“Bullying is bad for your health,” the Daily Mail reports. The story comes from research which found that victims of childhood bullying had a higher risk of poor health, poverty and problems with social relationships in adulthood.

The study, which followed more than 1,400 participants from childhood to young adulthood, looked at three groups involved in bullying:

• Victims only – who reported being bullied but never bullying others
• Bullies only – who bullied, but had never been bullied themselves
• Bully-victims – who had been victims of bullying and also bullied others

They found that “bully-victims” seemed to be the most vulnerable group, being six times more likely to have a serious illness, smoke regularly or develop a psychiatric disorder in adulthood. “Bullies only” were at no increased risk of problems in adulthood, once other risk factors had been taken into account.

• This large study addresses an important issue – whether the damaging effects of bullying last into adulthood.

The study cannot prove that being bullied causes problems in adulthood. It is possible for example, that involvement in bullying is a marker for a pre-existing problem which would also lead to difficulties in adulthood, such as psychiatric problems or family dysfunction.

Still, this was a well-conducted study carried out over a lengthy period and its findings should be taken seriously.

Signs your child is being bullied

Sometimes children don’t talk to their parents or carers because they don’t want to upset them, or they think it will make the problem worse.

However, if you suspect that your child is being bullied, there are signs to look out for, according to the NSPCC. These include:

• Coming home with damaged or missing clothes, without money they should have, or with scratches and bruises
• Having trouble with homework for no apparent reason
• Using a different route between home and school
• Feeling irritable, easily upset or particularly emotional

For more advice and information visit the NHS Choices Bullying hub

Where did the story come from?

The study was carried out by researchers from the University of Warwick, UK  and Duke University in the US. It was funded by the by the National Institute of Mental Health, the National Institute on Drug Abuse, the Brain & Behavior Research Foundation, the William T. Grant Foundation, all in the US, and the UK Economic and Social Research Council.

The study was published in the peer-reviewed journal Psychological Science. Due to the study’s topicality, it was covered widely and for the most part fairly, in the media.

What kind of research was this?

This was a prospective cohort study which followed more than 1,400 participants from childhood into young adulthood.

Its aim was to assess whether involvement in childhood bullying had any effects on areas in adult life such as:

• Health
• Wealth
• Social relationships
• Educational achievements
• Involvement in risky or illegal behaviours

Cohort studies enable researchers to follow large groups of people for lengthy periods and are useful to look at associations between behaviour (in this case, involvement in bullying) and later outcomes.

Their main limitation is whether they are able to take account of all the other factors (called confounders) which might affect those outcomes. This means cohort studies can never prove cause and effect, only highlight associations.

The researchers point out that being bullied or bullying others is a relatively common experience in childhood and adolescence. While the damaging effects of involvement in bullying in childhood are recognised, they say that this is the first study to investigate how it might affect adult life.

What did the research involve?

In 1993, the researchers recruited a random sample of three groups of children aged 9, 11 or 13 years, from 11 counties in North Carolina, 80% agreed to participate. Each child, or their caregiver, was assessed annually by structured interview, until the age of 16. Each participant was interviewed again at ages 19, 21, and 24 to 26 years. Of the 1,420 children, 89.6% were followed up into young adulthood.

At each assessment between 9 and 16 years old, children and their parents reported on whether the child had been bullied or teased, or had bullied others in the three months before the interview.

Those who had been involved in bullying were then asked for further details such as how often bullying had occurred and where (the focus in the current study was peer bullying at school, rather than for example, sibling bullying at home).

Definitions of bullying and the questions used in the interview were taken from a validated child and adolescent psychiatric assessment. Frequency of bullying and its onset were also assessed.

The definition of being bullied used in the study is that the child is a particular object of repeated mockery, physical attacks, or threats by peers or siblings.

The definition of bullying is where a child repeatedly engages in deliberate actions aimed at causing distress to another or attempts to force another to do something against his or her will by using threats, violence, or intimidation.

To assess bullying involvement, interviewers asked questions such as:

• “Do you get teased or bullied at all by your siblings or friends and peers?”
• “Is that more than other children?”
• “Are other boys and girls mean to you?”
• “Do you ever do things to upset other people on purpose or try to hurt them on purpose?”
• “Do you ever try to get other people into trouble on purpose?”
• “Have you ever forced someone to do something s/he didn’t want to do by threatening or hurting him/her?”
• “Do you ever pick on anyone?”

