psychiatry.
The study is published in the May issue of Archives of General Psychiatry.
Significant Dose Effect
The researchers studied 6437 individuals in early adolescence (average age, 12.9 years) who were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Parents had completed regular mailed questionnaires about their child's health and development since birth, and the children underwent yearly physical and psychological assessments from the age of 7 years.
At each visit, trained interviewers rated the children on whether they had experienced psychotic symptoms, including hallucinations, delusions, or thought disorders, during the previous 6 months.
Children, parents, and teachers also reported on whether the child had experienced peer victimization, defined as negative actions by 1 of more other students with the intention to hurt.
The researchers categorized 46.2% of participants as victims and 53.8% as not victimized at either age 8 or 10 years. Dr. Wolke pointed out that this includes being victimized at any time in childhood, not just during the year in question.
At age 12.9, 13.7% of subjects had broad psychosis-like symptoms with 1 or more symptoms suspected or definitely present; 11.5% had intermediate symptoms with 1 or more symptoms suspected or present at times other than going to sleep, waking from sleep, fever, or after substance use; and 5.6% had 1 or more symptoms definitely present.
The odds ratio for psychotic symptoms was 1.94 among victims of bullying at ages 8 and/or 10 years and jumped to 4.60 for repeated or severe victimization.
Victims Often Less Socially Skilled
Dr. Wolke said it is doubtful that being a target of peer victimization was the result rather than the cause of an underlying predisposition to psychotic symptoms.
"This is the issue of reverse causality," Dr. Wolke said. "We are fairly certain that this is not the case, as victimization reported by mothers from 4 years onward also related to psychotic symptoms. Also, it is not possible to measure psychotic symptoms before 8 years believing in Santa Claus or fairies is not a delusion but part of appropriate development until that age."
"However," Dr. Wolke added, "we know victims show a reaction to bullying more often by crying for example are less socially skilled, and have no or few friends who can protect them. Thus, while the children may not have had psychotic symptoms, they may be socially awkward and were more likely to become targets. However, monozygotic twin studies that are discordant for bullying show that the victimized twin is more likely to develop depression and behavioral symptoms."
The researchers suggest further research is needed to sort out whether repeated victimization experiences alter cognitive and affective processing or reprogram stress response or whether psychotic symptoms are more likely due to genetic predisposition.
"Social victimization by peers is a severe stress. It may lead to reprogramming of the hypothalamic pituitary adrenal axis or a different cognitive style, both found in those with psychosis. It may be more severe in those with genetic susceptibility. However, these are speculations that require more research, Dr. Wolke said.
"A major implication is that chronic or severe peer victimization has nontrivial, adverse, long-term consequences. Reduction of peer victimization and of the resulting stress caused to victims could be a worthwhile target for prevention and early intervention efforts for common mental health problems and psychosis," the authors conclude.
Cause and Effect Not Demonstrated
David Fassler, MD, from the University of Vermont College of Medicine, in Burlington, told Medscape Psychiatry that bullying is a common experience for many young people.
"Surveys indicate that over half of all children are bullied at some time during their school years, and at least 10% are bullied on a regular basis, Dr. Fassler said.
According to Dr. Fassler, previous research suggests bullying may increase the risk of developing psychiatric disorders such as schizophrenia or depression later in life. In this regard, the results of the current study are consistent with previous reports and demonstrate that children who are bullied during childhood are more likely to show "psychoticlike" symptoms by early adolescence.
"Due to the design of the study, the authors can't actually prove that these symptoms are a direct result of the bullying. However, they do demonstrate a significant association," said Dr. Fassler. He warned that the results of this study should be interpreted with caution due to a number of methodological issues.
"For example, the authors experienced a significant dropout rate over the course of the study. They were ultimately able to follow less than half their original sample. In addition, they didn't have access to baseline data on 'psychoticlike' symptoms for the children. However, despite these limitations, the article represents a useful addition to the literature on bullying.
"Hopefully, subsequent studies will help us identify kids who are particularly vulnerable, so we can intervene as early as possible to minimize the risk of lasting emotional consequences," Dr. Fassler said.
