Peer Victimization, Depression, and Suicidality in Adolescents

16 Pages·2017·0.17 MB·English

CCiittyy UUnniivveerrssiittyy ooff NNeeww YYoorrkk ((CCUUNNYY))
CCUUNNYY AAccaaddeemmiicc WWoorrkkss
Publications and Research City College of New York
2007
PPeeeerr VViiccttiimmiizzaattiioonn,, DDeepprreessssiioonn,, aanndd SSuuiicciiddaalliittyy iinn AAddoolleesscceennttss
Anat Brunstein Klomek
Columbia University
Frank Marrocco
Columbia University
Marjorie Kleinman
Columbia University
Irvin Sam Schonfeld
CUNY Graduate Center
Madelyn S. Gould
Columbia University
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166 Suicide and Life-Threatening Behavior 38(2) April 2008
 2008 The American Association of Suicidology
Peer Victimization, Depression, and Suicidiality
in Adolescents
Anat Brunstein Klomek, PhD, Frank Marrocco, PhD, Marjorie Kleinman, MS,
Irvin Sam Schonfeld, PhD, MPH, and Madelyn S. Gould, PhD, MPH
The association between specific types of peer victimization with depres-
sion, suicidal ideation, and suicide attempts among adolescents was examined. A
self-reportsurveywascompletedby2,342high-schoolstudents.Regressionanaly-
ses indicated that frequent exposure to all types of peer victimization was related
tohighriskofdepression,ideation,andattemptscomparedtostudentsnotvictim-
ized. Infrequent victimization was also related to increased risk, particularly
amongfemales.Themoretypesofvictimizationthehighertheriskfordepression
and suicidality among both genders. Specific types of peer victimization are a
potential risk factor for adolescent depression and suicidality. It is important to
assess depression and suicidality among victimized students in order to develop
appropriate intervention methods.
Peer victimization is a prevalent problem mately 10 to 20% of high school students in
among high school students (Brunstein Klo- theU.S.reportmoderateorfrequentvictim-
mek, 2007; Nansel, Overpeck, Pilla, Ruan, ization (Klomek et al., 2007; Nansel et al.,
Simons-Marten, & Scheidt, 2001). Approxi- 2001). Nansel and colleagues’ national study
assessed five specific types of victimization:
belittlingaboutreligion/race;belittlingabout
Dr.BrunsteinKlomekisanassistantpro- looks/speech; hitting, slapping, or punching;
fessorofclinicalpsychologyatColumbiaUniver-
rumor spreading or lying about the target;
sity in the Division of Child and Adolescent Psy-
and sexual comments/gestures (Nansel et al.,
chiatry;Dr.MarroccoisanInstructorofClinical
Psychology in the Division of Child and Adoles- 2001). The prevalence of these types of vic-
cent Psychiatry; Ms. Kleinman is a research sci- timization among adolescents ranged from 8
entist in the Division of Child and Adolescent to 20%; the most common being belittling
Psychiatry; Dr. Schonfeld is a lecturer at Co-
aboutlooks orspeech andthe leastprevalent
lumbia University in the Department of Psychia-
being belittling about religion or race
tryandaProfessorattheCityCollegeoftheCity
UniversityofNewYork;andDr.GouldisaPro- (Nanseletal.,2001).Beingbulliedviae-mail
fessor at Columbia University in the Division of or the Internet (cyber victimization) is the
ChildandAdolescentPsychiatryandDepartment newesttypeofvictimization(Patchin&Hin-
ofEpidemiology(SchoolofPublicHealth),anda
duja, 2006;Ybarra, 2004;Ybarra &Mitchell,
researchscientistattheNewYorkStatePsychiat-
2004). The prevalence of this type of victim-
ricInstitute.
ThisprojectwassupportedbyNationalIn- zation varies, from 4 to 35% in adolescent
stituteofMentalHealthgrantRO1-MH64632. samples(Patchin&Hinduja,2006;Ybarra&
AddresscorrespondencetoAnatBrunstein Mitchell, 2004).
