A longitudinal study found that individuals who were bullied and those who bullied others as children are at an elevated risk of psychiatric disorders as adults. Specifically, victims were more likely to develop anxiety disorders like agoraphobia and panic disorder. Those who were both bullies and victims, called "bully/victims", faced the highest risks, including depression, panic disorder, agoraphobia, and suicidal thoughts. Bully/victims were over 4 times more likely to experience depression and over 14 times more likely to develop panic disorder compared to those not involved in bullying. The study suggests bullying has long-term negative mental health effects and interventions are needed to reduce victimization and promote healthier development for children.

1. Adult Psychiatric Outcomes of Bullying and Being Bullied
Bullies and victims show elevated rates of young adult psychiatric disorders
Aldo Battiste, MD
January 8, 2015 – A longitudinal study has shown that bullying and victimization are
associated with psychiatric disorders that extend into adulthood and that those
involved as both bullies and victims are at a highly increased risk of depression and
suicidality.
William E. Copeland, PhD of the Department of Psychiatry and Behavioral Sciences,
Center for Developmental Epidemiology, Duke University Medical Center, Durham,
North Carolina and colleagues reported their findings in the April 2013 issue of
JAMA Psychiatry.
Longitudinal studies on bullying and victims of bullying have suggested a causal
relationship with psychiatric disorders but they have only followed affected
children for a few years into adolescence.
In this prospective study, a population-based sample consisting of 3 cohorts, aged 9,
11, and 13 were studied. Participants were assessed through age 16 and were
categorized as bullies, victims, bullies and victims (bully/victims) or neither. Adult
outcomes were assessed at ages 19, 21 and 24 to 26 years of age. Status was
considered positive if the participant met criteria for a psychiatric disorder through
self-report interviews using the Young Adult Psychiatric Assessment (YAPA).
Childhood psychiatric problems and family hardship were detected using the
Childhood and Adolescent Psychiatry Assessment.
Victims showed a higher prevalence of agoraphobia (odds ratio [OR], 4.6 [95% CI,
1.7-12.5]; P<.01), generalized anxiety (OR, 2.7 [95% CI, 1.1-6.3]; P<.001, and panic
disorder (OR, 3.1 [95% CI, 1.5-6.5]; P<.01). Bully/victims were at increased risk of
young adult depression (OR, 4.8 [95% CI, 1.2-19.4]; P<.05, panic disorder (OR, 14.5
[95% CI, 5.7-36.6]; P<.001); agoraphobia (young women only; OR, 26.7 [95% CI, 4.2-
52.5]; P<.001), and suicidality (young men only; OR, 18.5, [95% CI, 6.2-55.1];
P,.001). Bullies were at risk for antisocial personality disorder only (OR, 4.1 [95% CI,
1.1-15.8]; P<.04).
The study indicates that being a victim and a perpetrator of bullying is associated
with a very high risk of depression and equally affects young men and women. Only
male bully/victims reported suicidality more often, whereas female bully/victims
reported agoraphobia more often in early adulthood, indicating different tendencies
by the sexes of dealing with distress caused by being a bully/victim.

2. According to the authors, this raises the question: “How does being involved in
bullying and/or victimization lead to emotional disorders and suicidality?” They
point out that victimization has been found to “alter hypothalamic-pituitary-adrenal
activity, and abnormal cortisol excretion is associated with both an increase in
depression.” The same mechanism can also cause alteration of telomere length,
which is a biomarker of stress. Shortened telomeres have been found in children
with a history of various forms of violence. They also site evidence for gene-
environmental interaction by “variation in the serotonin transporter gene of
children exposed to bullying.” They suggest that these aspects of stress response
should be targets for future research efforts.
The authors conclude that bullying is not just a “harmless rite of passage or an
inevitable part of growing up.” Children affected by bullying are at increased risk of
emotional disorders in adulthood. Bully/victims are at highest risk and most likely
to engage in suicidal ideation. They suggest that health professionals and school
personnel enact effective interventions that reduce victimization, indicating this will
“reduce human suffering and long-term health care costs and provide a (healthier)
environment for children to grow up in.”
The authors report no conflicts of interest.
Original article, JAMA Psychiatry, February 2013