Table 1.
Authors & Date (study acronym) | Aim | Study Population | Main Results |
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Brunner et al. 2014 (SEYLE study) | Exploration of the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behaviour. | Community-based adolescents (age range: NR); n= 12,068; RR: 49%. | SBV & SB were both found to be strong predictors of SI in the univariate regression analysis (UA) and also showed an independent effect on the multivariate regression analysis (MA); SBV as a risk factor for lifetime SI: UA/ OR (95% CI): 3.39 (2.96-3.89) & MA/ 1.68 (1.43-1.98), p<0.01 |
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Brunstein Klomek et al. 2016 (SEYLE study) |
To examine the association between victimization by bullying and direct self-injurious behaviour. | Community-based adolescents (age range: NR); n= 11.110; RR: 72% of the schools approached. | SBV(physical/verbal/relational) was strong predictors of SI (lifetime, both occasional and repetitive) in the univariate regression analysis and also showed an independent effect on the multivariate regression (MA) model: SBV (physical/verbal/relational) as a risk factor for lifetime SI: UA/ OR (95% CI): 2.10-2.78 (1.90 to2.51 – 2.32 to 3.08) & MA/ 1.33-1.72 (1.18 to 1.49-1.50-2.07), p<0.01 The effect of relational & verbal SBV on SI was partially mediated by depressive symptoms (Sobel test = 7.33; p<0.0001; Sobel test=5.22; p<0.0001). |
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Claes et al. 2015 | Investigation of the association between bullying victimization and NSSI and the mediating effect of depressive symptoms & parental support. | Community-based adolescents 7th- 12th grade; n= 785; RR: NR | The association between SBV and NSSI (β=0.23, p<0.001) was partially mediated by depressive symptoms [x2 = 16.44, p=0.003; CFI=0.948; RMSEA=0.063]. |
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Elgar et al. 2014 (2012 Dane County Youth Assessment Study) |
Exploration of the association among cyberbullying victimization, traditional bullying, self-injurious behaviour & related mental health problems, as well as the moderating role of family contact. | Community-based adolescents 12-18 years; n= 18.834; RR: 90%. | SBV was a risk factor for SI [OR (95% CI): 1.10 (1.08- 1.13)]. |
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Espelage & Holt 2013 | Exploration of the differences in the frequency of suicidal ideation and suicidal behaviours across a group of verbal bullies, bully victims, victims, physically aggressive bullies, and students not involved in bullying. | Community-based adolescents 5th- 8th grade (10-13 years; n= 661; RR: 93%. | SI was statistically significantly higher in victims of school bullying compared to uninvolved students (28.2% vs. 8.7%; x2 = 53.89; p<0.001), while depressive symptoms only partially explain the difference (F= 126.5; p<0.0001; n2 =0.17). |
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Ford et al. 2017 (K-cohort Longitudinal Study of Australian Children) | Exploration of the association between all types of bullying and adverse mental health outcomes, including self-harming behaviours and suicidality. | Community-based adolescents 14-15 years; n=2304; RR:59% | The prevalence (%)(95%CI)]) of self-harm in adolescents of both genders self-reported as bullying victims (all types of bullying victimization) was higher [18.6 (15.1-22.7)]compared to uninvolved adolescents [5.3(4.3-6.5)], adjusted score. Similarly, the risk factor for self-harming behaviour was higher in bullying victims [3.4(2.4-4.7)], adjusted score (gender, household type & income, home language spoken, parental education, Aboriginal/Torres Strait Islander heritage).The highest risk factors regarded experience of all three types of SBV [OR(95%CI): 4.6 (3.2-6.6)] and the lowest physical SBV[OR(95%CI): 2.9 (1.7-4.8)]. The mediating effect of DS in the association between SBV and SI was not assessed. |
