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Lereya, S.T., Copeland, W.E., Costello, E.J., & Wolke, D. (2015). Adult mental health consequences of peer bullying and maltreatment in childhood: Two cohorts in two countries. The Lancet Psychiatry, 2, 524-531.

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Verbal and physical abuse and systematic social exclusion might be seen as peer maltreatment and are often described as bullying or peer victimization. Bullying is characterized by repetitive aggressive behavior engaged in by an individual or peer group with more power than the victim. Being bullied is reported to have adverse effects, including physical or mental health problems such as anxiety, depression, an increased risk of self-harm, and attempt or completion of suicide. Results from recent studies also show that being bullied can modify stress responses.

Method: The Great Smoky Mountains Study in the USA (GSMS) was conducted with 1420 children, aged 9, 11, and 13 years, recruited from 11 counties in western North Carolina. Maltreatment and bullying were repeatedly assessed with annual parent and child interviews between ages 9 and 16 years. Lifetime occurrence of physical and sexual abuse was assessed at every interview, whereas harsh parental discipline was assessed in the 3 months immediately preceding the interview. Maltreatment was present if the child or parent reported that the child had been physically abused, sexually abused, or the target of harsh parental discipline. The child and their parent reported on whether the child had been bullied in the 3 months before the interview as part of the Child and Adolescent Psychiatric Assessment (CAPA). ICD-10 diagnoses of anxiety and depression at age 18 years were obtained from a computerized version of the Clinical Interview Schedule (CIS-R). Self-harm was assessed at 18 years from the CIS-R, with the following two questions: “Have you ever hurt yourself on purpose in any way (eg, by taking an overdose of pills, or by cutting yourself)?” If yes, “How many times have you harmed yourself in the last year?” (not in the past year versus once, two-to-five times, six-to-ten times, or more than ten times). The researchers measured any DSM-IV anxiety disorder, depression, and suicidality with the Young Adult Psychiatric Assessment (YAPA). Scoring programs combined information about the date of onset, duration, and intensity of each symptom to create diagnoses according to the DSM-IV.

Results: 18% of young adults in the sample had overall mental health problems. 12% were classified as having anxiety, 6% as having depression, and 7% as having reported self-harm in the past year. 15% of children were exposed to only maltreatment, 16% to only bullying, and 10% to both maltreatment and bullying. Maltreated children were more often bullied than those not maltreated. Children who were only bullied by peers were significantly more likely to have all mental health problems than were children who did not experience maltreatment or bullying. Those who were both maltreated and bullied were more likely to have overall mental health problems, anxiety, and depression. Being bullied only was a higher risk for overall mental health problem than was being maltreated only. Children who were bullied were more likely to have anxiety as adults than children who were maltreated by adults.

Discussion: The results showed an increased risk of young adult mental health problems in children who were bullied by peers whether or not they had a history of maltreatment by adults. Maltreatment by itself did not increase the risk of any mental health problem except for depression. Maltreatment mainly had adverse effects on mental health problems when the children had also been bullied. Experience of other forms of victimization might create susceptibility for being bullied. The effects of maltreatment on young adult mental health may be at least partly due to being bullied. A recent study showed that the relationship between maltreatment and depression was mediated by overt and relational peer victimization.