Klomek, PhD, Division of Child & Adolescent
The classification and definition of
Psychiatry, Department of Psychiatry, Columbia
specific types of victimization varies among
University/ NYSPI, 1051 Riverside Drive, Unit
72,NewYork,NY10032;E-mail:klomeka@child studies (Wolke & Stanford, 1999), making
psych.columbia.edu comparisonsamongstudiesdifficult(Hawker
Klomek et al. 167
& Boulton, 2000). Overt victimization in- 2000; Kumpulainen, Rasanen, & Henttenen,
cludes acts that are meant to harm a peer 1999; Mills, Guerin, Lynch, Daly, & Fitzpa-
physically, verbal threats of such acts (e.g., trick, 2004; Neary & Joseph, 1994; Slee,
threateningtobeatupapeer),andnamecall- 1995; van der Wal et al., 2003; Williams,
ing (Crick & Grotpeter, 1995; Grotpeter & Chambers, Logan, & Robinson, 1996). In a
Crick, 1996; Prinstein, Boergers, & Vern- meta-analysis, peer victimization was most
berg, 2001). Similarly, direct victimization in- strongly related to depression in comparison
cludesdiversephysicalandverbalmethodsof to other types of maladjustment (Hawker &
victimization; for example, kicking, hitting, Boulton, 2000). Compared to nonvictims,
threatening, name calling, and insulting (van victims are also found to exhibit high levels
der Wal, de Wit, & Hirasing, 2003). Direct ofsuicidalideation(BrunsteinKlomek,2007;
victimization has also included having be- Hold, Finkelhor, & Kantor, 2006; Kaltiala-
longingstaken,havingliestoldaboutthetar- Heino, Rimpela, Marttunen, Rimpela, &
get, having nasty tricks played on the target, Rantanen,1999;Rigby&Slee,1999;Roland,
and having been threatened or blackmailed 2002; van der Wal et al., 2003) and are more
(Wolke, Woods, Bloomfield, & Karstadt, likely to have attempted suicide (Brunstein
2000). Indirect victimization has been defined Klomek, 2007; Cleary, 2000; Eisenberg,
as aggression that is enacted through third Neumark-Sztainer, & Story, 2003; Kim, Koh,
parties (Bjorkqvist, 1994; Rivers & Smith, & Levanthal, 2005; Mills et al., 2004).
1994). It includes aspects of social isolation Studies have found significant interac-
such as ignoring, excluding, and backbiting tions between gender and victimization with
(van der Wal et al., 2003) as well as rejecting regard to depression and suicidality risk; the
and having rumors spread about them (Bal- results, however, are not consistant. Kim et
dry&Farrington,1999).Relationalvictimiza- al.(2005)foundthatfemalebutnotmalestu-
tion includesbehaviors thatcause orthreaten dents who were victimized were at signifi-
to damage peer relationships, particularly cantlygreaterriskforsuicidalideation.Simi-
friendship and acceptance (Crick, Kasas, & larly, Katliala-Heino et al. (1999) found that
Ku, 1999; Crick & Grotpeter, 1995, 1996; severe ideation was associated with frequent
Wolke et al., 2000). Studies have compared victimization only among girls and there was
different subsets of these constructs: direct no gender interaction for depressive symp-
andindirectvictimization(Baldry&Farring- toms. van der Wal et al. (2003) found that
ton, 1999; van der Wal et al., 2003); direct among both genders indirect victimization
and relational victimization (Wolke et al., was associated with depression and suicidal
2000;vanderWaletal.,2003);overtandre- ideation. Direct victimization, however, was
lational victimization (Prinstein et al., 2001); associated with depression and suicidal ide-
physical, verbal, and indirect victimization ationamonggirlsbutnotboys.Inourearlier
(Bjorkqvist, 1994; Rivers & Smith, 1994); study (Brunstein Klomek et al., 2007), we
and physical and relational victimization found adifferent thresholdat whichbullying
(Crick et al., 1999). Given this lack of clarity wasassociatedwithdepressionandsuicidality
in the classification of peer victimization, in among females and males. Among females,
the present study we examined discrete peer victimization at any frequency increased the
victimizations as suggested by the World risk of depression, ideation, and attempts.
