Bullying victimisation ralph lauren pony polo and risk of self harm in early cheap ralph lauren polo adolescence


Abstractobjectives to test whether frequent bullying victimisation in childhood increases the likelihood of self harming in early adolescence, and to identify which bullied children are at highest risk of self harm.Results self harm data were available for2141 children.Among children aged12whoHad self harmed(2.9%;N=62), more than half were victims of frequent bullying(56%;N=35).Exposure to frequent bullying predicted higher rates of self harm even after children's pre morbid emotional and behavioural problems, low iq, and family environmental risks were taken into account(Bullying victimisation reported by mother:Adjusted relativE risk1.92, 95% confidence interval1.18 to 3.12;Bullying victimisation reported by child:2.44,1.36 to 4.40).Victimised twins were more likely to self harm than were their non victimised twin sibling(Bullying victimisation reported by mother:13/162 v 3/162,Ratio=4.3, 95% confidence interval1.3 to14.0;Bullying victimisation reported by child:12/144 v 7/144,Ratio=1. 7,0.71 to 4.1).Compared with bullied children who did not self harm, bullied children who self harmed were distinguished by a family history of attempted/completed suicide, concuRrent mental health problems, and a history of physical maltreatment by an adult.Conclusions prevention of non suicidal self injury in young adolescents should focus on helping bullied children to cope more appropriately with their distress.Programmes should target children who have additional mental health problems, have a family history of attempted/completed suicide,Orhave been maltreated by an adult.Introductionbullying by peers is a major problem; approximately25% of children in the United Kingdom report exposure to such victimisation.1 Bullying victimisation is associated with a myriad of emotional and behavioural problems throughout adolescence.2 Over the past few years, the media have focused public attention on instances of suicide and self harm among adolescents who have been bullied, and a commensurate rise in anti bullying policies and laws has occuRred on both sides of the Atlantic.3 4 Surprisingly, very few studies have tested the assumption that exposure to bullying in childhood increases the likelihood that a childOradolescent will self harm.Existing studies are often limited by cross sectional designs, the possibility that unmeasured background risk factors can lead children both to be victimised and to self harm(Selection effects), and reliance on the same person to report both exposure to bullying and self harm behaviour, which may create spurious associations(Reporter bias).5 6 7 8 Moreover, a need exists for research into self harm as early as possible in adolescence, to inform prevention of injuries.Randomised trials exposing children to bullying are clearly unethical.Instead, we added several design features to an observational study to strengthen inferences that could be drawn about the effects of bullying victimisation on self harm. Firstly, we used a prospective longitudinal study following a nationally representative cohort of children from early childhood to12years of age, which enabled us to control statistically for a range of potentially confounding and pre morbid Selection effects.Secondly, because our cohort comprises twins, we were able to caRry out a co twin control analysis among pairs discordant for bullying victimisation, to test if the bullied sibling was more likely to self harm than the non bullied sibling, despite their shared family background.Thirdly, to minimise reporter bias and ascertain the robustness of our findings across different reporters, we measured children's exposure to bullying by interviewing both the children and their mothers. Thus, because mothers might not be aware of all of their children's exposure to bullying, we tested the association between the12year old children's own reports of bullying victimisation and their self harm outcomes.However, because in theory children who self harm might give exaggerated reports of their exposure to bullying as a result of co morbid psychological difficulties, we also tested the association between mothers' reports of bullying victimisation and children's self harm outcomes. Fourthly, our longitudinal design allowed us to establish temporal ordering by testing the association between mothers' prospective reports of bullying victimisation up to the age10 assessment and children's self harm outcomes at the age12assessment.Even if bullying victimisation is linked to increased risk of self harm, most bullied children do not resort to self harm.Given the ubiquity of bullying, doctors, social care professionals, teachers, and parents need help to identify which bullied children are at greatest risk, to target interventions effectively.Several factors are known to increase thE risk of self harm:Being brought up in a deprived area, a family history of self harming behaviour, maltreatment, co occuRring behavioural and emotional problems, and a low iq have all been associated with high rates of self harm. 910 To inform clinical practice, we examined which of these family level and child level characteristics could help to identify, among bullied children, who is at greatest risk of self harm.Methodstudy cohortparticipants were members of the environmental risk(E risk) study, which tracks the development of a birth cohort of2232 British children. The sample was drawn from a larger birth register of twins born in England and Wales in1994 95.11 Full details about the sample are reported elsewhere.12Briefly, the E risk sample was constructed in19992000, when1116 (93% of those eligible)Families with same sex 5 year old twins participated in home visit assessments. Families