Being Bullied in Childhood Associated With Psychotic Symptoms Among Pre-Teens

CHICAGO—Children who are consistently victimized by peers appear more likely to develop psychotic symptoms in early adolescence, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Some psychosis-like symptoms such as hallucinations and delusions are commonly experienced in childhood and adulthood, according to background information in the article. Children with these symptoms are at increased risk of developing psychosis in adulthood. "Recent studies have demonstrated an association between traumatic events such as abuse in childhood and psychosis in adults," the authors write.

Andrea Schreier, Ph.D., of Warwick Medical School, University of Warwick, Coventry, England, and colleagues studied 6,437 individuals in early adolescence (average age 12.9) who were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Parents had completed regular mailed questionnaires about their child's health and development since birth, and the children underwent yearly physical and psychological assessments from age 7.

At each visit, trained interviewers rated the children on whether they had experienced psychotic symptoms (hallucinations, delusions or thought disorders) during the previous six months. Children, parents and teachers reported on whether the child had experienced peer victimization, defined as negative actions by one of more other students with the intention to hurt.

A total of 46.2 percent of participants were categorized as victims and 53.8 percent were not victimized at either ages 8 or 10. At age 12.9, 13.7 percent had broad psychosis-like symptoms (one or more symptoms suspected or definitely present), 11.5 percent had intermediate symptoms (one or more of the symptoms was suspected or present at times other than going to sleep, waking from sleep, fever or after substance use) and 5.6 percent had narrow symptoms (one or more symptoms definitely present).

The risk of psychotic symptoms was approximately doubled among children who were victims of bullying at age 8 or 10, independent of other psychiatric illness, family adversity or the child's IQ. The association was stronger when victimization was chronic or severe.

"A range of mechanisms has been proposed to explain the link between traumatic events, such as victimization, and psychotic symptoms," the authors write. For instance, chronic stress from bullying may act on a genetic predisposition to schizophrenia to trigger symptoms.

"Whether repeated victimization experiences alter cognitive and affective processing or reprogram stress response or whether psychotic symptoms are more likely due to genetic predisposition still needs to be determined in further research," the authors conclude. "A major implication is that chronic or severe peer victimization has non-trivial, adverse, long-term consequences. Reduction of peer victimization and of the resulting stress caused to victims could be a worthwhile target for prevention and early intervention efforts for common mental health problems and psychosis." (Arch Gen Psychiatry. 2009;66[5]:527-536. Available to the media pre-embargo at www.jamamedia.org).

Editor's Note: The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for ALSPAC. This study was funded by a grant from the Wellcome Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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