HealthOrganization(WHO)studyonyouth Amongmales onlyfrequent victimizationin-
health (Nansel et al., 2001). creased the risk of depression and ideation.
Peer victims are found to manifest Most of the existing research on the
moredepressivesymptomscomparedtonon- association between peer victimization with
victims (Brunstein Klomek, 2007; Craig, depression and suicidality have examined
1998;Crick&Grotpeter,1996;Fekkes,Pijpers, overall victimization (Cleary, 2000; Eisen-
& Verloove-Vanhorick, 2004; Hawker & berg et al., 2003; Kaltiala-Heino et al., 1999;
Boulton, 2000; Kumpulainen & Rasanen, Kim et al., 2005; Mills et al., 2004; Rigby &
168 Adolescent Peer Victimization
Slee,1999;Roland,2002;Slee,1995;vander participating students was 14.8 (1.2) years.
Waletal.,2003).Onlyafewstudieshaveex- There were no significant differences be-
aminedtheassociationbetweenspecifictypes tweenparticipantsandnonparticipantsinsex,
of peer victimization with depression (Crick age, and race/ethnicity.
& Grotpeter, 1996; Prinstein et al., 2001). Students were recruited with a waiver
Specific types ofpeer victimization examined of parental consent for parents and active
include weight-based teasing (Eiesnberg et written assent for youth. The recruitment
al., 2003; Janssen, Craig, Boyce, & Pickett, procedures were based on those used in our
2004) and sexual victimization (Gidycz & earlier study (Gould, Velting, Kleinman, Lu-
Koss,1989). Toour knowledge,no studyhas cas, Thomas, & Chung, 2004) and were de-
examined the association between specific velopedin responsetowhatthe schoolscon-
types of peer victimization with suicidality. sidered would best meet the needs of their
The purpose of the current research communities. The current study received
was to examine the association between spe- IRB approval of a waiver of consent, based
cific types of peer victimization with depres- on Federal Regulations (Title 45; Part 46,
sion, suicidal ideation, and suicide attempts Article 46.116(d)). Two mailings with an in-
amongalargesampleofAmericanhighschool formation sheet describing survey content
students. Specifically, we examined the preva- and procedures, a response form, and a
lenceofsixspecifictypesofpeervictimization; stamped response envelope were sent to par-
the associationof thesetypes of victimizations ents 6and 4 weeks beforesurvey administra-
with depression, suicidal ideation, and suicide tion, providing parents opportunities to re-
attempts by gender; and the co-occurrence of fuse their children’s participation and giving
multiple types of peervictimization. them ample pertinent information about the
project.Students’writtenassentwasobtained
immediately before the survey.
SUBJECTSANDMETHODS
The study procedures, consistent with
the Family Educational Rights and Privacy
Participants
Act and the Protection of Pupil Rights
This study targeted adolescents aged Amendment, were approved by the IRB of
13 through 19 years, enrolled in nineth theNewYorkStatePsychiatricInstitute/Co-
through twelfth grade in six high schools in lumbia University Departmentof Psychiatry.
Nassau, Suffolk,and Westchestercounties in
NewYorkState.Fiveschoolswerepublicco- Measures
educational schools and one was a parochial
all-boys school. These schools were part of a A self-report questionnaire assessed de-
study examining whether asking about sui- pression, suicidal ideation, suicide attempts,
cidality during a screening program creates and peer victimization. The assessment time
distress or increases suicidal ideation (Gould frame was the past 4 weeks, with the excep-
et al., 2005). This study included 2,341 of tion of measuring lifetime suicide attempts.