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Garish & Wilson 2010 | Investigation of potential risk factors for deliberate self-harm among adolescents, specifically focusing on peer victimization and alexithymia, as well as the mediating effect of depressive symptoms. | Community-based adolescents 16-23 years; n= 325; RR: 86% | Adolescents who reported at least one incidence of SI were more likely to report experiences of all types of SBV (df>302, t> 3.30, p<0.005). A positive association was also reported between SBV and SI (0.36, p<0.001). Depressive symptoms only partially mediated the relationship between SBV and SI, as the association between SBV and SI decreased (b weigh from 0.36 to 0.25) after controlling for depressive symptoms. |
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Giletta et al. 2012 | Exploration of risk factors for NSSI including bullying victimization, in adolescents across three different countries (Italy, the Netherlands, and the USA). | Community-based adolescents 14-19 years; n= 1,862; RR:79.7%(n=82) in Italy; 89.3 % (n=675) in the Netherlands; and 50.6% (n=360) in the USA. | In multivariate analysis SBV was a risk factor for NSSI for the entire sample: sociodemographic covariates adjusted score (gender, age, ethnicity, and parental education) OR (95% CI): 1.96 (1.50-2.57), p<0.0001. In the subgroups: Italy: OR95%CI: 1.61 (1.08-2.41), p<0.05 The Netherlands: OR(95%CI) ]: 2.80(1.74-4.50), p<0.0001 USA: OR95%CI: 1.33(0.67-2.64), p<0.0001 |
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Gower & Borowsky, 2013 (2010 Minnesota Student Survey) | Exploration of the association between the frequency of bullying involvement and both internalizing and externalizing problems, including deliberate self-harm. | Community-based adolescents 6th-12th grade; n= 128.681; RR: 71% | Infrequent (1-2 times in ones' lifetime compared to no SBV was a risk factor for engagement in SI (6th, 9th, and 12th grade) SI boys OR(95% CI): 1.93 to 2.17 (1.71 to 1.92 – 2.17 to 2.44), p<0.001 SI girls OR(95% CI): 2.07 to 2.23 (1.91 to 2.00 – 2.23 to 2.47), p<0.001 Even occasional SBV is associated with SI during adolescence. |
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Hay & Meldrum, 2010 | Exploration of the hypotheses that bullying victimization is significantly related to NSSI & SI, mediated by DS. | Community- based adolescents 10-21 years; n=424; RR: 93% | NSSI was associated with SBV (B=0.32, p<0.001/ Adjust R2 =0.23), partially mediated by depressive symptoms (B=0.18, p<0.001/ Adjust R2 =0.28) controlled for age, gender, ethnicity/origin, impulsivity, type of parenting, family type, and school performance. [reduction of 44% in the association] |
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Jantzer et al. 2015 | Exploration of the relationship between school bullying victimization (Type/Frequency) and NSSI/ SB. | Community-based adolescents 9-18 years; n= 647; RR:NM |
Repetitive SBV was a risk factor for NSSI [NSSI OR(95% CI): 11.75(5.54-24.94), p<0.001]; Occasional SBV was a risk factor for NSSI [NSSI OR(95% CI): 4.74 (2.36-9.54), p<0.001]; There was a difference in the effect size between repetitive and occasional SBV: Variance explained regarding the prediction of SBV was R2=0.053 and for the prediction of NSSI R2=0.093 (no effect of grade/gender) => Dose-response relationship regarding the frequency of SBV [Even occasional SBV had an impact on SI]. The mediating effect of depressive symptoms was not assessed. |
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McMahon et al. 2010 (CASE study) | Exploration of the association between self-injury and psychological, life-style, and stressful life event- related factors in school adolescents. | Community-based adolescents 15-17 years; n= 3881; RR: 85% | SBV was a risk factor for a lifetime history of SI in both genders in univariate analysis: [girls OR: 2.61 95% CI (1.97-3.46), p<0.0005 / boys OR: 4.07 95% CI (2.57-6.44), p<0.0005]. In multivariate analysis to predict a lifetime history of SI, SBV remained a risk factor only for boys [OR age-adjusted score (95% CI): 2.83 (1.50-5.36), p=0.001] |
