Peer Victimization and Impacts on Mental Health for Adolescents
School Bullying is a serious problem all over the country. A total of 12% of males and 8% of females report being bullied in school, meaning 20% of adolescents (roughly 13 years of age) are being bullied in schools every day (Stadler, Feifel, Vermerien, & Postka, 2010; Tillfors, Persson, Willén, & Burk, 2012). Bullying can include direct aggressive behavior, such as physical intimidation and verbal threats, or indirect aggressive behavior, such as exclusion or rejection (Evan, Fraser, & Cotter, 2014). According to Evan, Fraser, and Cotter (2014), three defining features are used to classify bullying: intent to harm (bully intends to harm the victim), imbalance of power (the bully is physically stronger and/or has more social power than the victim), and repetition (bullying is focused on particular children and occurs repeatedly).
Adolescence is a developmental period characterized by biological, cognitive, and psychosocial changes, including pubertal maturation, perspective-taking, and identity development (Tillfors, Persson, Willén, & Burk, 2012). Adolescence is also an important transitional period in which there is more emphasis being put on peer relationships and an increased vulnerability to developing depressive and anxiety disorders. Mixing these developmental changes with peer victimization can have both negative short-term and long-term implications for an adolescent’s mental health.
Types of Peer Victimization
There are two types of peer victimization that have been identified in the literature. Overt victimization is the target of physical aggression, threats, or verbal aggression and is more likely to have stronger implications on boys than girls (Hatzenbuehler, Hilt, & McLaughlin, 2009; Tillfors, Persson, Willén, & Burk, 2012). Relational victimization is when the relationship status is being used as the mechanism of aggression through social exclusion, gossip, or other means and is more likely to have stronger implications for girls than boys (Abramson et al., 2013; Hatzenbuehler, Hilt, & McLaughlin, 2009; Stradler, Feifel, Vermerian, & Poustka, 2010). Both types of peer victimization can lead to various types of internalizing symptoms (Abramson, et al., 2013). While both females and males are at risk for certain types of peer victimization and internalizing symptoms, Overall, females are more at risk (Boxer, Gohl, & Niwa, 2013; Stadler, Feifel, Vermerien, & Poustka, 2010).
Internalizing Psychopathology
Internalizing psychopathology that will be addressed consists of major depressive disorder as well as social anxiety disorder or social phobias. The DSM- 5 characterizes major depressive disorder as the loss of interests or pleasure, increase or decrease in appetite, excessive sleeping or difficulty sleeping, feelings of depression, sadness, worthlessness or hopelessness, psychomotor changes such as agitation or retardation, decreases in energy, impaired thinking, and/or thoughts of death or suicide ideation (American Psychiatric Association, 2013). Social anxiety disorder or social phobias are characterized by marked or intense fear of anxiety of social situations in which the individual may be scrutinized by others (American Psychiatric Association, 2013). By age 18, 20% of adolescents experience their first onset of major depressive disorder and one-third of them have reported anxiety disorder (Abramson, et al., 2013). Compared to boys, girls reported higher levels of depressive symptoms and major depressive disorder as well as symptoms of anxiety and social anxiety (Abramson, et al., 2013; Boxer, Ghoul, & Niwa, 2013; Stadler, Feifel, Vermerien, & Poustka, 2010).
Major Depressive Disorder
As adolescents put more emphasis on crowd affiliations and rely on peers for social support during these years of development, they become more sensitive to relationally oriented peer victimization. Studies have found that relational peer victimization can lead to increases in depressive symptoms (Abramson, et al., 2013). Many risk factors have been examined to explain the relationship between peer victimization and depressive symptoms.