3,635students(64.4%participationrate)from Demographic Questionnaire. The de-
the fall of 2002 through the spring of 2004. mographicquestionnaireelicitedinformation
Reasonsfornonparticipationincludedparen- with regard to age, grade, gender, racial/eth-
talrefusals(61.9%),studentrefusals(14.3%), nic background, and household composition.
and absences (23.7%). The ethnic distribu- Depression. The Beck Depression In-
tion of the participating sample was 80.3% ventory(BDI-IA,versionIamended;Beck&
White, 5.1% Black, 7.3% Hispanic, 3.8% Steer, 1993) assessed cognitive, behavioral,
Asian, and 3.5% other. A total of 58.1% of affective,andsomaticcomponentsofdepres-
the students were boys (the inclusion of an sion. Loss of libido was not assessed. The
all-male parochial school explains the high BDI has been used in over 200 studies, in-
percentage of boys). The mean (SD) age of cludingthosewithadolescentssamples(Rob-
Klomek et al. 169
erts, Lewinsohn, & Seeley, 1991; Strober, attempts were derived from the depression
Green, & Carlson, 1981; Teri, 1982). Each moduleoftheDiagnosticInterviewSchedule
responserangedfrom0(symptomsnotpresent) for Children (DISC-IV; Shaffer, Fisher, Lu-
to3(symptomissevere),withamaximumtotal cas, Dulcan, & Schwab-Stone, 2000) and an
score of 60. A cut-off point of 16 was em- earlier suicide screen (Shaffer et al., 2004).
ployed to dichotomize BDI scores. This cut- These items have demonstrated good con-
off has correctly classified 81% of adolescent struct validity (Gould et al., 1998; Shaffer et
psychiatric patients with major depressive al., 2004). The assessment of an attempt in-
disorder (Strober et al., 1981) and has been cluded questions about occurrences, injuries
recommended to detect possible depression sustained, medical care sought, and hospital-
in normal populations (Beck & Steer, 1993). ization(Meehan,Lamb, Saltzman,&O’Car-
The internal consistency reliability (as mea- roll,1992).Theadolescentwasconsideredto
sured by Cronbach’s alpha) of the BDI-IA is have a history of an attempt if he or she re-
.89 (Beck, Steer, Ball, & Ranieri, 1996). portedanypastattempt,regardlessoftiming,
Suicidal Ideation. The Suicide Ide- injury, or medical attention.
ation Questionnaire (SIQ-JR) assesses sui- Specific Types of Peer Victimization.
cidalthoughtsandisdesignedforlarge-scale, Several questions regarding victimization
school-basedscreeningofadolescents(Reyn- werederivedfromtheWHOstudyonyouth
olds, 1988). The 15-item SIQ-JR uses a 7- health (Nansel et al., 2001). Questions about
point Likert-type scale, ranging from 0 (I victimization were preceded with the follow-
never had this thought) to 6 (This thought was ing explanation. “We say a student is being
inmymindalmosteveryday),assessingthefre- bullied when another student or group of
quency of specific suicidal thoughts during students says or does nasty and unpleasant
the past month. It assesses thoughts related things to him or her. It is also bullying when
todeathanddying,passiveandactivesuicidal apupilisteasedrepeatedlyinawayheorshe
ideation, and suicidal intent. Reliability of doesn’t like. But it is not bullying when two
the SIQ-JR is high, ranging from .91 to .96 students of about the same strength quarrel
(Keane, Dick, Bechtold, & Manson, 1996; or fight.” Victimization was assessed by six
Reynolds, 1988; Reynolds & Mazza, 1999) questions asking respondents to report the
for internal consistency and from .87 to .93 frequencywithwhichtheywerevictimizedin
for test-retest reliability (Reynolds & Mazza, differentways.Thedifferenttypesofvictim-
1999). The SIQ-JR has demonstrated crite- ization assessed were: “Made fun of you be-
rion validity (King et al., 1993; Reynolds, causeofyourreligionorrace”;“Madefunof
1988, 1990; Reynolds & Mazza, 1999), con- you because of your looks or speech”; “Hit,
structvalidityinclinicalsamples(King,Gha- slapped,orpunchedyou”;“Spreadrumorsor
ziuddin, McGovern, Brand, Hill, & Naylor, mean lies about you”; “Made sexual jokes,
1996; King, Hill, Naylor, Evans, & Shain, comments,orgesturestoyou”;“Usede-mail
1993; King, Katz, Ghaziuddin, Brand, Hill, or Internet to be mean to you.” The fre-
& McGovern, 1997; Sibthorpe, Drinkwater, quency items were coded on a 5-point scale
Gardner, & Bammer, 1995; Siemen, War- ranging from not at all to most days. Respon-
rington, & Mangano, 1994), and predictive dents were classified as never victimized, vic-
validity(Keaneetal.,1996).Suicidalideation timized less than weekly, or victimized fre-
was considered serious if the adolescent quently (at least 3 to 4 times in the past 4
scored31orhigherontheSIQ-JR;orscored weeks).
