Child Psychiatry Hum Dev DOI 10.1007/s10578-014-0510-2
ORIGINAL ARTICLE
Physical Child Abuse and Teacher Harassment and Their Effects on Mental Health Problems Amongst Adolescent Bully–Victims in Taiwan Cheng-Fang Yen • Chih-Hung Ko • Tai-Ling Liu Huei-Fan Hu
•
Ó Springer Science+Business Media New York 2014
Abstract This study compared physical child abuse and teacher harassment of bully–victims with other groups and examined their associations with mental health problems in bully–victims. For 6,160 adolescents, experiences of physical child abuse, teacher harassment, peer bullying, and six mental health problem indicators were assessed. Adolescents that had experienced physical child abuse and teacher harassment were more likely to be bully–victims but not neutral or pure victims. Adolescents who reported physical child abuse were more likely to be bully–victims but not pure bullies. Bully–victims that had experienced teacher harassment exhibited more severe depression and insomnia than did those without teacher harassment. Gender had moderating effects on the difference in physical child abuse between bully–victims and neutrals and on the association between physical child abuse and suicidality in bully–victims. Physical child abuse and teacher
Cheng-Fang Yen and Chih-Hung Ko have contributed equally to this study. C.-F. Yen C.-H. Ko T.-L. Liu Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan C.-F. Yen C.-H. Ko T.-L. Liu Department of Psychiatry, Faculty of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan C.-H. Ko Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan H.-F. Hu (&) Department of Psychiatry, Tainan Municipal Hospital, 670 Chongde Road, East District, T’ai-nan 701, Taiwan e-mail: [email protected]
harassment should be considered when preventive and intervention programs are developed for adolescents. Keywords Bullying Bully–victims Physical child abuse Teacher harassment
Introduction Involvement in peer bullying is a critical problem amongst children and adolescents. Research has revealed that bully– victims, defined as people who bully others but are also bullied themselves, are a distinct group and the most troubled amongst all children and adolescents involved in peer bullying [1]. Compared with pure bullies and victims, bully–victims have been found to have the greatest risk of psychological and psychosomatic symptoms [2, 3], suicidal ideation [4], school and interpersonal dysfunction [5], externalizing behavioural problems [6], and alcohol use [5]. Identifying factors that might increase the risk of children and adolescents of becoming bully– victims can guide prevention strategies for reducing behaviours involving bullying. An ecological framework focusing on the interplay of individual characteristics in the multilevel contexts of development is useful for understanding bullying and for developing effective interventions [7]. As living environments, both family and school are crucial for the development of adolescent behaviours. In the family and at school, physical child abuse and teacher harassment, respectively, are two forms of adverse context that have been considered to contribute to young people’s involvement in bullying. Considering the effects of physical child abuse and teacher harassment at the same time can provide a broader understanding of young people’s involvement in bullying than can focusing on only one type of exposure.
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As in other countries, physical child abuse is a critical concern in Taiwan. A survey study on adolescents living in rural Taiwan revealed that 22.2 % of adolescents reported experiencing physical abuse in their childhood [8]. Several retrospective [9–11] and prospective [11–13] studies have demonstrated that physical child abuse increases the risk of bullying perpetration and victimisation. Victimisation in physical child abuse also predicts poor mental health in adolescents [14] and adults [15]. Several psychosocial models have been proposed to explain the relationships between physical child abuse with young people’s involvement in bullying and poor mental health. Based on attachment theory [16], physical child abuse not only harms the relationship between young people and parents but also damages young people’s framework for perceiving stressful situations, the actions of others, and their own capacities [17]. For example, victims of physical child abuse can perceive the need for selfprotection in social interaction and then act violently towards peers [18]. Based on the theory of shame, victims of physical child abuse often live with a sense of being disgraced, which can compromise their psychobiological functioning and result in being prone to shame and psychopathology. Such effects can become a source of interpersonal relationship difficulties, including involvement in bullying [17, 19]. Based on the social learning theory [20], young people who experience physical child abuse might learn that violence is a normal way of being treated or that violence is an acceptable way to respond to disagreements and become aggressive with weaker peers [9]. The ecological perspective of individual developmental trajectories proposes a transactional relationship between young people and social context, in which the balance between potentiating and compensatory mechanisms is linked to young people’s display of behavioural competence or failure to adapt [21]. Physical child abuse can cause young people to become unbalanced and increase their difficulties in social adaptation, which further increases the risk of involvement in peer bullying and poor mental health [22]. Physical child abuse can also cause some maltreated children to adopt a submissive posture with their parents in an effort to maintain their safety in violent homes [23]; they are then less likely to defend themselves when they are the targets of peer bullying in extrafamilial environments [24]. Neurobiological research has postulated that physical child abuse can damage victims’ cognitive development and impair their ability to manage negative life events optimally [25]. Physical child abuse can also result in biases amongst victims regarding perceived threats and hostile attribution, the cognition of hopelessness, and depressive symptomatology [26], and further increases the risk of involvement in bullying [27].
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Several concerns exist regarding experiences with physical child abuse and mental health problems amongst bully–victims that require further study. First, a previous longitudinal study [12] and a cross-national study [10] revealed significant relationships between physical child abuse and all three types of involvement in peer bullying: as bullies, as victims, and as bully–victims. Based on the explanatory models previously described, physical child abuse has significant psychosocial and biological impacts on the development of young people, and it is reasonable to hypothesise that bully–victims are more likely to report experiences of physical child abuse than are pure victims and pure bullies. However, no study has compared bully– victims’ experiences of physical child abuse with those of pure victims and pure bullies. Second, both physical child abuse and involvement in bullying are associated with poor mental health in young people. A cohort study revealed that compared with bullied children who did not self-harm, bullied children who self-harmed were more likely to have experienced physical child abuse [28]. However, whether physical child abuse has an additional effect on poor mental health in bully–victims requires further study. Third, the results of previous studies on gender differences in the relationship between physical child abuse and bullying involvement have been mixed. A previous study revealed that maltreated boys and girls were at a similar risk for bullying and victimisation [11, 29], whereas other studies have revealed that maltreated girls are significantly more likely to become bullying victims [30] or bully–victims compared with boys [31]. Meanwhile, research has revealed that the negative mental health consequences of physical abuse in childhood are more detrimental for girls than they are for boys [32]. Further study is required to determine gender differences in the relationship between physical child abuse and bullying perpetration-victimisation, as well as in the relationship between physical child abuse and mental health problems in bully–victims. If gender differences exist, these should be considered when developing prevention and intervention programs for bully–victims that have been subjected to physical child abuse. Teacher harassment in schools is an adverse context for students. A previous study in Taiwan revealed that 26.9 % of junior-high students reported having been maltreated by teachers in the previous semester [33]. Research has revealed that teacher harassment is associated with peer bullying perpetration [34] and victimisation [35]. Compared with adolescent students who were not involved in bullying, pure victims, and pure bullies, bully–victims reported the highest levels of teacher harassment [34]. Research has revealed that teachers perceive bully–victims as restless and hot-tempered, characterised by deficient academic performance [36]. Teachers in Taiwan are seen
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as playing an essential role in terms of providing a safe environment for students’ social, psychological, and academic development [37]. Once students experience teacher harassment, they are more likely to suffer severe mental health problems and a poor quality of life [38]. Research in other countries has also revealed that students who experience teacher harassment have increased risks of poor selfesteem [39], somatic complaints [39], suicidal tendencies [40], and drug and alcohol use [41]. To our knowledge, only one previous study has compared bully–victims’ experiences of teacher harassment with those of pure victims and pure bullies while investigating the moderating effect of gender [34]. Further study is required to examine bully–victims experiences of teacher harassment and the moderating effect of gender by considering physical child abuse. Whether gender moderates the relationship between experiences of teacher bullying and mental health problems in bully–victims also requires further study. This study had two main aims. First, this study compared adolescent bully–victims’ experiences of physical child abuse and teacher harassment with those of pure victims, pure bullies, and adolescents who were not involved in bullying. The moderating effect of gender on the difference in physical child abuse and teacher harassment between bully–victims and other groups was also examined. Second, our previous study revealed that bully– victims were more likely to report severe depression, suicidality, and alcohol abuse than were pure bullies and pure victims, and bully–victims reported more severe insomnia and anxiety than did pure bullies [3]. Thus, this study further examined the associations of physical child abuse and teacher harassment with mental health problems and the moderating effect of gender amongst bully–victims. We hypothesised that experiences of physical child abuse and teacher harassment are more prevalent amongst bully– victims than they are amongst other groups, and that gender moderates this difference. We also hypothesised that physical child abuse and teacher harassment are significantly associated with mental health problems and that bully–victims differ by gender in this regard.
