Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

Kodish, Herres, and Shearer, et al’s Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample seeks to explore what, if any, causal relationship there may be between bullying and the prevalence of suicide among youth aged 14 to 24 years.  Uniquely, their study seeks to identify not only the relationship between bullying and suicide among youth, but also to distinguish between the different types of bullying and their associated effects on suicidal ideation, as well as to explore what role depression may have as a moderating factor between bullying and suicide risk.  Kodish, et al, derived their cohort for study from ten primary care practices located in rural and semi-urban Northeastern Pennsylvania,and used the Behavioral Health Screen (BHS) to arrive at a sample of 5,429 participants.


By using the DSM in conjunction with the BHS, the surveyors were able to assess risk for bullying by type (verbal, physical, and/or cyber) as well as the presence of depressive symptoms (using five factors gauged over a two week period), and also included a four item mean from the lifetime suicide scale that included questions to determine if the participant had felt life to be not worth living; had considered suicide; planned to commit suicide; or had attempted suicide.  Controlling for depression and demographics, the collected data was then analyzed to determine what relationship, if any, existed between the types of bullying and suicidal risk levels, as well as testing the interactions between each bullying type and incidences of depression (Kodish, et al, 2016).  It was determined that there is a statistically significant relationship between risk of suicide and all three types of bullying, with a cumulative bullying experience also associated with a heightened risk of suicide.  It should also be noted that significance was recognized between all four bullying factors (verbal, physical, cyber, cumulative) and incidences of depression, with a stronger link between bullying occurrences and suicide severity among patients with depressive symptoms.  While the effects of physical, cyber, and cumulative bullying experiences were found not to be statistically significant with regard to suicide attempts, patients who experienced verbal bullying were shown to be 1.5 times more likely to report a suicide attempt (Kodish, et al, 2016).


Overall, it was discovered that all three forms of bullying were linked to suicide risk severity, with the effect being acutely heightened when symptoms of depression were present.  Of the three forms of bullying assessed, it was discovered that verbal bullying had, by far, the most impact, which may be due to it being the most common type reported (25% of the sample cohort reported verbal abuse in bullying situations).  This may be due to the fact that it is usually delivered publicly and in person.  By contrast, physical bullying, which may be painful and socially humiliating, may have a lesser psychological impact than other forms of bullying.  This could be due to any number of factors (“David v Goliath”-type situation, physical confrontation being motivated by racism, etc).  In regards to cyber bullying, the fact that it is usually done anonymously as well as the fact that the Internet is impersonal in nature may have a curtailing effect on the impact of this particular type of bullying.  Depression has been shown in this particular study to definitely be a moderator between bullying and suicide risk, but further study is warranted to determine the overall extent to which this relationship exists, as well as determining the extent of moderation for each type of bullying.


Looking at the relationship between bullying, suicidal ideation and the relevance of associated depression provides insight into developing appropriate and effective treatment protocols for those who are most at-risk.  By establishing a solid connection between bullying, suicidal ideation, and depression, the authors have furthered insight into a serious issue facing our youth, and it should be noted that not only does this research benefit those who are bullied, but also those who do the bullying; youth who bully others have been found to be at significantly increased risk for suicide and depression as well.


Delving further into these issues will help to improve not only the understanding necessary for addressing the victims of bullying but also to understand what it is that causes a bully to victimize others, thus allowing earlier interventions for prevention of escalation, and ultimately the reversal of those trends that lead to bullying, depression, and suicidal ideation.  The authors note that assessing for these issues during primary care visits is warranted.  Going forward, improving the assessment for these issues through clinical interviews should be a priority for those not only in healthcare occupations, but also those who are likely to have the most social non-parental contact with children (teachers, clergy, etc).


Kodish, T., Herres, J., Shearer, A., Atte, T., Fein, J., & Diamond, G. (2016). Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample. Crisis, 37(3), 241-246. doi:10.1027/0227-5910/a000378



Teresa King
PMHC Doctoral Intern


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