5 or 6 on two or more of the six “critical”
SIQ-JR items (Reynolds, 1988); or re- Statistical Analysis
sponded with either of the two most serious
response options of the BDI suicide item. Chi-squareanalyseswereconductedto
Suicide Attempt History. Seven ques- examinegenderdifferences intheprevalence
tionsaskingaboutlifetimeandrecentsuicide of specific types of peer victimization. A se-
170 Adolescent Peer Victimization
ries of logistic regression models was con- RESULTS
ducted to examine the association between
specifictypesofvictimization(lessthanweekly Frequency of Specific Types
and frequently) with depression, serious sui- of Victimization
cidal ideation, and suicide attempts (as di-
chotomized outcomes). The category “never The most common experience of be-
victimized” was the reference group in these ing bullied involved having one’s looks or
analyses.These regressionanalyses werefirst speech belittled ([infrequently] less than
conducted separately for males and females weekly, 20.4%; frequently, 9.1%) (Table 1).
and were adjusted for schools and grade. In- Being bullied via e-mail or the Internet oc-
teractions between gender and the specific curredwiththelowestfrequency(infrequently,
typesofvictimizationwereexaminedinaddi- 5%; frequently, 2.3%).
tional models. A power analysis revealed suf- Malesweremorelikelythanfemalesto
ficient power (greater than .80) to detect po- bebelittledbecauseofreligionorraceandto
tential interactions. be bullied by being hit, slapped, or punched
Another series of logistic regression (χ2=41.15, p<.001; χ2=47.53, p<.001, re-
analyses was conducted to examine the rela- spectively) (Table 1). Females were more
tion of each of the three outcome measures likely than males to be the subject of rumors
totheco-occurrenceofthedifferenttypesof (χ2=26.10, p<.001); sexual jokes, comments,
victimization. A count of the number of the or gestures (χ2=28.31, p<.001); and mean-
different types of victimization was created ness by use of e-mail or the Internet (χ2=
for each respondent. The maximum count 18.99, p<.001).
was 5 or 6 types of victimization. We com- Alltypesofvictimizationsweresignifi-
bined having been victimized in 5 or 6 ways cantly correlated (Table 2) but they were not
in order to avoid small ns. For this analysis redundant,giventhemodestsizesofthecor-
wecombinedfrequentandinfrequentvictim- relations.Wethereforeexaminedtheassocia-
izationwithineachtypeofvictimization.Re- tion of specific types of peer victimization
spondents who were never victimized served with depression, serious suicidal ideation, and
as the reference group in the logistic regres- suicide attempts by gender (see Table 3).
sion. In addition, within the victimization Belittled About Religion or Race. This
groups we conducted tests for linear trends type of victimization was significantly associ-
(Fleiss, Levin, & Paik, 2003). atedwithdepressionandsuicideattemptsfor
We chose not to include random ef- females, but was not significantly associated
fects for school or class in the regression withserioussuicidalideation(SSI)amongfe-
analyses because the sample clusters (school) males. Among males, being bullied frequently
and the randomization unit (class within but not infrequently was associated with de-
school) had little impact on the outcomes or pression and SSI. This type of victimization
correlates(gender,depression,serioussuicide at anyfrequency was not associatedwith sui-
ideation/behavior, peer victimization), as in- cide attempts among males. Interactions be-
dicated by the intraclass coefficients (ICCs), tweenvictimizationandgenderwerenotsig-
which were all close to zero (ICCs<.06). nificant with regard to depression, SSI, and
Moreover, meaningful differences between attempts.
results of random effects regression models BelittledAboutLooksorSpeech. Among
andouranalysiswerenotanticipatedbecause females,beingbelittledaboutlooksorspeech
thereweremanyunitsofrandomization(181 at any frequency was significantly associated
classes) of relatively small average size (Mur- with depression, SSI, and attempts. Among
ray, 1998). Analyses were conducted using malesfrequent,butnotinfrequent,victimiza-
the SPSS software package, version 12. Re- tion was associated withdepression, SSI, and
sults were considered significant at α<.05. attempts. Significant interactions between
0 20 0 0 0
s 0 90 0 0 0
e 0 00 0 0 0
χ2 nderrenc =p. =p.=p. =p. =p. =p.