Methods Participants The present study was based on data from the 2009 Project for the Health of Children and Adolescents in Southern Taiwan, a mental health research survey of adolescents in Grades 7 through 12 (ages 12–18 years) recruited from three metropolitan areas and four counties in Southern Taiwan [42]. In 2009, there were 202,883 students in 143 senior high/vocational schools and 254,130 students in 205
junior high schools in this area. On the basis of the definitions of rural and urban districts in the Taiwan-Fukien Demographic Fact Book [43] and on school and grade characteristics, a stratified random sampling strategy was used to ensure that districts, schools, and grades were proportionally represented. Five junior high schools and four senior high/vocational schools were randomly selected from rural districts; similarly, five senior high/vocational schools and five junior high schools were randomly selected from urban districts. The classes in these schools were further stratified into three levels, based on grade, in the primary, junior high, and senior high/vocational schools. Subsequently, a total of 6,703 high school students were randomly selected based on the ratio of students in each grade. The Institutional Review Board of Kaohsiung Medical University agreed to the use of passive consent from parents and students. Before conducting the study, we prepared a leaflet explaining the purpose and procedures of the study. Students took the leaflet home to their parents or main caretakers, who could telephone the researchers, write a written message to the researchers, or ask their children to refuse to join the study directly. The students also had the right to refuse to participate in this study by returning blank questionnaires. Instruments Chinese Version of the School Bullying Experience Questionnaire (C-SBEQ) The self-reported C-SBEQ was used to evaluate participants’ involvement in school bullying in the previous year with 16 items answered on a 4-point Likert scale from 0 (never) to 3 (all the time) [44]. Items 1–8 evaluated experiences of peer bullying victimisation, including social exclusion; being called a mean nickname; being spoken ill of; being beaten up; being forced to do work; and having money, school supplies, and snacks taken away. Items 9–16 evaluated experiences of peer bullying perpetration. Participants who answered 2 or 3 on any item amongst Items 1–8 and Items 9–16 were identified as self-reported victims and bullies, respectively. A previous study revealed that the test–retest, internal reliability, and congruent validity of bullying involvement nominated by classmates and teachers were satisfactory [44]. In this study, participants who reported that they had never been involved in bullying were classified as the neutral group, those who reported being victims but not bullies were the pure victims, those who reported being bullies but not victims were the pure bullies, and those who reported being both victims and bullies were the bully–victims.
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Physical Child Abuse and Teacher Harassment Victimisation through physical child abuse in the previous year was assessed by the question [14]: ‘‘Have you been struck, slapped, kicked, or otherwise physically injured by family members where the abrasions, bruises, or pain caused by the injury lasted into the next day?’’ If the participant answered ‘‘yes’’ to this question, he or she was classified as having experienced physical child abuse. The experience of teacher harassment in the previous year was assessed by the question: ‘‘Is there a teacher who picks on you on purpose?’’ If the participant answered often or all the time to this question, he or she was classified as having experienced teacher harassment. Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale
participants’ self-reported anxiety symptoms [52, 53]. The MASC-T consisted of 39 items answered on a 4-point Likert scale. A higher total score on the MASC-T represented a more severe level of general anxiety. The psychometrics of the MASC-T for assessing anxiety symptoms amongst nonreferred adolescents in Taiwan were satisfactory [53]. Rosenberg Self-Esteem Scale We used the Rosenberg Self-Esteem Scale (RSES) to evaluate participants’ self-esteem levels [54]. The RSES consisted of 10 items answered on a 4-point Likert scale, and high total scores indicated high levels of self-esteem. This scale was previously used to evaluate self-esteem levels amongst Taiwanese adolescents [55]. CRAFFT Alcohol Abuse Screening Test
The Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale (MC-CES-D) used in this study was a 20-item self-administered questionnaire that used a 4-point evaluation scale to assess the frequency of depressive symptoms in the preceding week [45, 46]. Higher MC-CES-D scores indicated more severe depression. The psychometrics of the MC-CES-D were satisfactory for assessing depressive symptoms amongst nonreferred adolescents in Taiwan [47].
The 6-item CRAFFT Alcohol Abuse Screening Test was used to assess alcohol abuse in adolescents [56, 57]. Each question elicited a ‘‘yes’’ (with a score of 1) or ‘‘no’’ (with a score of 0) answer. High total scores indicated severe alcohol abuse. The CRAFFT was previously used for assessing alcohol abuse amongst adolescents in Taiwan [57]. Procedure and Statistical Analysis
Athens Insomnia Scale We used the Taiwanese version of the 8-item Athens Insomnia Scale (AIS-8) to assess the severity of subjective insomnia over the previous month [48, 49]. Higher total scores indicated more severe insomnia symptoms and subjective sleep-related distress. The psychometrics of the AIS-8 were satisfactory for assessing insomnia amongst nonreferred adolescents in Taiwan [49]. Suicidality The 5-item questionnaire from the epidemiological version of the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS-E) [50] was used to assess the occurrence of suicide attempts and of four forms of suicidal ideation in the preceding year [51]. Each question elicited a ‘‘yes’’ (with a score of 1) or ‘‘no’’ (with a score of 0) answer. Higher total scores indicated more severe suicidal risk. The agreement between participants’ self-reported suicide risk and their parents’ reports was significant [51]. Taiwanese Version of the Multidimensional Anxiety Scale for Children We used the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) to evaluate
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A total of 6,445 students (96.2 %) agreed to join this study. Of the 258 students who refused to join this study, 68 students refused based on their parents’ opinion, 128 returned blank questionnaires, and 62 were absent when the research assistants visited their classes. Each participant completed the research questionnaire anonymously under the direction of research assistants in each classroom during school hours. All students received a gift worth NT$33 (US$1) at the end of the assessment. Bully–victims’ experiences of physical child abuse and teacher harassment were compared with those of members of the neutral group, the pure victims, and the pure bullies by using logistic regressive analysis models to control for the effects of gender and age. We also used standard criteria [58] to examine whether the associations of physical child abuse and teacher harassment with peer bullying involvement differed regarding the participants’ gender and age. According to the criteria, moderation occurred when the interaction term for the predictor (physical child abuse and teacher harassment) and the hypothesised moderator (gender and age) were significantly associated with the dependent variable (peer bullying involvement) after controlling for the main effects of both the predictors and hypothesised moderator variables. In this study, when physical child abuse/teacher harassment and hypothesised moderators were significantly associated with peer bullying
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involvement, the interactions (physical child abuse/teacher harassment 9 hypothesised moderators) were further investigated using regression analysis to examine for moderating effects. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated. The effects of physical child abuse and teacher harassment on depression, insomnia, suicidality, anxiety, selfesteem, and alcohol abuse in bully–victims were examined using multiple regression analysis to control for the effects of gender and age. The moderating effects of gender on the association between physical child abuse/teacher harassment and mental health problem indicators were examined based on the standard criteria that were previously described [58]. A two-tailed p value of less than 0.05 was considered statistically significant.