Participants were categorised as:

• Victims only (they never indicated that they had bullied others)
• Bullies only (they never indicated that they had been a victim of bullying)
• Bully-victims (they had indicated that they both bullied others and had been victims of bullying )
• Not involved in bullying

When the children had become young adults, they were asked about the following issues.

Health

For example, whether they had been diagnosed with a serious illness, been in a serious accident, or had a positive test result for sexually transmitted disease or whether they smoked. Weight and height measurements were also taken to work out their body mass index (BMI).

Risky or illegal behaviour

For example, they were asked whether they had been involved in fighting, property break ins, frequent drunkenness, frequent use of illegal drugs, frequency of one time sexual encounters with strangers. Official criminal charges were checked from court records.

Wealth, financial and educational status

They were asked about income and family size, whether they had completed high school or college, whether they had work or financial problems.

Social relationships

At the last adult assessment, participants were asked about their marital, parenthood and divorce status; and the quality of relationships with parents, partners and friends.

The researchers also assessed any disadvantages the child might have suffered – which they call “Childhood hardships” – using established risk scales. Hardships included, low socioeconomic status, unstable family structure, maltreatment at home and family dysfunction.

They also assessed psychiatric problems between 9 and 16, using formal diagnostic definitions. Psychiatric problems assessed included anxiety, depression, disruptive behaviour disorders and substance use disorders.

They analysed their results using standard statistical methods. The results were adjusted for both presence of ‘childhood hardships’ and childhood psychiatric disorders.

What were the basic results?

Nearly two thirds (62.5%) of the children said they had not been involved in bullying.

Nearly a quarter (23.6%) said they had been victims only, 7.9% said they had been bullies only and 6.1% had been bully-victims.
Both bully-victims and bullies were more likely to be male, but victim status did not differ by sex.

Over one third (37.8%) of victims and bully-victims had been chronically bullied (bullied at two or more time points).

Once they had adjusted for childhood hardships and psychiatric problems, the researchers found that both “victims only” and “bully-victims” were at risk of poorer health, poorer finances and poorer social relationships in adulthood, compared to those who had not been involved in bullying.

By contrast “pure bullies” were not at increased risk of poorer outcomes in adulthood.

Those who had been chronically bullied had a higher level of social problems and showed a trend to financial problems, compared to those who were only bullied at one time point.

Bully victims were six times more likely to have a serious illness, smoke regularly or develop a psychiatric disorder as adults, than those who had not been involved in bullying.

How did the researchers interpret the results?

Being bullied is not a harmless rite of passage but throws a “long shadow over affected people’s lives”, say the researchers.

They suggest that being bullied may alter physiological responses to stress or interact with genetic vulnerability.

Interventions in childhood are likely to reduce long-term health and social costs, they argue.

Conclusion

This long term study suggests that victims of bullying, in particular chronic bullying, suffer long term damage which lasts into adulthood. As the authors point out, early monitoring, assessment and interventions are vital to prevent or stop such destructive behaviour.

The study does have some limitations. It relied heavily on children and adults self-reporting in many areas of life, which could affect the reliability of its results. Also, as the authors point out, the findings may not apply to other populations, particularly since American Indians (Native Americans) were overrepresented and African Americans under-represented.

In their analysis the authors tried to take account of other factors in childhood which might influence adult prospects, such as family and psychiatric problems. However, in this type of study it is always possible that both measured and unmeasured confounders might have an effect on outcomes.

This is a complex area and it is possible that involvement in bullying is a marker for a pre-existing condition such as a psychiatric problem which could also damage prospects in adulthood. On the other hand, as the authors point out, it is possible that bullying was caused by psychiatric problems in childhood, a factor that was adjusted for in their analysis. This may have led to an underestimate of the long term effects.

This is a difficult area to research and this study overall provides useful initial insights into the potential prolonged effects of childhood events.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Bullying is bad for your health,” the Daily Mail reports. The story comes from research which found that victims of childhood bullying had a higher risk of poor health, poverty and problems with social relationships in adulthood.