The UK Medical Research Council, the Wellcome Trust, and the University of Bristol provide core support for ALSPAC. This study was funded by a grant from the Wellcome Trust. The authors have disclosed no relevant financial relationships.
Arch Gen Psychiatry. 2009;66: 527-536.
Clinical Context
Nonclinical psychotic symptoms (also known as psychosis-like symptoms [PLIKS]), are commonly experienced in childhood and have been linked to adult onset of psychosis, and peer victimization or bullying may be a risk factors for psychotic symptoms.
This is a longitudinal cohort study of the ALSPAC birth cohort to examine the association between self-, parent-, and teacher-reported peer victimization at ages 8 and 10 years and psychotic symptoms as determined by the PLIK Symptoms Interview (PLIKSi).
Study HighlightsIncluded were children from the ALSPAC birth cohort born in 1991 and 1992 in South West England whose parents completed regular postal questionnaires about their children's health.
From age 7.5 years, the children attended annual assessment clinics with face-to-face interviews and psychological and physical tests.
The cohort for this study consisted of 6437 children who completed the PLIKSi at age 12.9 years.
Psychotic symptoms were assessed by psychology graduates, who rated symptoms during the past 6 months using the PLIKSi, for symptoms of hallucinations, delusions, and bizarre delusions as not present, suspected, or definitely present.
Peer victimization was defined as a student being exposed to negative actions by 1 or more other students with the intention to hurt.
Bullying was defined as repeated action with time involving imbalance of power.
The Bullying and Friendship Interview Schedule was used to assess each child at ages 8 and 10 years, with 5 items referring to overt victimization and 4 items to relational victimization.
Overt victimization was defined as receipt of physical or verbal aggression such as being threatened or blackmailed or beaten up.
Relational victimization was defined as social exclusion from peer relationships such as spreading rumors and spoiling games to upset the victim.
Repeated exposure was defined as 4 or more times during the past 6 months.
Very frequent exposure was defined as 1 or more times a week.
Chronicity was defined as stable (at ages 8 and 10 years).
Unstable exposure was defined as reported at the 8- or 10-year assessment, but not both.
Severity was defined as the presence of both types of victimization.
Parents and teachers reported peer victimization using the Strengths and Difficulties Questionnaire administered repeatedly across childhood using a rating question asking if the child was picked on or bullied by other children.
54.2% of the cohort was lost to follow-up, leaving 6437 respondents with the PLIKSi data.
Peer victimization was reported less frequently by girls vs boys.
Overt victimization was more frequent in boys (46.2% vs 35.0%), whereas relational victimization was more common in girls (21.1% vs 18.2%).
Prevalence of peer victimization as reported by parents was 37.8%; by teachers, it was 14.2%.
Chronic peer victimization was found in 13.7% and severe in 5.2% of children at age 10 years.
Victimization as reported by children, parents, or teachers was a significant predictor of PLIKSi symptoms independent of the definition.
Being a repeated victim was associated with an odds ratio of 1.94 for definite psychotic symptoms.
Both chronic and severe victimization were more strongly associated with PLIKSi symptoms vs unstable of less severe victimization.
Chronic victimization was associated with an odds ratio of 3.52 for narrowly defined PLIKSi symptoms, and the presence of both types of victimization had an even higher odds ratio at 4.60.
There was a dose-response association between the severity or chronicity of victimization exposure and the development of psychotic symptoms.
Neither overt nor relational victimization was more strongly related to PLIKSi symptoms.
The association was independent of family adversity, previous psychopathologic condition, and IQ.
The authors concluded that peer victimization had a significant impact on psychotic symptoms in children and nonclinical populations, with potential adverse long-term effects, and prevention efforts for mental health should target this adverse exposure.Clinical Implications
Peer victimization is more frequent in boys and is a predictor of psychotic symptoms in children.
There is a dose-response association between the chronicity and severity of peer victimization and psychotic symptoms in children.
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thread:896991
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