Results Characteristics of Participants A total of 6,160 participants completed the research questionnaires without omission. Those who had missing data in the questionnaires were more likely to be boys (v2 = 22.958, p \ 0.001) and younger (v2 = 62.931, p \ 0.001). The demographic characteristics and the ratios of physical child abuse and teacher harassment amongst the participants with various peer bullying involvement experiences are shown in Table 1. The bully–victims were more likely to be boys than were the pure victims and neutrals, but no difference in gender was found between the bully– victims and pure bullies. The bully–victims were younger than the pure bullies and the neutrals, but no difference in age was found between the bully–victims and pure victims. The bully–victims were more likely to report experiences of physical child abuse and teacher harassment than the pure bullies, pure victims and neutrals. Comparisons of Physical Child Abuse and Teacher Harassment Experienced by Bully–Victims and Other Groups The results of logistic regression analyses comparing physical child abuse and teacher harassment between bully–victims and other groups and the moderating effects of gender are shown in Table 2. The results indicated that adolescents who reported physical child abuse and teacher harassment were more likely to be bully–victims rather than neutrals or pure victims. Adolescents who reported physical child abuse were more likely to be bully–victims but not pure bullies, whereas no significant difference in teacher harassment was found between the bully–victims and pure bullies.
A difference in gender was found between the bully– victims and neutrals, as well as between the bully–victims and pure victims. Thus, the interactions between physical child abuse/teacher harassment and gender were selected for examination using logistic regression analysis models. A difference in the interaction term for physical child abuse and gender was found between the bully–victims and the neutrals, which indicated that gender exerted a moderating effect on the difference in physical child abuse between the bully–victims and the neutrals. The results of further analysis showed that the difference in physical child abuse between the bully–victims and the neutrals was more significant in girls (OR 3.123, 95 % CI 2.246–4.343) than in boys (OR 2.049, 95 % CI 1.504–2.792). The mean (standard deviation) levels of depression on the MC-CES-D, insomnia on the AIS-8, suicidality on the questionnaire for suicidal risk, anxiety on the MASC-T, self-esteem on the RSES, and alcohol abuse on the CRAFFT were 15.6 (9.8), 6.2 (3.1), 0.7 (1.3), 38.5 (15.4), 19.2 (5.6), and 0.6 (1.0), respectively. The effects of physical child abuse and teacher harassment on depression, insomnia, suicidality, anxiety, self-esteem, and alcohol abuse amongst bully–victims are shown in Tables 3 and 4. The results showed that bully–victims who reported physical child abuse had more severe depression, insomnia, suicidality, anxiety, low self-esteem, and alcohol abuse than did bully–victims who did not report physical child abuse. Bully–victims who reported teacher harassment had more severe depression and insomnia than did bully–victims who did not report teacher harassment. There were differences in gender in regard to depression, insomnia, suicidality, anxiety, and self-esteem in bully–victims, and thus, the interactions between physical child abuse and gender and teacher harassment and gender were further selected for examination using multiple regression analysis models. The results showed that the interaction term for physical child abuse and gender was significantly associated with suicidality, which indicated that gender exerted a moderating effect on the association between physical child abuse and suicidality in bully–victims. The results of further analysis showed that a significant association between physical child abuse and suicidality in bully–victims was found only in girls (Beta = 0.212, t = 3.367, p = 0.001) and not in boys (Beta = 0.040, t = 0.720, p = 0.472).
Discussion The results of this study showed that physical child abuse was more prevalent amongst bully–victims than amongst neutrals, pure victims, and pure bullies. Although this study only determined the occurrence of physical child abuse in
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Child Psychiatry Hum Dev Table 1 Sex, age, physical child abuse, and teacher bullying of participants with different peer bullying involvement experiences v2 or F
Bully–victims (n = 591)
Pure bullies (n = 612)
Pure victims (n = 930)
Neutrals (n = 4,027)
Sex: boys [n (%)]
343 (58.0)
368 (60.1)
437 (47.0)
1,805 (44.8)
Age (years) [mean (SD)]
14.5 (1.8)
15.1 (1.8)
14.3 (1.7)
14.9 (1.8)
Physical child abuse [n (%)]
152 (25.7)
86 (14.1)
178 (19.1)
416 (10.3)
135.648***
Teacher harassment [n (%)]
125 (21.2)
92 (15.0)
67 (7.2)
113 (2.8)
376.156***
76.605*** 36.180***
*** p \ 0.001
Table 2 Comparisons of physical child abuse and teacher harassment between the bully–victims and the neutrals, pure victims, and pure bullies: Logistic regression analysis Bully–victims Compared with neutrals OR
95 % CI
OR
Compared with pure victims 95 % CI
OR
95 % CI
OR
Compared with pure bullies 95 % CI
OR
95 % CI
Physical child abuse
2.476
1.975–3.105
3.243
2.338–4.499
1.379
1.065–1.785
1.764
1.218–2.556
1.774
1.311–2.401
Teacher harassment
7.741
5.850–10.244
8.934
5.569–14.332
3.220
2.334–4.443
3.271
1.946–5.500
1.324
0.972–1.804
Sex
1.481
1.233–1.781
1.441
1.164–1.783
0.898
0.708–1.138
1.686
1.357–2.094
1.609
1.249–2.072
Physical child abuse 9 sex
0.609
0.389–0.953
0.625
0.375–1.043
Teacher harassment 9 sex
0.804
0.447–1.445
0.979
0.505–1.897
Controlling for the effects of age CI confidence interval, OR odds ratio
the previous year and the cross-sectional research design of this study limited the possibility of determining causal relationships between physical child abuse and involvement in both bullying victimisation and perpetration, research has revealed that physical child abuse can reoccur over a long period of time [59] and thus, it is highly possible that physical child abuse during childhood and early adolescence increases the risk of later becoming a bullyvictim. Research has revealed that bully–victims are bullied, for the most part, during an earlier time period than they bullied others, and few were bullies and victims during the same period or bullied others before becoming a victim of bullying [60]. The experience of physical child abuse can cause victims to experience difficulty in correctly interpreting others’ intentions and to act violently towards peers when they perceive the need to protect themselves [18]. The experience of physical child abuse can also cause victims to learn that violence is an acceptable way to respond to others’ aggression [9]. Thus, compared with those without the experience of physical child abuse, those with experiences with physical child abuse might have a higher risk of becoming a bully-victim and will not remain pure victims. Meanwhile, based on the ecological perspective on human development, physical child abuse has a detrimental effect on an individual’s social adaptation and increases the risk of both bullying
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victimisation and perpetration [22]. Thus, victims of physical child abuse might have a higher risk of becoming bully–victims compared with those who are not victims of physical child abuse, but they are not prone to becoming pure bullying victims, pure bullies, or those who are not involved in bullying. Another possibility regarding the direction of the association between physical child abuse and involvement in both bullying victimisation and perpetration is that schoolteachers can perceive bully–victims as the most troublesome students and complain of their problems to adolescents’ parents or caregivers; furthermore, the difficulties of managing bully–victims’ peer-interaction problems at school can provoke parents or caregivers and result in further physical child abuse. It is also possible that the significant association between physical child abuse and involvement in both bullying victimisation and perpetration is partially accounted for by adolescents’ behavioural problems apart from bullying. Research has revealed that compared with pure bullies and victims, bully–victims have the greatest risks of externalising behavioural problems [6], hyperactivity/ impulsivity symptoms [3], and alcohol use [5], which might increase the opportunity for corporal punishment by parents or caregivers and result in physical child abuse.
