Bullying Found to Increase Risk for Adolescent Suicide Attempts Worldwide

Adolescents who are bullied have a threefold higher risk of suicide attempts globally, according to a study published in March in the Journal of the American Academy of Child & Adolescent Psychiatry. The findings emphasize the importance of screening youth for exposure to bullying, assessing suicidality in youth who have been bullied, as well as enhancing youth coping and problem-solving skills.

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“Bullying victimization may be an important risk factor of suicide attempts among adolescents globally,” wrote Ai Koyanagi, M.D., Ph.D., of the Research and Development Unit at the Universitat de Barcelona in Barcelona, Spain, and the Centro de Investigación Biomédica en Red de Salud Mental in Madrid, Spain, and colleagues. “Thus, there is an urgent need to implement effective and evidence-based interventions to address bullying in order to prevent suicides and suicide attempts among adolescents worldwide.”

Self-harm is the third-leading cause of death among adolescents worldwide, resulting in about 67,000 deaths a year, according to the World Health Organization. For this study, researchers examined data from 134,000 adolescents aged 12 to 15 years from 48 mostly lower- to middle-income countries who took the Global School-Based Student Health Survey. The researchers collected information on past 30-day bullying victimization and past 12-month suicide attempts and analyzed the association between them.

About 30% of students reported being victims of bullying, and nearly 11% of students reported attempting suicide. There was a wide variation by country in the percentage of students who attempted suicide, ranging from 4% in Indonesia to 61% in Samoa.

Countries with a higher prevalence of bullying victimization also tended to have a higher prevalence of suicide attempts, the researchers wrote. The country with the highest prevalence of bullying, Samoa (74%), also had the most adolescent suicide attempts (61%).

Being bullied for at least one day in the past 30 days was associated with a more than threefold higher risk for suicide attempts overall, and the more days that an individual was bullied was associated with a correspondingly increased risk for suicide attempt.

The past-year prevalence of suicide attempts ranged from nearly 6% of students who were in the “no bullying” group up to 33% of students who were being bullied for “20 to 30 days a month.”

The association between bullying victimization and suicide attempts may be mediated by factors such as depression; low self-esteem; hopelessness; loneliness; or exacerbation of the effects of an adverse family environment, such as domestic violence or poor parenting, the authors wrote.

“Efforts to reduce bullying, especially at school, may be fundamental to prevent or reduce adolescent suicides,” the authors wrote. Still, one study found that school-based anti-bullying programs can cut bullying by only 17% to 20%, highlighting the need to develop other interventions, they added.

“With respect to victims of bullying, it has been suggested that interventions to enhance coping and problem-solving skills for psychological distress associated with bullying increase social connectedness, improve conditions within the home, and cultivate inclusive and safe environments/spaces in schools may be effective,” the authors wrote. “Mental health practitioners should consider bullying as an important potential risk factor for suicide attempts.”

This study was supported in part by the European Regional Development Fund and the National Institute for Health Research. ■