were recruited to represent the UK population of families with newborns in the1990s, on the basis of residential location throughout England and Wales and mother's age (Older mothers having twins via assisted reproduction were under selected, and teenage mothers with twins were over selected).We used this sampling to replace high risk families who were selectively lost to the register through non response and to ensure sufficient numbers of children growing up in high risk environments.The sample includes 55% monozygotic and 45% dizygotic twin pairs.Sex is evenly distributed within zygosity(49% male).Follow up home visits took place when the children were aged 7(98% participation),10 (96% participation), and, most recently,12years (96% participation). Bullying victimisationBullying victimisation was assessed during interviews with mothers when the children were aged 7 and10 years, and separately in private interviews with the children during home visits when the children were12years old.Details of psychometric measurements for the bullying measures reported here have been described previously.1314 We explained to the motherOrchild that: "Someone is being bullied when another child says mean and hurtful things, makes fun,Orcalls a person mean and hurtful names;Completely ignoresOrexcludes someone from their group of friendsOrleaves them out of things on purpose;Hits, kicks,Orshoves a person,Orlocks them in a room;Tells liesOrspreads rumours about them;Or does other hurtful things like these.We call it bullying when these things happen often and it is difficult for the person being bullied to stop it happening.We do not call it bullying when it is done in a friendlyOrplayful way. "When bullying was reported, the interviewer asked the motherOrchild to describe what happened.An independent rater later checked notes taken by the interviewers to verify that the events described related to instances of bullying, operationally defined as evidence of repeated harmful actions between children where a power differential existed between the bully and the victim.This review was done blind to data on self harm.Mothers' and children's naRratives of bullying experiences were coded as"Never," "Yes, but isolated incidents,"Or"Frequently. "Children were also asked directly if they had been bullied"A lot. " Of the cohort children,16.5%(350/2127) were reported by their mothers to have been Frequently bullied before age10, and11.2% (237/2124) of the children reported themselves to have been bullied A lot before age12. Self harmMothers were asked whether each twin had ever deliberately harmed him/herselfOrattempted suicide in the previous six months, as part of a face to face interview when the children were aged12.Mothers who responded positively to this question were asked to provide a description of what took place.An independent rater blind to other data later checked the notes taken during the interview to verify that the description provided was clearly an act of self harm.We asked only mothers, and not children, to report the child's self harm because of ethical considerations.Examples of self harming behaviours included cutting and biting arms, pulling out clumps of hair, banging head against walls, and attempted suicides by strangulation. Of the cohort,2.9% (62/2141)Had self harmed;Of these children, 52%(N=32)Were girls. Potential confounding variablesMothers reported on their children's exposure to maltreatment during a standardised clinical interview protocol,1516 used when the child was aged 5, 7,10, and12years. Only those children whom the interviewers rated as having definitely experienced physicalOrsexual harm by an adult before age12were considered to have been maltreated.17 We assessed internalising and externalising problems at age 5 byUsing thechild behavior checklist in face to face interviews with mothers and the teacher's report form by mail for teachers.1819 The internalising problems scale is the sum of items in the withdrawn and anxious/depressed subscales, and the externalising problems scale is the sum of items from the aggressive and delinquent behaviour subscales.We summed and standardised mothers' and teachers' reports to create cross informant scales.We tested children's iq at age 5 individually by using a short form of the wechsler preschool and primary scale of intelligence revised.2021Indicators of clinical concernWe constructed socioeconomic deprivation at age 5 from a standardised composite of household income, parents' highest education, and parents' highest occupational grade.22 We defined deprivation as the lowest third of the distribution. We determined attemptedOrcompleted suicide by any of the child's biological mother, father, grandparents, aunts,Oruncles from reports by biological parents, according to a standardised and validated protocol.23 We calculated a modified Reed's score, which takes into account the number of affected relatives given the size and demographic structure of the family,24 and we considered children whose score was atOrabove the 80th centile to have a strong positive family history of suicide. When the children were aged10 and12, we interviewed mothers about the presence of attention/hyperactivity and conduct problems by using items drawn from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Dsm iv).25 We considered attention deficit/hyperactivity disorder to be present if the child met Dsm iv criteria for this disorder at either10 or12years of age;Similarly, we deemed children to have conduct disorder if they met the relevant dsm iv criteria at either of these ages. We classified children as having Extreme borderline personality characteristics if they scored atOrabove the 95th centile on a shortened version of the Shedler Westen assessment procedure200 for adolescents (SWAP200A),26 which mothers completed when the twins were aged12.27 We calculated the score with the self harm item excluded. At age12, children completed the10 item version of the multidimensional anxiety scale for children (Masc).28 Children scoring atOrabove the 95th centile (raw score of13Ormore)Constituted the"Extreme"Anxiety group. We used scores of20Ormore on the children's depression inventory (Cdi)To indicate clinically significant depressive symptoms.29 30 We assessed the definite presence of any psychotic symptoms during a private interview conducted with each child, as previously reported. 