0.014 -2.456 0.142 -1.471 -0.108
0.529 -0.630 -0.041
0.858 Controlling for the effects of age
-0.013 Teacher harassment 9 sex
-0.179
0.268 -1.109 -0.073 Physical child abuse 9 sex
0.192 -0.145 4.292 \0.001 -4.207 \0.001 0.181 -0.176 Teacher harassment Sex
0.154 Physical child abuse
-0.158
0.668 0.012 -0.429 -2.523 -0.017 -0.119 -0.452 0.652 -4.373 \0.001 -0.018 -0.178 0.009 0.356 2.635 -0.923 0.182 -0.047 0.016 0.025 2.425 -2.241 0.100 -0.092
0.102 0.001 3.303 0.205 3.657 \0.001
t Beta t
p
0.007 0.005
2.927 0.120 0.034 2.120 2.457
0.014
0.131
t Beta p t Beta p Beta
2.719 -2.802
3.795 \0.001 0.004
0.230
t Beta p t Beta p
Suicidality Insomnia Depression
Table 3 Effects of physical child abuse and teacher harassment on depression, insomnia, and suicidality among bully–victims: multiple regression analysis
Research has revealed that bully–victims have a greater risk of psychological symptoms than do pure bullies and victims [2, 3]. This study further revealed that bully–victims subjected to physical child abuse had more severe depression, insomnia, suicidality, anxiety, low self-esteem, and alcohol abuse than did bully–victims who did not experience physical child abuse. Physical child abuse can damage people’s cognitive development and the accuracy with which they judge social cues, which can further impair their ability to manage negative life events optimally [25] and increase the possibility of a cognition of hopelessness and depressive symptomatology [26]. The results of this study indicated that physical child abuse not only increases the risk of being involved in both bullying victimisation and perpetration but is also associated with poor mental health conditions in bully–victims. Young people who have experienced physical child abuse should be the target of preventive programs for school bullying involvement, and mental health conditions should be carefully evaluated in bully–victims who have experienced physical child abuse. This study revealed that adolescents who reported teacher harassment were more likely to be bully–victims but not pure victims or neutrals; however, no significant difference in the experience of teacher harassment was found between the bully–victims and the pure bullies. Bullying peers at school is a behavioural problem that teachers have to handle in their daily work, and the difficulty of preventing and handling bullying behaviours can provoke a teacher’s temper and increase the possibility of teacher harassment. Both bullying behaviours and the characteristics of bully–victims, such as restlessness and a hot temper, can also be difficult to handle and can cause teachers to be impatient in their interactions with bullies. Teacher harassment can consequently cause school to be difficult for bullies and they might further engage in bullying others. This study also revealed that bully–victims who had experienced teacher harassment exhibited more severe depression and insomnia than did those who did not experience teacher harassment. This result indicated that teacher harassment might have an additional negative impact on the mood and sleep conditions of the bully– victims, or that the depressed mood and sleep problems of the bully–victims might make it difficult for teachers to treat them impartially. The results of this study indicated that teacher harassment is a critical problem that should be taken into consideration when developing prevention and intervention programs to address adolescent bullying. Counselling resources and training opportunities should be provided to teachers to improve their ability and confidence to manage students’ bullying victimisation and perpetration effectively. Clinicians and mental health
p
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0.725 -0.353 0.657 0.444 0.029 0.592 0.537 0.038 Controlling for the effects of age
-4.213 -0.187 Sex
Physical child abuse 9 sex
\0.001 -0.200 \0.001
-3.924
\0.001
0.112 0.066
-0.014 0.029 2.191 0.107
1.591
3.582 0.053
0.110 -1.602
-1.942 -0.121
-0.068 0.110
0.017 -2.385
-1.603 -0.068
-0.101 0.207 1.264 0.084
-0.057
0.013
Teacher harassment
t
2.488
-1.260
0.111
-0.056
Physical child abuse
p
0.208
t Beta
-1.270
p
0.205
0.148
t Beta Beta Beta
t
p
Beta
t
p
Alcohol abuse Self-esteem Anxiety
Table 4 Effects of physical child abuse and teacher harassment on anxiety, self-esteem, and alcohol abuse among bully–victims: Multiple regression analysis
p
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professionals should pay special attention to monitoring teachers’ harassment of adolescents. The present study revealed that the difference in physical child abuse between the bully–victims and neutrals was more significant in girls than in boys, and the significant association between physical child abuse and suicidality in bully–victims was found only in girls and not in boys. The results of the present study further supported the results of previous studies that have shown that girls who experienced physical child abuse were significantly more likely to become bully–victims than were boys [31] and that the negative consequences of physical abuse on mental health are more detrimental for girls than they are for boys [32]. However, the aetiology of this difference in gender in the association between physical child abuse, involvement in both bullying victimisation and perpetration, and suicidality requires further study. Future studies can investigate whether the gender of the perpetrators of violence—for example, whether the father or mother perpetrates violence—plays a role in the moderating effect of gender. Further study as to whether physical child abuse varies in psychological meaning to girls and boys, resulting in different psychological adverse consequences, is also necessary. Regardless of their aetiology, mental health and educational professionals should take gender differences into consideration when developing prevention and intervention programs for bully–victims who experience physical child abuse. Our investigation had several limitations that deserve attention. First, the cross-sectional research design of this study limited our ability to draw conclusions regarding the causal relationships of physical child abuse and teacher harassment with bullying involvement and mental health problems. Second, the experiences of physical child abuse and teacher harassment were derived from participants’ self-reported answers to only two yes/no questions. The data were provided by the adolescents themselves, and further studies that apply other sources of information or measurement are necessary to replicate the results of this study. Third, in this study, teacher harassment was assessed using a single question, and thus, whether various types of teacher harassment, such as physical and verbal types, have distinct relationships with peer bullying is unknown. Fourth, further study is required to examine whether various types of bullying involvement, such as physical, social, and verbal bullying, have distinct relationships with physical child abuse and teacher harassment amongst adolescents.