GeDiffe 1.15, 4.77,7.53, 6.10, 8.31, 8.99,
4 4 2 2 1
y
uentl(n) 109) 197)116) 109) 151) (50)
q% 0( 1(3( 0( 9( 3
re 5. 9.5. 5. 6. 2.
F
Total=aN2,181) Lessthanweekly%(n) 8.0(175) 20.4(443)11.5(250) 14.0(305) 11.0(239) 5.0(109)
(
7) 6)0) 4) 8) 1)
ern) 89 5381 76 78 02
Nev%( 0(1, 6(1,2(1, 0(1 1(1, 7(2,
7. 0.3. 1. 2. 2.
8 78 8 8 9
y
quentl%(n) 1(19) 5(68)8(25) 0(54) 2(83) 0(27)
e 2. 7.2. 6. 9. 3.
r
F
Female=aN907) essthanweekly%(n) 5.7(52) 0.2(183)7.6(69) 8.1(164) 3.9(126) 7.2(65)
( L 2 1 1
6) 5)3) 9) 7) 6)
Never%(n) 2.2(83 2.3(659.6(81 6.0(68 6.9(69 9.9(81
9 78 7 7 8
er equently%(n) 7.1(90) 0.2(129)7.2(91) 4.3(55) 5.3(68) 1.8(23)
nd Fr 1
tionbyGe Male=aN1,274) Lessthanweekly%(n) 9.7(123) 20.5(260)14.3(181) 11.1(141) 8.9(113) 3.5(44) ngdata.
Victimiza ( Never%(n) 3(1,061) 4(881)6(997) 6(1,075) 8(1,091) 7(1,205) eofmissi
r 3. 9.8. 4. 5. 4. us
Pee r8r67 8 8 9 eca
u u b
TABLE1PrevalenceofSpecificTypesof MadefunofyoubecauseofyoreligionorraceMadefunofyoubecauseofyolooksorspeechHit,slapped,orpunchedSpreadrumorsormeanliesaboutyouMadesexualjokes,comments,orgesturestoyouUsede-mailorInternettobemeantoyou aNote.N’svaryslightly
172 Adolescent Peer Victimization
TABLE2
Correlation Matrix of the Specific Types of Peer Victimization
Victimized Victimized Victimized
about about byhit, Victimized Victimized
religion/ looks/ slappedor byspreading bysexual Victimized
Correlations race talks punched rumors jokes bye-mail
Victimizedabout
religion/race .290** .159** .174** .149** .110**
Victimizedabout
looks/talks .322** .358** .353** .248**
Victimizedbyhit,
slapped,punched .302** .302** .225**
Victimizedbyspread-
ingrumors .391** .383**
Victimizedbysexual
jokes .249**
Victimizedbye-mail
Note.**<.01
gender and victimization by looks or speech Amongmales,victimizationatanyfrequency
indicated that females who were belittled was associated with depression and SSI but
about looks or speech were at significantly only frequent victimization was associated
higherriskfordepressioncomparedtomales withattempts.Interactionsbetweenthistype
(OR =3.71, 95% CI=2.41–5.72, p< of victimization and gender were not signifi-
infrequently
.001; OR =10.81, 95% CI=6.20–18.85, cant with regard to depression, SSI, and at-
frequently
p<.001). Interactions between victimization tempts.