Emotion dysregulation is the mechanism that links perceived stress to internalizing symptoms (Hatzenbuehler, Hilt, & McLaughlin, 2009). Mechanisms linking victimization to the development of internalizing symptoms differ depending on whether victimization experiences are overt or relational (Hatzenbuehler, Hilt, & McLaughlin, 2009). Overt Victimization is more likely to elicit fear whereas relational victimization can cause depression and other internalizing symptoms (Hatzenbuehler, Hilt, & McLaughlin, 2009). Studies found that adolescents with symptoms of depression were more likely to be targets of relational peer victimization instead of other types of peer victimization, such as overt (Hatzenbuehler, Hilt, & McLaughlin, 2009). The more relationally oriented peer victimization that was experienced by adolescents, the more emotion dysregulation increased over time (Hatzenbuehler, Hilt, & McLaughlin, 2009).
Emotional maltreatment conceptualized as emotional abuse (verbal assaults on self-worth by parent/caretaker) and emotional neglect (parental/caretaker emotional unresponsive), is one risk factor (Abramson, et al. 2013). Emotional abuse but not neglect during childhood years has been found to make depressive symptoms worse when combined with peer victimization (Abramson, et al., 2013). Emotional abuse significantly predicted hopelessness and in turn, hopelessness predicted increases in depressive symptoms (Abramson, et al., 2013). However, the existence of hopelessness does not mean that adolescents who experience relational peer victimization will develop depressive symptoms (Abramson, et al., 2013). In this particular study, girls reported higher levels of hopelessness than males, which is consistent with the fact that girls are more likely to report depressive symptoms and major depressive disorder (Abramson, et al., 2013; Boxer, Ghoul, & Niwa, 2013; Stadler, Feifel, Vermerien, & Poustka, 2010).
Another risk factor which contributes to the development of depressive symptoms is an adolescent’s dependence on contingent self-worth. Contingent self-worth is the extent to which individuals “stake” their self-worth and self-esteem on external factors and perceptions of others (Boxer, Ghoul, & Niwa, 2013). Studies show that if adolescents depend on others to develop a high self-esteem then experiencing relational peer victimization at any degree would put them at risk for developing major depressive disorder (Boxer, Ghoul, & Niwa, 2013). This positive relationship between contingent self-worth and peer victimization can lead to many important implications for intervention and prevention strategies and programs.
Long-term implications of peer victimization which can lead to internalizing symptoms can affect adolescents when adjusting to college. Previously bullied students have reported higher levels of depression in the fall and in the spring of their freshman year of college (Bowman, et al., 2016). The stress-buffering theory suggests that perceived social support acts as a buffer against the negative effects of stressful life experiences, such as peer victimization (Bowman, et al., 2016). Therefore, perceptions of social support potentially protect against poor mental health outcomes among first-year students who have previously been bullied. Social support was shown to decrease the amount of fall and spring depression symptoms experienced by first-year students (Bowman, et al., 2016). Interestingly, support by family decreased amounts of depressive symptoms significantly when compared to peer social support which was shown to have an insignificant effect on student’s mental health (Bowman et al., 2016). More remarkably, perceived friend support has shown to be protective for boys (Bowman et al., 2016; Boxer, Ghoul, & Niwa, 2013). Main effects theory suggests that those with high levels of social support will always have better mental health compared to those with little social support, regardless of the stress that one experiences (Bowman et al., 2016). In a separate study on the effects of parent support as a moderator between general peer victimization and homophobic victimization, they found that adolescents who have depression with suicide ideation benefited from parental support compared to those who did not have parental support (Poteat, Merish, DiGiovanni, & Koenig, 2011).
Social Anxiety Disorder (Social Phobia)
Studies have also shown there is a link between peer victimization and symptoms of anxiety (Abramson, et al., 2013). Peer victimization can lead to emotion dysregulation which is linked to symptoms of anxiety (Hatzenbuehler, Hilt, & McLaughlin, 2009). These internalizing symptoms are caused by peer rejection which in turn suggests that adolescents with symptoms of anxiety or depression are more likely to be targets of relational peer victimization (Hatzenbuehler, Hilt, & McLaughlin, 2009).