Summary The results of this study indicated that adolescents who reported physical child abuse or teacher harassment had an
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increased risk of being bully–victims. Bully–victims who reported physical child abuse or teacher harassment reported poor mental health indicators in several dimensions. Gender exerted moderating effects on the association between physical child abuse and involvement in bullying victimisation and perpetration and suicidality. Physical child abuse and teacher harassment are essential environmental factors that should be considered when mental health and educational professionals develop preventive and intervention programs for adolescents who are involved in school bullying, particularly programmes targeted at bully–victims. Mental health conditions should also be carefully evaluated in bully–victims who experience physical child abuse or teacher harassment. Acknowledgments This study was supported by grants NSC 98-2410-H-037-005-MY3 and 99-2314-B-037-028-MY2 awarded by the National Science Council, Taiwan (ROC), and grant KMUH 100-0R48 awarded by Kaohsiung Medical University Hospital.
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ORIGINAL ARTICLE
Physical Child Abuse and Teacher Harassment and Their Effects on Mental Health Problems Amongst Adolescent Bully–Victims in Taiwan Cheng-Fang Yen • Chih-Hung Ko • Tai-Ling Liu Huei-Fan Hu
•
Ó Springer Science+Business Media New York 2014
Abstract This study compared physical child abuse and teacher harassment of bully–victims with other groups and examined their associations with mental health problems in bully–victims. For 6,160 adolescents, experiences of physical child abuse, teacher harassment, peer bullying, and six mental health problem indicators were assessed. Adolescents that had experienced physical child abuse and teacher harassment were more likely to be bully–victims but not neutral or pure victims. Adolescents who reported physical child abuse were more likely to be bully–victims but not pure bullies. Bully–victims that had experienced teacher harassment exhibited more severe depression and insomnia than did those without teacher harassment. Gender had moderating effects on the difference in physical child abuse between bully–victims and neutrals and on the association between physical child abuse and suicidality in bully–victims. Physical child abuse and teacher
Cheng-Fang Yen and Chih-Hung Ko have contributed equally to this study. C.-F. Yen C.-H. Ko T.-L. Liu Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan C.-F. Yen C.-H. Ko T.-L. Liu Department of Psychiatry, Faculty of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan C.-H. Ko Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan H.-F. Hu (&) Department of Psychiatry, Tainan Municipal Hospital, 670 Chongde Road, East District, T’ai-nan 701, Taiwan e-mail: [email protected]
harassment should be considered when preventive and intervention programs are developed for adolescents. Keywords Bullying Bully–victims Physical child abuse Teacher harassment
Introduction Involvement in peer bullying is a critical problem amongst children and adolescents. Research has revealed that bully– victims, defined as people who bully others but are also bullied themselves, are a distinct group and the most troubled amongst all children and adolescents involved in peer bullying [1]. Compared with pure bullies and victims, bully–victims have been found to have the greatest risk of psychological and psychosomatic symptoms [2, 3], suicidal ideation [4], school and interpersonal dysfunction [5], externalizing behavioural problems [6], and alcohol use [5]. Identifying factors that might increase the risk of children and adolescents of becoming bully– victims can guide prevention strategies for reducing behaviours involving bullying. An ecological framework focusing on the interplay of individual characteristics in the multilevel contexts of development is useful for understanding bullying and for developing effective interventions [7]. As living environments, both family and school are crucial for the development of adolescent behaviours. In the family and at school, physical child abuse and teacher harassment, respectively, are two forms of adverse context that have been considered to contribute to young people’s involvement in bullying. Considering the effects of physical child abuse and teacher harassment at the same time can provide a broader understanding of young people’s involvement in bullying than can focusing on only one type of exposure.
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As in other countries, physical child abuse is a critical concern in Taiwan. A survey study on adolescents living in rural Taiwan revealed that 22.2 % of adolescents reported experiencing physical abuse in their childhood [8]. Several retrospective [9–11] and prospective [11–13] studies have demonstrated that physical child abuse increases the risk of bullying perpetration and victimisation. Victimisation in physical child abuse also predicts poor mental health in adolescents [14] and adults [15]. Several psychosocial models have been proposed to explain the relationships between physical child abuse with young people’s involvement in bullying and poor mental health. Based on attachment theory [16], physical child abuse not only harms the relationship between young people and parents but also damages young people’s framework for perceiving stressful situations, the actions of others, and their own capacities [17]. For example, victims of physical child abuse can perceive the need for selfprotection in social interaction and then act violently towards peers [18]. Based on the theory of shame, victims of physical child abuse often live with a sense of being disgraced, which can compromise their psychobiological functioning and result in being prone to shame and psychopathology. Such effects can become a source of interpersonal relationship difficulties, including involvement in bullying [17, 19]. Based on the social learning theory [20], young people who experience physical child abuse might learn that violence is a normal way of being treated or that violence is an acceptable way to respond to disagreements and become aggressive with weaker peers [9]. The ecological perspective of individual developmental trajectories proposes a transactional relationship between young people and social context, in which the balance between potentiating and compensatory mechanisms is linked to young people’s display of behavioural competence or failure to adapt [21]. Physical child abuse can cause young people to become unbalanced and increase their difficulties in social adaptation, which further increases the risk of involvement in peer bullying and poor mental health [22]. Physical child abuse can also cause some maltreated children to adopt a submissive posture with their parents in an effort to maintain their safety in violent homes [23]; they are then less likely to defend themselves when they are the targets of peer bullying in extrafamilial environments [24]. Neurobiological research has postulated that physical child abuse can damage victims’ cognitive development and impair their ability to manage negative life events optimally [25]. Physical child abuse can also result in biases amongst victims regarding perceived threats and hostile attribution, the cognition of hopelessness, and depressive symptomatology [26], and further increases the risk of involvement in bullying [27].