Although depressive symptoms were reported as a risk factor for SI in univariate analysis for both genders [OR 1.25-1.27; 95% (1.18-1.22 to 1.32; p<0.0005)], it was not the case in multivariate analysis, implying that when other variables such as SBV exist, the independent effect of depressive symptoms on SI is not significant in adolescents. | |||
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Noble et al. 2011/ Kansas City/USA (Kauffman Teen Survey) | Exploration of the association between NSSI and perceived school safety & trust. | Community-based adolescents 11-19 years; n= 1276; RR: NM | SBV in a high school group was a risk factor for NSSI [B=0.41, SE:0.22, OR: 1.52, p<0.01]. SBV in a middle school group was a risk factor for NSSI [B=0.55, SE:0.18, OR: 1.73, p<0.01]. The mediating effect of depressive symptoms was not assessed. |
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O'Connor et al. 2009/ Scotland, UK (CASE Study) | Exploration of the prevalence of DSH and related factors in Scottish adolescents | Community-based adolescents 15-16 years; n= 2008; RR: 80% | SBV was found to constitute a risk factor for SI in both genders (The lifetime prevalence of SBV was strongly associated with SI in both boys and girls): [girls OR(95%CI): 3.09 (2.06-4.64), p<0.0001 / boys OR(95%CI): 2.18 (1.11-4.28), p<0.005] |
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O'Connor et al. 2014/ N. Ireland (CASE Study) | Exploration of the prevalence of DSH and related factors (exposure to the Troubles & relevant internet/social media pictures) in Northern Irish adolescents | Community-based adolescents 11-16 years; n= 3,526; RR: 80% | SBV was a risk factor for SI in both genders (The lifetime prevalence of SBV was strongly associated with SI, in both boys and girls): [girls OR(95%CI): 2.09 (1.59-2.73), p=0.0001 / boys OR(95%CI): 2.24(1.25-4.01), p=0.007]. |
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Thomas et al. 2017/ Australia (2ndAustralian & Adolescent Survey of Mental Health Wellbeing-Young Minds Matter Survey) | Exploration of the association between mental health, including self-harming & suicidal behaviour, and the three classes of bullying. | Community-based adolescents 11-17 years; n= 2967; RR: 89% | The risk factor for self-harming behaviour in those self-reported as bullying victims was higher compared to uninvolved participants [OR(95%CI):7.32(5.15-10.40)], adjusted score (gender, age). The mediating effect of DS on the association between SBV and SI was not assessed. |
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Fisher et al. 2012/England & Wales, UK (Environmental Risk Study) | Exploration of the association between the frequency of bullying victimization and occurrence of self-harm in early adolescence, as well as identifying which bullied children are at highest risk of self-harm. | Community-based twins 5-12 years; n= 2,232; RR:NR | Exposure to frequent SBV before the age of 12 years was a risk factor for SI at 12 years [RRisk(95%CI): 3.53 (2.10-5.93)- reports from mother] |
[RRisk (95% CI): 3.33 (1.91-5.82)-reports from child] | |||
Among the 62 children who engaged in self-harm, 35 (56%) had been victimized by bullying, while 42.8% of the self-harm cases could have been prevented [95% CI (23.1%-57.5%)] if SBV could be eliminated (other factors remaining constant). More than 90% of the children exposed to SBV did not engage in SI. Those who did were significantly more likely to (a) have a family member who attempted/completed suicide, (b) have been physically abused by an adult, and (c) exhibit conduct disorder, borderline personality characteristics, depressive, and psychotic symptoms. | |||
