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doi:10.1136/bmj.323.7311.480 2001;323;480-484 BMJ Lyndal Bond, John B Carlin, Lyndal Thomas, Kerryn Rubin and George Patton prospective study of young teenagers Does bullying cause emotional problems? A http://bmj.com/cgi/content/full/323/7311/480 Updated information and services can be found at: These include: Data supplement http://bmj.com/cgi/content/full/323/7311/480/DC1 "Questionnaires" References http://bmj.com/cgi/content/full/323/7311/480#otherarticles 26 online articles that cite this article can be accessed at: http://bmj.com/cgi/content/full/323/7311/480#BIBL This article cites 16 articles, 4 of which can be accessed free at: Rapid responses http://bmj.com/cgi/eletter-submit/323/7311/480 You can respond to this article at: http://bmj.com/cgi/content/full/323/7311/480#responses at: 2 rapid responses have been posted to this article, which you can access for free service Email alerting the top left of the article Receive free email alerts when new articles cite this article - sign up in the box at Topic collections (265 articles) Abuse (child, partner, elder) (502 articles) Adolescents (2712 articles) Other Public Health (317 articles) Child and adolescent psychiatry (701 articles) Mood disorders (including depression) (344 articles) Sociology Articles on similar topics can be found in the following collections Notes To order reprints follow the "Request Permissions" link in the navigation box http://resources.bmj.com/bmj/subscribers go to: BMJ To subscribe to on 19 February 2008 bmj.com Downloaded from
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Does bullying cause emotional problems? A prospective study of young teenagers Lyndal Bond, John B Carlin, Lyndal Thomas, Kerryn Rubin, George Patton Abstract Objectives To establish the relation between recurrent peer victimisation and onset of self reported symptoms of anxiety or depression in the early teen years. Design Cohort study over two years. Setting Secondary schools in Victoria, Australia. Participants 2680 students surveyed twice in year 8 (aged 13 years) and once in year 9. Main outcome measures Self reported symptoms of anxiety or depression were assessed by using the computerised version of the revised clinical interview schedule. Incident cases were students scoring > 12 in year 9 but not previously. Prior victimisation was defined as having been bullied at either or both survey times in year 8. Results Prevalence of victimisation at the second survey point in year 8 was 51% (95% confidence interval 49% to 54%), and prevalence of self reported symptoms of anxiety or depression was 18% (16% to 20%). The incidence of self reported symptoms of anxiety or depression in year 9 (7%) was significantly associated with victimisation reported either once (odds ratio 1.94, 1.1 to 3.3) or twice (2.30, 1.2 to 4.3) in year 8. After adjustment for availability of social relations and for sociodemographic factors, recurrent victimisation remained predictive of self reported symptoms of anxiety or depression for girls (2.60, 1.2 to 5.5) but not for boys (1.36, 0.6 to 3.0). Newly reported victimisation in year 9 was not significantly associated with prior self report of symptoms of anxiety or depression (1.48, 0.4 to 6.0). Conclusion A history of victimisation and poor social relationships predicts the onset of emotional problems in adolescents. Previous recurrent emotional problems are not significantly related to future victimisation. These findings have implications for how seriously the occurrence of victimisation is treated and for the focus of interventions aimed at addressing mental health issues in adolescents. Introduction Bullying occurs in all schools, but its relevance to health and wellbeing is uncertain. 1–3 On the one hand it can be considered a common and normal develop- mental experience; alternatively, it can be considered an important cause of stress and of physical and emo- tional problems. 4–6 A meta-analysis of studies investi- gating the relation between victimisation and psycho- social maladjustment found a stronger association with measures of depression than with anxiety, loneliness, or general self esteem. 1 Unfortunately, the cross sectional design of most studies precludes inferences about causality. The few available prospective studies have generally focused on primary school children before the early increase in depression in adolescence, 7 with the principal out- comes being school maladjustment, loneliness, and depression. 8–10 One small longitudinal study of adoles- cents found that high levels of victimisation predicted poor physical health for boys and girls and poor men- tal health for girls. 11 Olweus found that boys victimised between the ages of 12 and 16 had increased levels of depression as young adults; however, no adjustment was made for previous mental health states in this study. 5 We carried out a prospective study of secondary school students. The data derive from three waves of data collected from students involved in a randomised controlled trial of a school based intervention to promote the emotional wellbeing of young people. 