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Several concerns exist regarding experiences with physical child abuse and mental health problems amongst bully–victims that require further study. First, a previous longitudinal study [12] and a cross-national study [10] revealed significant relationships between physical child abuse and all three types of involvement in peer bullying: as bullies, as victims, and as bully–victims. Based on the explanatory models previously described, physical child abuse has significant psychosocial and biological impacts on the development of young people, and it is reasonable to hypothesise that bully–victims are more likely to report experiences of physical child abuse than are pure victims and pure bullies. However, no study has compared bully– victims’ experiences of physical child abuse with those of pure victims and pure bullies. Second, both physical child abuse and involvement in bullying are associated with poor mental health in young people. A cohort study revealed that compared with bullied children who did not self-harm, bullied children who self-harmed were more likely to have experienced physical child abuse [28]. However, whether physical child abuse has an additional effect on poor mental health in bully–victims requires further study. Third, the results of previous studies on gender differences in the relationship between physical child abuse and bullying involvement have been mixed. A previous study revealed that maltreated boys and girls were at a similar risk for bullying and victimisation [11, 29], whereas other studies have revealed that maltreated girls are significantly more likely to become bullying victims [30] or bully–victims compared with boys [31]. Meanwhile, research has revealed that the negative mental health consequences of physical abuse in childhood are more detrimental for girls than they are for boys [32]. Further study is required to determine gender differences in the relationship between physical child abuse and bullying perpetration-victimisation, as well as in the relationship between physical child abuse and mental health problems in bully–victims. If gender differences exist, these should be considered when developing prevention and intervention programs for bully–victims that have been subjected to physical child abuse. Teacher harassment in schools is an adverse context for students. A previous study in Taiwan revealed that 26.9 % of junior-high students reported having been maltreated by teachers in the previous semester [33]. Research has revealed that teacher harassment is associated with peer bullying perpetration [34] and victimisation [35]. Compared with adolescent students who were not involved in bullying, pure victims, and pure bullies, bully–victims reported the highest levels of teacher harassment [34]. Research has revealed that teachers perceive bully–victims as restless and hot-tempered, characterised by deficient academic performance [36]. Teachers in Taiwan are seen
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as playing an essential role in terms of providing a safe environment for students’ social, psychological, and academic development [37]. Once students experience teacher harassment, they are more likely to suffer severe mental health problems and a poor quality of life [38]. Research in other countries has also revealed that students who experience teacher harassment have increased risks of poor selfesteem [39], somatic complaints [39], suicidal tendencies [40], and drug and alcohol use [41]. To our knowledge, only one previous study has compared bully–victims’ experiences of teacher harassment with those of pure victims and pure bullies while investigating the moderating effect of gender [34]. Further study is required to examine bully–victims experiences of teacher harassment and the moderating effect of gender by considering physical child abuse. Whether gender moderates the relationship between experiences of teacher bullying and mental health problems in bully–victims also requires further study. This study had two main aims. First, this study compared adolescent bully–victims’ experiences of physical child abuse and teacher harassment with those of pure victims, pure bullies, and adolescents who were not involved in bullying. The moderating effect of gender on the difference in physical child abuse and teacher harassment between bully–victims and other groups was also examined. Second, our previous study revealed that bully– victims were more likely to report severe depression, suicidality, and alcohol abuse than were pure bullies and pure victims, and bully–victims reported more severe insomnia and anxiety than did pure bullies [3]. Thus, this study further examined the associations of physical child abuse and teacher harassment with mental health problems and the moderating effect of gender amongst bully–victims. We hypothesised that experiences of physical child abuse and teacher harassment are more prevalent amongst bully– victims than they are amongst other groups, and that gender moderates this difference. We also hypothesised that physical child abuse and teacher harassment are significantly associated with mental health problems and that bully–victims differ by gender in this regard.
Methods Participants The present study was based on data from the 2009 Project for the Health of Children and Adolescents in Southern Taiwan, a mental health research survey of adolescents in Grades 7 through 12 (ages 12–18 years) recruited from three metropolitan areas and four counties in Southern Taiwan [42]. In 2009, there were 202,883 students in 143 senior high/vocational schools and 254,130 students in 205
junior high schools in this area. On the basis of the definitions of rural and urban districts in the Taiwan-Fukien Demographic Fact Book [43] and on school and grade characteristics, a stratified random sampling strategy was used to ensure that districts, schools, and grades were proportionally represented. Five junior high schools and four senior high/vocational schools were randomly selected from rural districts; similarly, five senior high/vocational schools and five junior high schools were randomly selected from urban districts. The classes in these schools were further stratified into three levels, based on grade, in the primary, junior high, and senior high/vocational schools. Subsequently, a total of 6,703 high school students were randomly selected based on the ratio of students in each grade. The Institutional Review Board of Kaohsiung Medical University agreed to the use of passive consent from parents and students. Before conducting the study, we prepared a leaflet explaining the purpose and procedures of the study. Students took the leaflet home to their parents or main caretakers, who could telephone the researchers, write a written message to the researchers, or ask their children to refuse to join the study directly. The students also had the right to refuse to participate in this study by returning blank questionnaires. Instruments Chinese Version of the School Bullying Experience Questionnaire (C-SBEQ) The self-reported C-SBEQ was used to evaluate participants’ involvement in school bullying in the previous year with 16 items answered on a 4-point Likert scale from 0 (never) to 3 (all the time) [44]. Items 1–8 evaluated experiences of peer bullying victimisation, including social exclusion; being called a mean nickname; being spoken ill of; being beaten up; being forced to do work; and having money, school supplies, and snacks taken away. Items 9–16 evaluated experiences of peer bullying perpetration. Participants who answered 2 or 3 on any item amongst Items 1–8 and Items 9–16 were identified as self-reported victims and bullies, respectively. A previous study revealed that the test–retest, internal reliability, and congruent validity of bullying involvement nominated by classmates and teachers were satisfactory [44]. In this study, participants who reported that they had never been involved in bullying were classified as the neutral group, those who reported being victims but not bullies were the pure victims, those who reported being bullies but not victims were the pure bullies, and those who reported being both victims and bullies were the bully–victims.
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Physical Child Abuse and Teacher Harassment Victimisation through physical child abuse in the previous year was assessed by the question [14]: ‘‘Have you been struck, slapped, kicked, or otherwise physically injured by family members where the abrasions, bruises, or pain caused by the injury lasted into the next day?’’ If the participant answered ‘‘yes’’ to this question, he or she was classified as having experienced physical child abuse. The experience of teacher harassment in the previous year was assessed by the question: ‘‘Is there a teacher who picks on you on purpose?’’ If the participant answered often or all the time to this question, he or she was classified as having experienced teacher harassment. Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale
participants’ self-reported anxiety symptoms [52, 53]. The MASC-T consisted of 39 items answered on a 4-point Likert scale. A higher total score on the MASC-T represented a more severe level of general anxiety. The psychometrics of the MASC-T for assessing anxiety symptoms amongst nonreferred adolescents in Taiwan were satisfactory [53]. Rosenberg Self-Esteem Scale We used the Rosenberg Self-Esteem Scale (RSES) to evaluate participants’ self-esteem levels [54]. The RSES consisted of 10 items answered on a 4-point Likert scale, and high total scores indicated high levels of self-esteem. This scale was previously used to evaluate self-esteem levels amongst Taiwanese adolescents [55]. CRAFFT Alcohol Abuse Screening Test
The Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale (MC-CES-D) used in this study was a 20-item self-administered questionnaire that used a 4-point evaluation scale to assess the frequency of depressive symptoms in the preceding week [45, 46]. Higher MC-CES-D scores indicated more severe depression. The psychometrics of the MC-CES-D were satisfactory for assessing depressive symptoms amongst nonreferred adolescents in Taiwan [47].