and gender were not significant with regard Subject of Sexual Jokes, Comments, or
to SSI and attempts. Gestures. Among females, being bullied in-
PhysicalVictimization(BeingHit,Slapped, frequently or frequently was significantly as-
or Punched). Among females, being physi- sociated with depression and attempts. Only
cally bullied at any frequency was signifi- frequent victimization was associated with
cantly associated with depression, SSI, and SSI. Among males only frequent victimiza-
attempts. Among males frequent, but not in- tion was associated with depression and both
frequent, physical victimization was associ- levels of victimization were associated with
ated with depression, SSI, and attempts. Sig- SSI and attempts. Interactions between this
nificant interactions between gender and type of victimization and gender were not
infrequent physical victimization indicated statistically significant with regard to depres-
that females who were physically victimized sion, SSI, and attempts.
infrequently were at significantly higher risk Cyber Victimization. Among females,
for depression than comparable males (OR= being bullied via Internet or e-mail infre-
.311, 95% CI=.13–.73, p<.001). Interac- quentlyorfrequentlywassignificantlyassoci-
tionsbetweenphysicalvictimizationandgen- ated with depression and SSI. Only frequent
der were not significant with regard to SSI victimization was associated with attempts.
and attempts. Among males, frequent but not infrequent
Subject of Rumors or Mean Lies. victimization was associated with depression
Among females, victimization by the spread and both levels of victimization were associ-
ofrumorsorliesatanyfrequencywasassoci- ated with SSI. The small number of males
ated with depression, SSI, and attempts. who were victimized via Internet or e-mail
Klomek et al. 173
and made an attempt (n =2; n =1) timized in five or six ways had any of these
infrequent frequent
precluded a meaningful examination of the three outcomes (depression, serious suicidal
risk of attempts. Interactions between this ideation, suicide attempts).
type of victimization and gender were not
significant with regard to depression, SSI,
DISCUSSION
and attempts.
The most common experience of be-
Impact of Co-Occurrence of Several Types ing bullied involved having one’s looks or
of Victimizations speech belittled, similar to Nansel’s findings
(Nansel et al., 2001). This result is not sur-
Among males who were victimized, prising in light of teens’ interest and invest-
44.9%experiencedonetypeofvictimization, mentintheirappearance.Beingbulliedviae-
26.6% experienced two types, 15.2% experi- mailortheInternetoccurredwiththelowest
enced three types, 7.5% experienced four frequency. Cyber victimization may have oc-
types, and 5.8% experiences five or six types curredinfrequentlyinthepresentsamplebe-
of victimization. Among females who were cause the data was collected between 2002–
victimized, 40.9% experienced one type of 2004. Cyber victimization may have become
victimization, 28.4% experienced two types, more frequent since then (Patchin & Hin-
18.1% experienced three types, 8.1% experi- duja,2006; Ybarra,2004;Ybarra &Mitchell,
enced four types, and 4.5% experienced five 2004).
or six types of victimization. Malesweremorelikelythanfemalesto
Overall, the more types of victimiza- be physically bullied and to be belittled be-
tion the higher the risk for depression, SSI, cause of religion or race. Females were more
and suicide attempts among both genders likelythanmalestobethesubjectofrumors,
(Table 4). A test for linear trends within the sexual gestures, and meanness by use of the
victimization groups indicated that as the Internet. The gender differences we found
types of victimization increased, the rates of are consistent with previous findings that
depressionandsuicidalityincreasedinanon- physicalvictimizationismoreprevalentamong
linear fashion (male depression: χ2=22.94, males (Baldry & Farrington, 1999; Prinstein
df=3, p<.001; female depression: χ2=25.16, et al., 2001). Adolescent males may be more
df=3, p<.001; male ideation: χ2=30.46, involved in physical victimization due to
df=3,p<.001;femaleideation:χ2=27.97,df= their generally higher levels of aggression
3, p<.001; male attempts: χ2=11.65, df=3, (Achenbach & Edelbrock, 1981). Our results
p<.05; femaleattempts: χ2=27.93, df=3, p< arealsoconsistentwithNansel’sfindingsthat
.001). When an individual is exposed to five formales,bothphysicalandverbalvictimiza-
or six types of peer victimization the risk of tion was common while for females verbal
depression and suicidality increases dramati- victimization and rumors were common
cally.Maleswhowerevictimizedinfiveorsix (Nansel et al., 2001). The high levels of ver-
ways were 12 times more likely to be de- balvictimizationamongbothgendersmaybe
pressed, nearly 20 times more likely to have explainedbytheincreaseinverbalaggression
reported serious suicidal ideation, and ap- with age (Conner, 2004).