Links to Headlines

• Childhood bullying ‘damages adult life’. BBC News, August 19 2013
• Bullying is bad for your health: Victims of playground taunts are SIX TIMES more likely to develop a serious illness in later life. Daily Mail, August 20 2013

Links to Science

• Wolke D, Copeland WE, Angold A, Costello EJ. Impact of Bullying in Childhood on Adult Health, Wealth, Crime, and Social Outcomes. Psychological Sciences. Published online August 19 2013

“Children who have overprotective parents are more likely to be bullied by their peers,” BBC News explains.

The news correctly presents the findings of a major study on the effects of parenting on a child’s risk of being bullied, but it focuses on the weakest finding of the research.

The study did suggest that overprotective parents may increase a child’s risk of being bullied by their peers. However, the study also found that children with neglectful or abusive parents had an even greater increased risk of being bullied.

The headlines could also have focused on the more positive results – researchers found that children brought up in an emotionally warm environment with clearly defined rules about right and wrong were less likely to be bullied. This finding is interesting given the recent news about the potentially positive effects of ‘tough-love’ parenting.

Further studies into the association between parenting and a child’s chance of being bullied could shed additional light on the importance of a parent’s behaviour. While the findings of this study are interesting, it is not easy to see how it could be used to persuade people to change their parenting styles for the better.

Worried that your child is being bullied?

Signs that your child may be being bullied include:

• Coming home with damaged or missing clothes, without money they should have or with scratches and bruises.
• Having trouble with homework for no apparent reason.
• Using a different route between home and school.
• Feeling irritable, easily upset or particularly emotional.

If you are concerned, you should talk both to your child and to their school. If this fails to resolve the problem, there are several organisations that may be of assistance.

Read more advice for parents who are worried their child is being bullied.

Where did the story come from?

The study was carried out by researchers from the University of Warwick and Kingston University London and was funded by the Economic and Social Research Council and the Qatar National Research Fund.

The study was published in the peer-reviewed medical journal Child Abuse and Neglect.

Media coverage of this review largely focused on one of eight studied parenting styles (overprotection or “mollycoddling”). While the Daily Mail at least mentioned the larger detrimental effects of other parenting styles, some outlets (including the BBC News and the Daily Express) focused solely on the impact of overprotective parents.

The fact that the study found that a more positive parenting style – combining a mixture of emotional warmth and “firm but fair” rules – was linked with reduced chance of being bullied was not highlighted in the reporting of the study.

What kind of research was this?

The study was a combination of a systematic review and meta-analysis. It examined the relationship between parenting styles, parent-child relationships and bullying.

Researchers believe that family experiences and parenting style before children start school can influence the child’s capacity to adapt and cope at school. This can influence their relationships with schoolmates, making a child less, or more, vulnerable to bullying from their peers.

The researchers pooled the results from both prospective cohort studies and cross-sectional studies. This was to investigate the association between parenting behaviour and victimisation, and from this to identify parenting styles and family relationships that may increase the risk of victimisation.

What did the research involve?

The researchers searched the available literature for cohort and cross-sectional studies of the association between parenting behaviour and peer victimisation or bullying. They included studies that were published between 1970 and 2012 and provided a measure of relational, physical, verbal or cyberbullying.

The researchers identified parenting variables that they classified into positive and negative parenting behaviours.

The positive parenting behaviours were:

• Authoritative parenting (highly demanding, but also highly responsive parents)
• Parent-child communication
• Parental involvement and support
• Supervision
• Warmth and affection

The negative parenting behaviours were:

• Abuse or neglect
• Maladaptive parenting (high levels of hostility, hitting and shouting)
• Overprotection (or mollycoddling, as the media termed it)

The researchers included studies that recorded two types of child outcomes – victims and those who were both bullies and victims (bully/victims). They pooled the results of identified studies for each of these parenting styles to determine whether there were specific types of parenting behaviour that were associated with either the risk of being bullied or becoming a bully/victim.

The size of the effect of parenting on a child’s risk of being bullied or becoming a bully/victim was estimated using a statistical scale called ‘Hedge’s g’. This scale is widely used to assess the impact of different types of effect or effect size. For example:

• A small effect would be a Hedge’s g measurement of 0.20
• A medium effect would be a Hedge’s g measurement of 0.50
• A large effect would be a Hedge’s g measurement of 0.80

A negative effect indicates a lower likelihood of victims of bullying having parents with that particular behaviour or style compared with non-victims.