The 6-item CRAFFT Alcohol Abuse Screening Test was used to assess alcohol abuse in adolescents [56, 57]. Each question elicited a ‘‘yes’’ (with a score of 1) or ‘‘no’’ (with a score of 0) answer. High total scores indicated severe alcohol abuse. The CRAFFT was previously used for assessing alcohol abuse amongst adolescents in Taiwan [57]. Procedure and Statistical Analysis
Athens Insomnia Scale We used the Taiwanese version of the 8-item Athens Insomnia Scale (AIS-8) to assess the severity of subjective insomnia over the previous month [48, 49]. Higher total scores indicated more severe insomnia symptoms and subjective sleep-related distress. The psychometrics of the AIS-8 were satisfactory for assessing insomnia amongst nonreferred adolescents in Taiwan [49]. Suicidality The 5-item questionnaire from the epidemiological version of the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS-E) [50] was used to assess the occurrence of suicide attempts and of four forms of suicidal ideation in the preceding year [51]. Each question elicited a ‘‘yes’’ (with a score of 1) or ‘‘no’’ (with a score of 0) answer. Higher total scores indicated more severe suicidal risk. The agreement between participants’ self-reported suicide risk and their parents’ reports was significant [51]. Taiwanese Version of the Multidimensional Anxiety Scale for Children We used the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) to evaluate
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A total of 6,445 students (96.2 %) agreed to join this study. Of the 258 students who refused to join this study, 68 students refused based on their parents’ opinion, 128 returned blank questionnaires, and 62 were absent when the research assistants visited their classes. Each participant completed the research questionnaire anonymously under the direction of research assistants in each classroom during school hours. All students received a gift worth NT$33 (US$1) at the end of the assessment. Bully–victims’ experiences of physical child abuse and teacher harassment were compared with those of members of the neutral group, the pure victims, and the pure bullies by using logistic regressive analysis models to control for the effects of gender and age. We also used standard criteria [58] to examine whether the associations of physical child abuse and teacher harassment with peer bullying involvement differed regarding the participants’ gender and age. According to the criteria, moderation occurred when the interaction term for the predictor (physical child abuse and teacher harassment) and the hypothesised moderator (gender and age) were significantly associated with the dependent variable (peer bullying involvement) after controlling for the main effects of both the predictors and hypothesised moderator variables. In this study, when physical child abuse/teacher harassment and hypothesised moderators were significantly associated with peer bullying
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involvement, the interactions (physical child abuse/teacher harassment 9 hypothesised moderators) were further investigated using regression analysis to examine for moderating effects. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated. The effects of physical child abuse and teacher harassment on depression, insomnia, suicidality, anxiety, selfesteem, and alcohol abuse in bully–victims were examined using multiple regression analysis to control for the effects of gender and age. The moderating effects of gender on the association between physical child abuse/teacher harassment and mental health problem indicators were examined based on the standard criteria that were previously described [58]. A two-tailed p value of less than 0.05 was considered statistically significant.
Results Characteristics of Participants A total of 6,160 participants completed the research questionnaires without omission. Those who had missing data in the questionnaires were more likely to be boys (v2 = 22.958, p \ 0.001) and younger (v2 = 62.931, p \ 0.001). The demographic characteristics and the ratios of physical child abuse and teacher harassment amongst the participants with various peer bullying involvement experiences are shown in Table 1. The bully–victims were more likely to be boys than were the pure victims and neutrals, but no difference in gender was found between the bully– victims and pure bullies. The bully–victims were younger than the pure bullies and the neutrals, but no difference in age was found between the bully–victims and pure victims. The bully–victims were more likely to report experiences of physical child abuse and teacher harassment than the pure bullies, pure victims and neutrals. Comparisons of Physical Child Abuse and Teacher Harassment Experienced by Bully–Victims and Other Groups The results of logistic regression analyses comparing physical child abuse and teacher harassment between bully–victims and other groups and the moderating effects of gender are shown in Table 2. The results indicated that adolescents who reported physical child abuse and teacher harassment were more likely to be bully–victims rather than neutrals or pure victims. Adolescents who reported physical child abuse were more likely to be bully–victims but not pure bullies, whereas no significant difference in teacher harassment was found between the bully–victims and pure bullies.
A difference in gender was found between the bully– victims and neutrals, as well as between the bully–victims and pure victims. Thus, the interactions between physical child abuse/teacher harassment and gender were selected for examination using logistic regression analysis models. A difference in the interaction term for physical child abuse and gender was found between the bully–victims and the neutrals, which indicated that gender exerted a moderating effect on the difference in physical child abuse between the bully–victims and the neutrals. The results of further analysis showed that the difference in physical child abuse between the bully–victims and the neutrals was more significant in girls (OR 3.123, 95 % CI 2.246–4.343) than in boys (OR 2.049, 95 % CI 1.504–2.792). The mean (standard deviation) levels of depression on the MC-CES-D, insomnia on the AIS-8, suicidality on the questionnaire for suicidal risk, anxiety on the MASC-T, self-esteem on the RSES, and alcohol abuse on the CRAFFT were 15.6 (9.8), 6.2 (3.1), 0.7 (1.3), 38.5 (15.4), 19.2 (5.6), and 0.6 (1.0), respectively. The effects of physical child abuse and teacher harassment on depression, insomnia, suicidality, anxiety, self-esteem, and alcohol abuse amongst bully–victims are shown in Tables 3 and 4. The results showed that bully–victims who reported physical child abuse had more severe depression, insomnia, suicidality, anxiety, low self-esteem, and alcohol abuse than did bully–victims who did not report physical child abuse. Bully–victims who reported teacher harassment had more severe depression and insomnia than did bully–victims who did not report teacher harassment. There were differences in gender in regard to depression, insomnia, suicidality, anxiety, and self-esteem in bully–victims, and thus, the interactions between physical child abuse and gender and teacher harassment and gender were further selected for examination using multiple regression analysis models. The results showed that the interaction term for physical child abuse and gender was significantly associated with suicidality, which indicated that gender exerted a moderating effect on the association between physical child abuse and suicidality in bully–victims. The results of further analysis showed that a significant association between physical child abuse and suicidality in bully–victims was found only in girls (Beta = 0.212, t = 3.367, p = 0.001) and not in boys (Beta = 0.040, t = 0.720, p = 0.472).