Other studies have shown that there is a relationship between childhood maltreatment and anxiety symptoms (Abramson, et al., 2013). Forms of peer victimization including, overt and relational, have been shown to be associated with anxiety (Abramson, et al., 2013). However, while relational peer victimization has been shown to be associated with social anxiety, overt peer victimization has not (Abramson, et al., 2013). An adolescent who has experienced emotional abuse when they were a child is more likely to develop social anxiety when exposed to peer victimization (Abramson, et al., 2013). The helplessness-hopelessness model of depression and anxiety says that anxiety arises from an uncertain sense of helplessness about future outcomes whereas depression comes from a mix of negative feelings about future events (Abramson, et al., 2013). Emotional abuse predicted hopelessness and in turn, hopelessness predicted increases in symptoms of social anxiety (Abramson, et al., 2013). Hopelessness has been shown to mediate the relationship between relational peer victimization and social anxiety (Abramson, et al., 2013).
Another risk factor that is associated with social anxiety can be explained by certain peer relationships that the adolescent may or may not have. The interpersonal model is used to explain social anxiety and its features (Tillfors, Presson, Willén, & Burk, 2012). This model suggests that peer relationships can be thought of as bi-directionally related, with social anxiety predicting increased trouble with peer relationship and peer relationships further exacerbating symptoms of social anxiety (Tillfors, Presson, Willén, & Burk, 2012). Social anxiety predicted decreased relationship support within close relationships among adolescent males but not females (Tillfors, Presson, Willén, & Burk, 2012). In addition to that socially anxious boys experienced greater emotional difficulty than socially anxious girls (Tillfors, Presson, Willén, & Burk, 2012). Less support will increase the frequency of self-protective behaviors, such as withdrawing from social supports to avoid victimization, which in turn increase the probability of negative feedback in a close relationship (Tillfors, Presson, Willén, & Burk, 2012).
The other half of the interpersonal model can be explained by looking at peer relationships and the effects they have on social anxiety. When contingent self-worth, being the amount adolescents “stake” their self-esteem on their peers, is at a high level, the effects of victimization are amplified compared to if contingent self-worth is at a low level (Boxer, Ghoul, & Niwa, 2013). Interestingly enough, high levels of contingent self-worth seem to intensify the effects of peer victimization for boys more than it does for girls (Boxer, Ghoul, & Niwa, 2013). However, studies found that less acceptance among peers predicted increases in social anxiety over time among both females and males (Tillfors, Presson, Willén, & Burk, 2012). Being less accepted by peer groups exacerbates social anxiety which in turn uniquely interferes with the social environment by increased peer victimization (Tillfors, Presson, Willén, & Burk, 2012).
Long-term implications of peer victimization and the development of anxiety can again be seen in first-year college students. Findings suggest that total perceived social support has a stress buffering effect and main buffering effect on fall semester anxiety (Bowman, et al., 2016). Although a main effect was shown for the fall, there was no main effect found for the spring semester, however, there was still a stress buffering effect for total perceived social support in the spring (Bowman, et al., 2016). Similar to depression symptoms, findings show that friend support in college moderated the relationship between being previously bullied and social anxiety (Bowman, et al., 2016). Interestingly, they found that high friend support was associated with high levels of spring anxiety (Bowman, et al., 2016). Consistent with the findings from the depression aspect of this study, previously bullied students with high levels of perceived family support reported lower levels of social anxiety in the spring semester (Bowman, et al., 2016).
Implications for School Psychologists
Overall, implications of these studies target school psychologists and express an urgency for the development and/or improvement of prevention strategies. An important target of these school-based prevention strategies should be focused on the various factors such as emotion dysregulation, emotion maltreatment, contingent self-worth, peer and parental support. Currently, there is not one single prevention strategy that is used across all schools, however, the most used one is the Olweus Anti-Bullying Program, which is described as having a focus on bystanders, bullies, victims, and the school climate (Evans, Fraser, & Cotter, 2014). Other prevention strategies used in schools, which yielded positive results, are as follows:
• Bully Prevention Challenge Course
• Bully-Proofing Your School
• Cool Kids Program
• Drama Program
• Empathy Training
• FearNot!
