Violent Behavior and Bullying in Adolescents

ABSTRACTS & COMMENTARY

Synopsis: Significant declines in fighting and weapon carrying among American adolescents were documented between 1991 and 1997. Among Australian teenage students, almost a quarter reported that they either bullied other students or were themselves bullied. Bullying behavior was associated with increased psychosomatic symptoms. Among Finnish adolescents, there was an increased rate of depression and suicidal ideation among both those who bullied and those who were bullied themselves.

Sources: Brener ND, et al. Recent trend in violence-related behaviors among high school students in the United States. JAMA 1999;282:440-446; Kaltiala-Heino R, et al. Bullying, depression, and suicidal ideation in Finnish adolescents: School survey. BMJ 1999;319:348-351; Forero R, et al. Bullying behaviour and psychosocial health among school students in New South Wales, Australia: Cross sectional survey. BMJ 1999;319:344-348.

Brener and associates from the centers for Disease Control measured trends in nonfatal violent behavior among adolescent students in the United States over the period 1991-1997 using nationally reported data from the biannual Youth Risk Behavior Surveys. The percentage of students reporting being involved in a physical fight decreased from 42.5% to 36.6% and the percentage injured in a fight decreased from 4.4% to 3.5%. Between 1993 and 1997, the percentage of students who carried a weapon decreased from 26.1% to 18.3% and the percentage who carried a gun decreased from 7.9% to 5.6%. All of these decreases were believed to be significant.

Forero and associates in New South Wales, Australia, and Kaltiala-Heino and colleagues from Finland quantitated bullying—both given and received in adolescent school children using surveys. In both populations, bullying was relatively common and consisted mostly of verbal teasing. Psychological symptoms, including depression and suicidal ideation, were increased in prevalence in both bullying and bullied teenagers when compared to teenagers who were not bullies or victims of bullying.

Comment by Walter R. Anyan, MD, FAAP

In these articles from three continents, adolescents’ in-school experience with violence of varying type and degree is a common focus. Brener et al’s data from the United States indicate that two behaviors in which males are much more likely to be involved than females decreased between 1993 and 1997. They were: fighting on school property during the past 30 days, which dropped from 16.2% to 14.8%, and carrying a weapon on school property in the past 30 days, which fell from 11.8% to 8.5%. The good news was that over the four years, gun-carrying decreased and the bad news was that carriage of other weapons did not change. Students became less likely to carry weapons as they moved from 9th to 12th grade, and we don’t know whether they realized that they didn’t need them, whether they became more responsive to potential legal consequences, or whether they quit school and took their weapons elsewhere. It was also encouraging to notice that reported concern about being threatened or injured with a weapon on school property also decreased perceptibly as grade in school advanced.

Both Kaltiala-Heino et al and Forero et al have studied in-school violence of another type: the verbal teasing and associated actions that make up bullying. Their articles provide some fresh insights on bullies and those who are bullied. In Kaltiala-Heino et al’s study, among males 14-16 years old, 9% of males bullied other students at least weekly and 6% of males reported being bullied as frequently, suggesting that there is a shortage of victims. However, among females, 2% of girls bully and 5% report being bullied, so the student population seems to have reached an equilibrium, with 11% involved in bullying. In addition, one learns that bullies don’t walk away symptom-free, as depression was noted to be as common in bullies as in those bullied, and was greater in both groups than in students who weren’t involved in bullying at all. Depression was most prominent in double-dippers (bullies who were themselves bullied). Not surprisingly, where depression exists, suicidal ideation lurks nearby, and the study found similar connections between bullying, being bullied, and suicidal thoughts.

In Australia, Forero et al found a higher overall level of both bullying (23.7%) and being bullied (12.7%), and noted that bullies were more likely to be male, to manifest psychosomatic symptoms, to be unhappy with school, and to smoke tobacco. Those who were bullied tended to be males who liked school but felt lonely and socially isolated. Bullied-bullies were males who experienced moderate social isolation and had the highest level of psychosomatic symptoms.

All of this work lends more support to the inescapable conclusion that youth don’t just get used to violence and that it isn’t good for them. Violence in adolescence is increasingly being likened with psychological distress, depression, aggressive behavior, reduced expectations about the future, and post-traumatic stress disorder. Along with the myriad screening we provide to patients, we might find a minute to ask patients about the teasing and the teased in their schools.

Study of adolescents concerning school behavior reveals:

a. the rate of both carriage of guns and other weapons decreased in the United States between 1991 and 1997.

b. equal numbers of girls and boys were bullied by peers.

c. symptoms of depression were about equal in male bullies as in males who were bullied.

d. there was no association between a history of bullying or being bullied and suicidal ideation.