12 Intervention effects in the trial are not the main focus of this paper. Data were collected at the beginning and end of year 8 (second year of secondary school, mean age 13 years) and 12 months later (end of year 9). Our aim was to use these prospective data to examine the relation between a history of victimisation (in year 8) and the incidence of self reported symptoms of anxiety or depression in year 9. Methods A cluster randomised controlled design was used for the allocation of education districts to intervention or control status. In metropolitan Melbourne, 12 districts were sampled with a probability proportional to the number of secondary schools (including government, independent, and Catholic schools) and were ran- domly allocated to intervention or control status. We used simple random sampling to select 12 schools from the “intervention” districts and 12 from the “con- trol” districts. Six country schools were randomly drawn from two regional districts. Twenty six (12 inter- vention and 14 control) schools agreed to participate. Students completed a self administered question- naire at school using laptop computers provided by the research team. Questionnaires took approximately 40 minutes to complete. Absent students were surveyed at school at a later date or by telephone. Ethics approval was granted by the Royal Children’s Hospital ethics in human research com- mittee, the Victorian Department of Education, Employment and Training, and the Catholic Education Office. Student participation was voluntary, with written parental consent required. Victimisation Participants were classified as victimised if they answered yes to items addressing four types of recent victimisation: being teased, having rumours spread about them, being deliberately excluded, or experienc- ing physical threats or violence. Respondents were classified on the basis of self report in year 8 as having experienced recurrent victimisation if they reported having been bullied at both times in year 8 (waves 1 and 2). Questionnaires used in the study are on the BMJ’s website Papers Centre for Adolescent Health, Royal Children’s Hospital, Parkville 3052, Victoria, Australia Lyndal Bond head, research unit Kerryn Rubin medical student George Patton director Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute and University of Melbourne Department of Paediatrics, Royal Children’s Hospital John B Carlin director Lyndal Thomas PhD scholar Correspondence to: L Bond [email protected]cryptic.rch. unimelb.edu.au BMJ 2001;323:480–4 480 BMJ VOLUME 323 1 SEPTEMBER 2001 bmj.com on 19 February 2008 bmj.com Downloaded from
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Answer the questions below. This process forms the basis of a critical appraisal and this will assist you in drawing your own conclusions about the study’s findings. Answer each of the questions in your own words. For example, quoting from the abstract that a “cohort study” was carried out is not sufficient. Statement of objectives 1 ) What were the investigators’ aims and objectives? If they are not stated explicitly in the paper, what do you think they were? [3 marks ] 2 ) What was the hypothesis that the authors were testing? If no hypothesis is stated, what do you think it was? [3 marks ] Study design 3 ) What type of study was carried out? The name of a study type as stated by the investigators (eg randomised controlled trial) is not sufficient, describe in your own words what they did. Do you think the study design is appropriate to the aims and objectives? [3 marks ] 4 ) What other study designs could have been used? Discuss the advantage and disadvantages of each. [3 marks ] Target/reference population 5 ) What is an appropriate target/reference population for this study? (That is, to whom did the investigators want to generalise the results?) Source/sampled population 6 ) Describe the source or sampled population from which sample was drawn. Is this an appropriate choice? Are there any potential biases introduced through specific groups being missed or under-presented? Sample frame 7 ) Did the investigators use a sample frame? If so, describe the sample frame and comment on its appropriateness. If not, what would you recommend as a sample frame and why? Sample selection 8 ) How was the study sample selected? Is this an appropriate sampling strategy? What, if any, are the potential biases in the sample selection? Method of measurement
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9 ) What method(s) was (were) used to obtain data from the sample? Comment on the appropriateness of the method(s). Discuss the advantages and disadvantages of other methods that could have been used? Measurement instrument ) How were the main variables of interest measured? Were valid and reliable measures obtained? What were the main outcome (dependent) variable(s) and study factors (or exposures or independent variables) of interest ? Statistical analysis 11 ) Suppose that you were assisting the authors with the data analysis and had to help them with the interpretation of the findings. Describe in your own words the results presented in Table 1 to Table 4. [5 marks ] Authors’ conclusions 12)What were the main conclusions drawn by the authors? Are they justified? Based on your reading of the paper, do you agree with them?
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