proximately 18 times more likely to have at- All types of victimization were associ-
temptedsuicidecomparedtomaleswhowere ated with depression and suicidality. Our
nevervictimized.Similarly,femaleswhowere findings support previous reports that both
victimized in five or six ways were approxi- direct and indirect victimization have nega-
mately 33 times more likely to be depressed, tive consequences for internalizing problems
27timesmorelikelytohaveexperiencedsui- (Crick&Grotpeter,1996;vanderWaletal.,
cidal ideation, and 19 times more likely to 2003). The pattern of associations we found
attempt suicide. Approximately 40% of the was consistent across the different types of
males and 70% of the females who were vic- peervictimization.Onaverage,themorefre-
5)5) 3)7) 7)0) 3)5) 8)4) 5)9) 4)6) 6)9)
19 53 69 36 39 11 08 30
7.8. 6.2. 6.0. 7.8. 3.5. 0.2. 7.2. 3.2.
1 2 1 11 11 1 12
I) –– –– –– –– –– –– –– ––
C 10 21 33 22 24 49 08 36
R 03 09 72 31 76 89 04 52
O% 2.1. 1.. .2. 2.6. 2.3. 1.2. 2.2. 2.3.
Gender equently (95 3.80***(3.41*( 2.58*(3.36( 2.20(6.83**( 4.12***(0.68***( 6.04***(7.62***( 4.32**(6.04***( 3.75***(5.65***( 5.82***(8.49***(
y r 1
b F
n
o
ati 5)7) 6)3) 4)5) 1)3) 2)4) 9)5) 5)1) 9)7)
ctimiz %(n) 16.7(136.8( 6.7(15.8( 4.7(26.3( 16.3(248.5(3 9.4(120.9(1 7.1(22.1(1 16.5(144.0(1 10.1(28.0(
Vi
esof 37)13) 75)56) 06)47) 36)75) 51)82) 65)74) 71)49) 05)80)
yp 3.4. 3.6. 5.0. 2.5. 4.4. 3.3. 2.7. 5.5.
cificT OR%CI) .80–1.07– .42–.88– .67–1.98–1 6.9–2.42– .79–1.20– .60–1.04– .73–2.55– .86–1.03–
gSpe thanekly (95 5(1*( 6(0( 5(5***( 8(3***( 8(0*( 8(7*( 0(7***( 9(5*(
ncin LessWe 1.62.1 1.22.4 1.84.5 1.23.7 1.82.4 1.41.9 1.44.3 2.02.4
e
ri
e
nsExp %(n) 8.1(10)5.0(13) 3.3(4)9.6(5) 4.1(5)7.6(9) 5.8(15)6.1(47) 3.1(8)7.7(14) 2.7(7)8.7(16) 6.6(12)8.8(26) 3.9(7)0.3(7)
e 2 1 2 3 1
e
T
ng CI)
mo OR% —— —— —— —— —— —— —— ——
a 5
mpts ever (9
te N 1)8) 6)2) 3)7) 9)6) 5)2) 6)0) 9)1) 0)6)
eAt %(n) 8(52(11 5(20(4 2(26(4 4(36(5 7(14(2 8(160(3 9(45(10 0(24(3
uicid 4.14. 2.5. 2.5. 4.8. 1.3. 1.4. 4.12. 2.4.
S
and race eech
n, or sp
Ideatio eligion ooksor
cidal ourr ourl
ui y y
S of of
n, e e d
TABLE3PrevalenceofDepressio MadefunofyoubecausDepressionaMalebFemaleSuicideideationaMalebFemaleSuicideattemptsaMalebFemaleMadefunofyoubecausDepressionaMalebFemaleSuicideideationaMalebFemaleSuicideAttemptsaMalebFemaleHit,slapped,orpuncheDepressionaMalebFemaleSuicideideationaMalebFemale