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Garish &Wilson 2015/ New Zealand | Investigation of the prevalence and correlates of NSSI in adolescents, including school bullying victimization. | Community-based adolescents 15-16 years (10th grade); n= 830; RR: 60% | SBV was a significant predictor of NSSI Cross-sectional association between Lifetime NSSI & SBV: r= 0.31; p<0.01; Cross-sectional association between NSSI in the previous 3-8 months & SBV: r= 0.21, p<0.01) |
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Giletta et al. 2015/ China | Investigation of the predictive effect of school bullying victimization on latent trajectories of suicide ideation and NSSI in adolescents. | Community-based adolescents 15-16 years (10th grade); n= 565; RR: 90.5% |
Overt & relational SBV significantly predicted NNSI after controlling for gender & depressive symptoms, irrespective of the frequency of these behaviours. SBV differentiated the low (none or very few episodes) from the high frequency [OR(95%CI): 2.19 (1.42-3.39), the moderate from the low [OR (95%CI): 1.23(0.80-1.89)], and the moderate from the high NSSI group [1.02(0.98-1.07) ], independent of depressive symptoms. SBV differentiated the low (none or very few episodes) from the high frequency [OR(95%CI): 1.71 (1.19-2.47), the moderate from the low [OR (95%CI): 0.99(0.68-1.42)], and the moderate from the high NSSI group [1.74(01.18-2.56) ], independent of depressive symptoms. Adolescents in the high frequency NSSI group had more severe SBV scores than adolescents in the low and moderate frequency group (dose-response effect) (p <0.01). |
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Heilbron & Prinstein 2010/USA | Exploration of whether overt and relational peer victimization predicts suicidal ideation and NSSI, both concurrently and longitudinally. | Community-based adolescents 11-15 years; n= 493; RR: 73%-84% | A univariate association was reported between overt SBV and NSSI, with boys reporting NSSI being more frequently bullied compared to those who did not report NSSI (MANCONA; p<0.05), while girls who reported NSSI were less frequently victims of overt SBV (MANCONA; p<0.05). However, there was no main effect of the SBV on the prediction of NSSI when controlled for depressive symptoms. |
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Lereya et al. 2015/ USA & UK (Avon Longitudinal Study of Parents & Children; Great Smoky Mountains Study) | Exploration of the effects of maltreatment and bullying victimization on mental health status (i.e., self-harm, suicidality, and depressive symptoms) in adolescents. | Community-based adolescents 13-17 years; n= 5.446; RR: 78.5% | Children who were bullied by peers were significantly more likely to report SI compared to those who were not bullied [ALSPAC Cohort: OR (95% CI): 1.7 (1.4-2.2), p<0.0001& GSMS Cohort:; OR (95% CI): 3.0 (1.2-7.7), p=0.002] The experience of SBV has similar, and in some cases even worse, long-term adverse effects on the mental health of young adults compared to abuse by parents. |
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Lereya et al. 2013/ UK (Avon Longitudinal Study of Parents & Children) | Exploration of the hypothesis that school bullying victimization/SBV between the age of 7 and 10 is directly associated with self-injurious behaviour in late adolescence (16-17 years old). | Community-based adolescents 16-17 years; n= 4,810; RR: 77% | After controlling for all potential confounders SBV between the age of 7 and 10 was found to be associated with a greater risk of SI in late adolescence, based on reports from the child [OR(95% CI): 1.78(1.29-2.46)], the mother [OR(95%):CI 1.70 (1.27-2.28)] and the teacher [OR95%CI: 4.57 (1.66-12.54)]. The association between SBV and SI was partially mediated by depressive symptoms (B=0.21; SE=0.036 p<0.0001), since path analysis showed that SBV indirectly increased the risk of SI through the development of depressive symptoms (B=0.07; SE=0.02; p<0.0001). |
SBV: school bullying victimization; NSSI: nonsuicidal self-injury; RR: response rate; n: number of participants; NM: not mentioned; NA: not assessed; SI: self-injury; SB: suicidal behaviour; and RRisk: relative risk.