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MONDAY, March 10, 2014 (HealthDay News) -- Children and teens involved in bullying -- victims and perpetrators alike -- are more likely to think about suicide or attempt it. And cyber bullying appears more strongly linked to suicidal thoughts than other forms of bullying, a new research review finds.
The findings "establish with more certainty that bullying is related to suicide thoughts and attempts," said study lead author Mitch van Geel, a researcher with the Institute of Education and Child Studies at Leiden University in the Netherlands. "And we establish that these results hold for boys and girls, and older and younger children."
Bullying is widespread among children and teens. According to previous studies, almost 50 percent of kids in grades 4 to 12 reported being bullied within the previous month. Nearly one-third said they were bullies themselves.
The new results, published March 10 in the journal JAMA Pediatrics, are based on 43 previous studies. They don't confirm that bullying directly pushes kids to be suicidal, however. It's possible that the connection is more complex, or even that suicidal kids are more likely to be bullied, the researchers said.
In recent years, highly publicized suicides of young people have focused attention on the subject. Last August, a Greenwich, Conn., sophomore who reportedly sustained years of bullying killed himself after the first day of school, according to news reports. In October, a 15-year-old from Carterville, Ill., who committed suicide reportedly left a note saying he was bullied at school. Two days before his death, two Florida girls were arrested for bullying a 12-year-old who killed herself.
Bullying can take many forms. Physical threats and attacks, such as shoving, pushing and hitting, as well as teasing, name-calling and spreading rumors are well-known bully behaviors.
Less common statistically but possibly more harmful is bullying through technology such as email and social media, the researchers said. The exact reasons for this aren't clear, they said, but more people can be reached through the Internet and offensive material can be stored and resent indefinitely.
Van Geel and his colleagues launched the new review of existing research to better understand the connection between bullying and suicide.
The researchers examined 34 studies with a total of about 285,000 participants that explored the relationship between bullying and suicidal thoughts. They looked at nine studies, with about 70,000 participants, that focused on bullying and suicide attempts. Only three studies in the review dealt with cyber-bullying.
The studies, which involved 9- to 21-year-olds, were from countries as varied as the United States, South Africa, New Zealand and South Korea.
In general, the studies found that bullies and bully-victims -- people who bully others and are bullied themselves -- are at higher risk of suicidal thoughts and suicide attempts. The design of the review didn't allow the authors to quantify the increased level of risk in lay terms, but a statistical analysis suggests the increased risk is significant, van Geel said.
Researchers believe suicidal thoughts and attempts are connected to completed suicides, van Geel said.
But spotting kids at risk of being bullied is a challenge, van Geel said. "Often victims choose not to share their problems," he said. Some fear they won't be taken seriously, or worry that talking might make the bullying worse, he said.
"Some victims may go unnoticed for a very long time," he added.
Still, some children -- gay or obese kids, for example -- are especially prone to becoming victims of bullying, van Geel said. "Teachers might use this knowledge to identify potential victims," he said.
Could kids be more vulnerable to bullying because they're already depressed?
Todd Herrenkohl, a professor of social work at the University of Washington, studies bullying and said this possibility deserves more research. Bullied kids often stand out as being different from others, he said, and those who are depressed or have other mental issues could fit into that vulnerable category.
As for future research, Herrenkohl said, one of the big mysteries about bullying is how some victims are resilient and recover, while others suffer. Researchers need to understand "how to help kids not only avoid becoming victims but rebound from a bullying experience in a way that doesn't lead to suicide attempts," he said.
For now, the authors support programs that teach kids to be more than bystanders when they witness bullying. Also valuable are programs for parents and educators on identifying and preventing bullying, they said.
"Make children feel that they can safely talk to teachers about bullying, and make children feel that bullying is a problem that will be taken seriously," van Geel said.
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SOURCES: Mitch van Geel, Ph.D., assistant professor, Institute of Education and Child Studies, Leiden University, the Netherlands; Todd Herrenkohl, Ph.D., professor of social work, University of Washington, Seattle; March 10, 2014, JAMA Pediatrics