Bullying is recognized as a major public health problem in the Western world, and it appears to have devastating consequences. Cyberbullying has become an increasing public concern in light of recent cases associated with youth suicides that have been reported in the mass media.
Most of the studies that have examined the association between bullying and suicidality have been cross-sectional. Those studies show that bullying behavior in youth is associated with depression, suicidal ideation, and suicide attempts. These associations have been found in elementary school, middle school, and high school students. Moreover, victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.
The results pertaining to bullies are less consistent. Some studies show an association with depression, while others do not. The prevalence of suicidal ideation is higher in bullies than in persons not involved in bullying behavior. Studies among middle school and high school students show an increased risk of suicidal behavior among bullies and victims. Both perpetrators and victims are at the highest risk for suicidal ideation and behavior.
Suicide risk by sex
Cross-sectional studies of the differential impact of school bullying by sex on the risk of depression and suicidal ideation have shown significant associations, but the results are not consistent. Some researchers have found stronger associations among girls.
Kim and colleagues1 reported that girls who were involved with school bullying (as either victim or perpetrator) were at significantly greater risk for suicidal ideation. Roland2 found that girls who were bullies had more suicidal thoughts. Van der Wal and colleagues3 found a strong association between being bullied and depression and suicidal ideation in girls, and Luukkonen and colleagues4 found that being bullied and bullying others are both potential risk factors for suicidal behavior in girls.
On the other hand, Rigby and Slee5 found that the association between being a bully and suicidal ideation applied only to boys. McMahon and colleagues6 recently reported that boys who had been bullied at school were more depressed and had a higher risk of thoughts about harming themselves and self-harming behavior than boys who had not been bullied. Kaltiala-Heino and colleagues7 reported that among girls, severe suicidal ideation was associated with frequently being bullied or being a bully and for boys it was associated with being a bully. No association was found between boys and girls for depressive symptoms.8
Our earlier work tried to explain the differences in the risks of depression and suicidality between girls and boys; we suggested that there is a difference in the threshold for depression and suicide between the sexes.9 Girls who bullied others were at risk for depression, suicidal ideation, and suicide attempts even when the bullying was infrequent. However, only frequent bullying was associated with depression, suicidal ideation, and suicide attempts among boys.
There may be a different sex threshold in victimization as well. Among girls, victimization at any frequency increased the risk of depression, suicidal ideation, and suicide attempts. On the other hand, only frequent victimization increased the risk of depression and suicidal ideation in boys, although infrequent victimization was associated with an increased risk of suicide attempts.
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