• Friendly Schools
• Friendly Schools and Friendly Families
• KiVa
• Lunch Buddies
• Olweus Anti-Bullying Program
• Ophelia Project
• Playworks
• Positive Actions
• Restorative Whole School Approach
• School-Wide Positive Behavioral Interventions and Supports Second Step
• Social Norms Projects
• Steps to Respect
• Take a Stand, Lend a Hand, Stop Bullying Now
• Take the LEAD
• WITS
• Youth Matters
• Zero Program Against Bullying (Evans, Fraser, & Cotter, 2014)
Many school-based programs fail to eliminate peer aggression completely (Hatzenbuehler, Hilt, & McLaughlin, 2009). Consequently, the development of effective programs for youth experiencing psychological distress related to peer victimization represents a critical goal (Hatzenbuehler, Hilt, & McLaughlin, 2009). Since emotion dysregulation contributes to the development of depression and anxiety, interventions that use cognitive- behavioral and social learning techniques to improve social skills, and develop prosocial attitudes and behaviors as well as enhance coping skills for managing bullying and peer pressure could be beneficial (Hatzenbuehler, Hilt, & McLaughlin, 2009). Programs in place that include these elements are, the Drama Program, Empathy Training, FearNot!, Friendly Schools, Restorative Whole Schools Approach, Steps to Respect, and Take the LEAD (Evans, Fraser, & Cotter, 2014).
Emotional abuse and relationally oriented victimization are both salient and damaging stressors that require a significant amount of attention during early adolescent years. The effects of emotional abuse highlight the need for early intervention strategies, that could identify emotional abuse as well as provide support and age-appropriate coping strategies (Abramson, et al., 2013). A specific mediator that should be targeted is hopelessness in adolescents, which has been shown to be a risk factor for depression and anxiety (Abramson, et al., 2013). The Ophelia Project, Positive Actions, Youth Matters, and Zero Program Against Bullying, are all program that incorporates these suggested elements (Evans, Fraser, & Cotter, 2014).
Another factor shown to increase depression and anxiety in adolescents is the level of contingent self-worth that they require. Implications suggest that prevention strategies should focus on increasing an adolescent’s self-esteem (Boxer, Ghoul, & Niwa, 2013). Many practices now focus on increasing the development of contingent self-worth based on external affirmation (Boxer, Ghoul, & Niwa, 2013). However, it is important to keep in mind that this can problematic for those who are or have experienced peer victimization because of the increased need that adolescents already have for their peer’s approval (Boxer, Ghoul, & Niwa, 2013). Practices including this now are the Bullying Prevention Challenge Course and the Cool Kids Program (Evans, Fraser, & Cotter, 2014).
Peer social support and parental social support have been shown to be excellent mediators in the development of depression and anxiety both short term and long term (Bowman, et al., 2016; Poteat, Merish, DiGiovanni, & Koenig, 2011; Tillfors, Presson, Willén, & Burk, 2012). All studies exemplify the need to look at the impact that peer relationships and parental relationships have on the effects of peer victimization. Prevention programs that encourage peers and parents to get involved include Bully-Proofing Your School, Friendly Schools, Friendly Families, KiVa, Take a Stand Lend a Hand, Stop Bullying Now, WITS, Lunch Buddies, Olweus Anti-Bullying Program, PlayWorks, School-Wide Positive Behavioral Interventions and Supports Second Step, and Social Norms Project (Evan, Fraser, & Cotter, 2014). While all of the prevention programs listed above are based on emotion dysregulation, emotion maltreatment, contingent self-worth, or peer and parental support, none of them are focused on improving all four risk factors. Therefore, the biggest implication for school psychologist is to develop a prevention program that focuses on all four of these aspects.
Conclusion
In conclusion, adolescence is a time of great vulnerability for mental health as well as a prominent time for someone to experience peer victimization. Many mediators such as emotion dysregulation, emotion maltreatment, contingent self-worth, and peer and parental social support, link peer victimization to negative mental health problems such as major depressive disorder and social anxiety disorder. However, there are still many improvements that can be done to our prevention programs to protect all adolescents suffering from being a victim of bullying.