What were the basic results?

The researchers identified 70 cohort and cross-sectional studies that met the inclusion criteria. These studies included 208,778 children and young people aged between 4 and 25 years. The researchers found that different parenting styles were associated with varying risk of being bullied or becoming a bully/victim.

Both victims and bully/victims were more likely to be exposed to negative parenting behaviour including abuse and neglect as well as maladaptive and overprotective parenting (effect size 0.26, 95% confidence interval (CI) 0.16 to 0.37). When examining the types of negative parenting styles, the researchers found that all had a significant association with victimisation, including:

• Abusive or neglectful parents (effect size 0.31, 95% CI 0.18 to 0.44)
• Maladaptive parenting (effect size 0.27, 95 CI 0.15 to 0.40)
• Overprotective parents (effect size 0.10, 95% CI 0.03 to 0.17)

Conversely, overall, positive parenting behaviour had a small but significant effect, reducing the likelihood of the child being bullied or becoming a bully/victim (effect size -0.19, 95% CI -0.23 to -0.15). All five of their selected styles were associated with lower likelihood of being bullied:

• Authoritative parents (effect size -0.19, 95% CI -0.28 to -0.11)
• Good parent-child communication (effect size -0.12, 95% CI -0.20 to -0.05)
• Involved and supportive parents (effect size -0.22, 95% CI -0.29 to -0.15)
• Parents providing supervision (effect size -0.16, 95% CI -0.21 to -0.12)
• Warm and affectionate parents (effect size -0.22, 95% CI -0.30 to -0.14)

For victims, the effects were generally small to moderate for positive parenting styles (effect size -0.12 to -22) and negative parenting styles (effect size 0.10 to 0.31). For bully/victims the effects were generally moderate for positive parenting styles (-0.17 to -0.42) and negative parenting styles (0.13 to 0.68).

How did the researchers interpret the results?

The researchers concluded that negative parenting styles are associated with “small to moderate effects on victim status at school” and that “intervention programs against bullying should extend their focus beyond schools to include families and start before children enter school“.

Conclusion

This research suggests that certain parenting styles may protect children against bullying risk. These include:

• Being authoritative
• Being involved and supportive
• Being warm and affectionate
• Having good communication with your child
• Providing appropriate supervision

On the other hand, negative parenting styles were linked with an increased likelihood of being bullied. The researchers defined negative parenting styles as both “caring too much” or being overprotective and “not caring enough” or being neglectful.

Most of the headlines state that ‘mollycoddling’ your children increases their risk of being bullied. While these headlines are supported by this research, overprotective parenting styles were in fact associated with the smallest effect on bullying risk of the eight styles investigated.

The researchers point out that the other two negative parenting styles (abuse and neglect, and maladaptive parenting) were far more likely to increase the risk of a child being bullied.

The review assessed the effects of these parenting behaviours on the likelihood of the child both being a victim of bullying as well as bullying others. Generally, the relationships between parenting and the child bullying others were stronger than those between parenting and victimisation alone. Sadly, this more important finding was largely ignored by the media.

The researchers suggest that, “intervention programs that target children who are exposed to harsh or abusive parenting, may prevent peer victimization”. They also conclude that “parental training programs may be necessary to strengthen supportive involvement and warm and affectionate parenting to improve family relationships and prevent or reduce victimization by peers”.

Read more advice and information about bullying.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Children who have overprotective parents are more likely to be bullied by their peers,” BBC News explains. The news correctly presents the findings of a major study on the effects of parenting on a child’s risk of being bullied, but it focuses only on the weaker findings.

Links to Headlines

• Over-protected children ‘more likely to be bullied’. BBC News, April 26 2013
• Youngsters mollycoddled by their parents ‘are more likely to be bullied by their peers’. Mail Online, April 26 2013
• Spoiled children are most bullied. Daily Express, April 26 2013

Links to Science

• Lereya ST, Samara M, Wolke D. Parenting behavior and the risk of becoming a victim and a bully/victim: A meta-analysis study. Child Abuse & Neglect. Published online April 25 2013