31 Finally, we individually tested children's IQ at age12by using a short form of the Wechsler intelligence scale for children, fourth edition.32 33Statistical analysisFirstly, we tested the relation between mothers' and children's reports of frequent bullying and mothers' reports of their self harm by using modified Poisson regression to estimate relative risks and robust 95% confidence intervals, 34 both unadjusted and then adjusted for the potentially confounding effects of physical maltreatment by adults, internalising and externalising problems at age 5, and IQ at age 5.We also calculated relative risks separately for girls and boys and evaluated the equality of the bullying coefficients across the sexes with an approach called"Seemingly unrelated regression"Using the"Suest"Command in stata(V11.2).Secondly, we did a discordant twin analysis to rule out family wide influences on the association between bullying victimisation and self harm.35 Here, we tested the hypothesis that bullied twins would be more likely to self harm than their non bullied co twins over and above shared familial environmental risks.Thirdly, we did a series of logistic regressions to test which risk factors could help to identify which bullied children would engage in self harm.We evaluated the following risks:Family adversities(Socioeconomic deprivation, family history of attempted/completed suicide, physical maltreatment), children's concuRrent mental health problems, and children's low IQ.Finally, we used the"Punaf"Command in stata(V11.2)To calculate the population attributable fraction for self harm based on exposure to bullying victimisation(reported by either motherOrchild)In this sample.We coRrected all analyses(Except the twin discordance analysis) for the non independence of the twin observations byUsing theHuber White variance estimator.We did a sensitivity analysis using multi level mixed models in sas with the proc glimmix procedure and obtained almost identical results(Data not shown).Resultsdoes frequent bullying predict self harm? Exposure to frequent bullying by peers before age12was associated with an increased risk of self harm at12years of age, whether bullying was reported by mothers (Relative risk 3. 53, 95% confidence interval2.10 to 5.93)Orby children themselves (3. 33,1.91 to 5.82).This association was equally evident among both boys and girls, for both reporting sources(Figure).Therefore, the remaining analysis included both sexes together. Prevalence of self harm at age12among Frequently bullied and non bullied children assessed by maternal reports of bullying (Top panel)And children's own reports of bullying(Bottom panel).Associations between bullying victimisation and self harm are expressed as relative risks(Rr)With 95% confidence intervalsopen in new tabcan maltreatment explain association between bullying and self harm?Bullying and parental maltreatment often occur to the same children, 36 and problem parenting has been implicated in elevated rates of self harm.9 Therefore, we tested whether exposure to physical maltreatment could account for the association between bullying and self harm.However, the association between frequent bullying and self harm behaviour remained after we controlled for lifetime exposure to physical maltreatment(table1). Table1 Association of children's bullying victimisation (As assessed by mothers' reports and children's own reports)With self harmview this table:View popupview inlinecan early mental health problems explain association between bullying and self harm? Children's emotionalOrbehavioural problems may make them greater targets for bullying and also increase the likelihood that they will engage in self harm.2 9 Nonetheless, the greater risk of self harm after exposure to bullying remained when we took these pre morbid problems into account (table1).Can low iq explain association between bullying and self harm?Children with low cognitive abilities are at greater risk of being targeted by bullies, 37 as well as engaging in self harm behaviours.9 However, adjustment for IQ at age 5 did not substantially alter ralph lauren short sleeved polo the association between bullying and self harm(table1).Can family environment explain association between bullying and self harm?Another possibility is that factors within the family environment(Such as poverty, parental psychopathology, domestic violence)Could account for the association we observed between bullying and self harm.To rule out the influence of these shared environmental risk factors, we compared twins within the same family to determine whether bullied twins were more likely to self harm than their non bullied age and sex matched co twin. Using mothers' reports,162 twin pairs were discordant for bullying, and the bullied twins were significantly more likely to self harm than were their non bullied co twins (13(8.0%)V 3(1.9%);Ratio=4.3, 95% confidence interval1.3 to14.0). Turning to children's ralph lauren city polo self reports,144 were discordant for bullying, and here we saw a similar trend for the bullied twins to self harm compared with their co twins (12(8.3%)V 7(4.9%);Ratio=1. 7,0.71 to 4.1).

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