články -patopsychologie

Processes

There are a variety of potential routes by which being victimised may affect later life outcomes. Being bullied may alter physiological responses to stress,74 interact with a genetic vulnerability such as variation in the serotonin transporter (5-HTT) gene,75 or affect telomere length (ageing) or the epigenome.76 Altered HPA-axis activity and altered cortisol responses may increase the risk for developing mental health problems77 and also increase susceptibility to illness by interfering with immune responses.78 In contrast, bullying may also differentially affect normal chronic inflammation and associated health problems that can persist into adulthood.64 Chronically raised C-reactive protein (CRP) levels, a marker of low-grade systemic inflammation in the body, increase the risk of cardiovascular diseases, metabolic disorders and mental health problems such as depression.79 Blood tests revealed that CRP levels in the blood of bullied children increased with the number of times they were bullied. Additional blood tests carried out on the children after they had reached 19 and 21 years of age revealed that those who were bullied as children had CRP levels more than twice as high as bullies, while bullies had CRP levels lower than those who were neither bullies nor victims (figure 2). Thus, bullying others appears to have a protective effect consistent with studies showing lower inflammation for individuals with higher socioeconomic status80 and studies with non-human primates showing health benefits for those higher in the social hierarchy.81 The clear implication of these findings is that both ends of the continuum of social status in peer relationships are important for inflammation levels and health status.

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Figure 2

Adjusted mean young adult C-reactive protein (CRP) levels (mg/L) based on childhood/adolescent bullying status. These values are adjusted for baseline CRP levels as well as other CRP-related covariates. All analyses used robust SEs to account for repeated observations (reproduced from Copeland et al64).

Furthermore, experiences of threat by peers may alter cognitive responses to threatening situations.82 Both altered stress responses and altered social cognition (eg, being hypervigilant to hostile cues38) and neurocircuitry83 related to bullying exposure may affect social relationships with parents, friends and co-workers. Finally, victimisation, in particular of bully/victims, affects schooling and has been found to be associated with school absenteeism. In the UK alone, over 16 000 young people aged 11–15 are estimated to be absent from state school with bullying as the main reason, and 78 000 are absent where bullying is one of the reasons given for absence.84 The risk of failure to complete high school or college in chronic victims or bully/victims increases the risk of poorer income and job performance.57

Summary and implications

Childhood bullying has serious effects on health, resulting in substantial costs for individuals, their families and society at large. In the USA, it has been estimated that preventing high school bullying results in lifetime cost benefits of over $1.4 million per individual.85 In the UK alone, over 16 000 young people aged 11–15 are estimated to be absent from state school with bullying as the main reason, and 78 000 are absent where bullying is one of the reasons given for absence.86 Many bullied children suffer in silence, and are reluctant to tell their parents or teachers about their experiences, for fear of reprisals or because of shame.87 Up to 50% of children say they would rarely, or never, tell their parents, while between 35% and 60% would not tell their teacher.11