Discussion The results of this study showed that physical child abuse was more prevalent amongst bully–victims than amongst neutrals, pure victims, and pure bullies. Although this study only determined the occurrence of physical child abuse in
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Child Psychiatry Hum Dev Table 1 Sex, age, physical child abuse, and teacher bullying of participants with different peer bullying involvement experiences v2 or F
Bully–victims (n = 591)
Pure bullies (n = 612)
Pure victims (n = 930)
Neutrals (n = 4,027)
Sex: boys [n (%)]
343 (58.0)
368 (60.1)
437 (47.0)
1,805 (44.8)
Age (years) [mean (SD)]
14.5 (1.8)
15.1 (1.8)
14.3 (1.7)
14.9 (1.8)
Physical child abuse [n (%)]
152 (25.7)
86 (14.1)
178 (19.1)
416 (10.3)
135.648***
Teacher harassment [n (%)]
125 (21.2)
92 (15.0)
67 (7.2)
113 (2.8)
376.156***
76.605*** 36.180***
*** p \ 0.001
Table 2 Comparisons of physical child abuse and teacher harassment between the bully–victims and the neutrals, pure victims, and pure bullies: Logistic regression analysis Bully–victims Compared with neutrals OR
95 % CI
OR
Compared with pure victims 95 % CI
OR
95 % CI
OR
Compared with pure bullies 95 % CI
OR
95 % CI
Physical child abuse
2.476
1.975–3.105
3.243
2.338–4.499
1.379
1.065–1.785
1.764
1.218–2.556
1.774
1.311–2.401
Teacher harassment
7.741
5.850–10.244
8.934
5.569–14.332
3.220
2.334–4.443
3.271
1.946–5.500
1.324
0.972–1.804
Sex
1.481
1.233–1.781
1.441
1.164–1.783
0.898
0.708–1.138
1.686
1.357–2.094
1.609
1.249–2.072
Physical child abuse 9 sex
0.609
0.389–0.953
0.625
0.375–1.043
Teacher harassment 9 sex
0.804
0.447–1.445
0.979
0.505–1.897
Controlling for the effects of age CI confidence interval, OR odds ratio
the previous year and the cross-sectional research design of this study limited the possibility of determining causal relationships between physical child abuse and involvement in both bullying victimisation and perpetration, research has revealed that physical child abuse can reoccur over a long period of time [59] and thus, it is highly possible that physical child abuse during childhood and early adolescence increases the risk of later becoming a bullyvictim. Research has revealed that bully–victims are bullied, for the most part, during an earlier time period than they bullied others, and few were bullies and victims during the same period or bullied others before becoming a victim of bullying [60]. The experience of physical child abuse can cause victims to experience difficulty in correctly interpreting others’ intentions and to act violently towards peers when they perceive the need to protect themselves [18]. The experience of physical child abuse can also cause victims to learn that violence is an acceptable way to respond to others’ aggression [9]. Thus, compared with those without the experience of physical child abuse, those with experiences with physical child abuse might have a higher risk of becoming a bully-victim and will not remain pure victims. Meanwhile, based on the ecological perspective on human development, physical child abuse has a detrimental effect on an individual’s social adaptation and increases the risk of both bullying
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victimisation and perpetration [22]. Thus, victims of physical child abuse might have a higher risk of becoming bully–victims compared with those who are not victims of physical child abuse, but they are not prone to becoming pure bullying victims, pure bullies, or those who are not involved in bullying. Another possibility regarding the direction of the association between physical child abuse and involvement in both bullying victimisation and perpetration is that schoolteachers can perceive bully–victims as the most troublesome students and complain of their problems to adolescents’ parents or caregivers; furthermore, the difficulties of managing bully–victims’ peer-interaction problems at school can provoke parents or caregivers and result in further physical child abuse. It is also possible that the significant association between physical child abuse and involvement in both bullying victimisation and perpetration is partially accounted for by adolescents’ behavioural problems apart from bullying. Research has revealed that compared with pure bullies and victims, bully–victims have the greatest risks of externalising behavioural problems [6], hyperactivity/ impulsivity symptoms [3], and alcohol use [5], which might increase the opportunity for corporal punishment by parents or caregivers and result in physical child abuse.
0.014 -2.456 0.142 -1.471 -0.108
0.529 -0.630 -0.041
0.858 Controlling for the effects of age
-0.013 Teacher harassment 9 sex
-0.179
0.268 -1.109 -0.073 Physical child abuse 9 sex
0.192 -0.145 4.292 \0.001 -4.207 \0.001 0.181 -0.176 Teacher harassment Sex
0.154 Physical child abuse
-0.158
0.668 0.012 -0.429 -2.523 -0.017 -0.119 -0.452 0.652 -4.373 \0.001 -0.018 -0.178 0.009 0.356 2.635 -0.923 0.182 -0.047 0.016 0.025 2.425 -2.241 0.100 -0.092
0.102 0.001 3.303 0.205 3.657 \0.001
t Beta t
p
0.007 0.005
2.927 0.120 0.034 2.120 2.457
0.014
0.131
t Beta p t Beta p Beta
2.719 -2.802
3.795 \0.001 0.004
0.230
t Beta p t Beta p
Suicidality Insomnia Depression
Table 3 Effects of physical child abuse and teacher harassment on depression, insomnia, and suicidality among bully–victims: multiple regression analysis
Research has revealed that bully–victims have a greater risk of psychological symptoms than do pure bullies and victims [2, 3]. This study further revealed that bully–victims subjected to physical child abuse had more severe depression, insomnia, suicidality, anxiety, low self-esteem, and alcohol abuse than did bully–victims who did not experience physical child abuse. Physical child abuse can damage people’s cognitive development and the accuracy with which they judge social cues, which can further impair their ability to manage negative life events optimally [25] and increase the possibility of a cognition of hopelessness and depressive symptomatology [26]. The results of this study indicated that physical child abuse not only increases the risk of being involved in both bullying victimisation and perpetration but is also associated with poor mental health conditions in bully–victims. Young people who have experienced physical child abuse should be the target of preventive programs for school bullying involvement, and mental health conditions should be carefully evaluated in bully–victims who have experienced physical child abuse. This study revealed that adolescents who reported teacher harassment were more likely to be bully–victims but not pure victims or neutrals; however, no significant difference in the experience of teacher harassment was found between the bully–victims and the pure bullies. Bullying peers at school is a behavioural problem that teachers have to handle in their daily work, and the difficulty of preventing and handling bullying behaviours can provoke a teacher’s temper and increase the possibility of teacher harassment. Both bullying behaviours and the characteristics of bully–victims, such as restlessness and a hot temper, can also be difficult to handle and can cause teachers to be impatient in their interactions with bullies. Teacher harassment can consequently cause school to be difficult for bullies and they might further engage in bullying others. This study also revealed that bully–victims who had experienced teacher harassment exhibited more severe depression and insomnia than did those who did not experience teacher harassment. This result indicated that teacher harassment might have an additional negative impact on the mood and sleep conditions of the bully– victims, or that the depressed mood and sleep problems of the bully–victims might make it difficult for teachers to treat them impartially. The results of this study indicated that teacher harassment is a critical problem that should be taken into consideration when developing prevention and intervention programs to address adolescent bullying. Counselling resources and training opportunities should be provided to teachers to improve their ability and confidence to manage students’ bullying victimisation and perpetration effectively. Clinicians and mental health
p
Child Psychiatry Hum Dev
123
123
0.725 -0.353 0.657 0.444 0.029 0.592 0.537 0.038 Controlling for the effects of age
-4.213 -0.187 Sex
Physical child abuse 9 sex
\0.001 -0.200 \0.001
-3.924
\0.001
0.112 0.066
-0.014 0.029 2.191 0.107
1.591
3.582 0.053
0.110 -1.602
-1.942 -0.121
-0.068 0.110
0.017 -2.385
-1.603 -0.068
-0.101 0.207 1.264 0.084
-0.057
0.013
Teacher harassment
t
2.488
-1.260
0.111
-0.056
Physical child abuse
p
0.208
t Beta
-1.270
p
0.205
0.148
t Beta Beta Beta
t
p
Beta
t
p
Alcohol abuse Self-esteem Anxiety
Table 4 Effects of physical child abuse and teacher harassment on anxiety, self-esteem, and alcohol abuse among bully–victims: Multiple regression analysis
p
Child Psychiatry Hum Dev
professionals should pay special attention to monitoring teachers’ harassment of adolescents. The present study revealed that the difference in physical child abuse between the bully–victims and neutrals was more significant in girls than in boys, and the significant association between physical child abuse and suicidality in bully–victims was found only in girls and not in boys. The results of the present study further supported the results of previous studies that have shown that girls who experienced physical child abuse were significantly more likely to become bully–victims than were boys [31] and that the negative consequences of physical abuse on mental health are more detrimental for girls than they are for boys [32]. However, the aetiology of this difference in gender in the association between physical child abuse, involvement in both bullying victimisation and perpetration, and suicidality requires further study. Future studies can investigate whether the gender of the perpetrators of violence—for example, whether the father or mother perpetrates violence—plays a role in the moderating effect of gender. Further study as to whether physical child abuse varies in psychological meaning to girls and boys, resulting in different psychological adverse consequences, is also necessary. Regardless of their aetiology, mental health and educational professionals should take gender differences into consideration when developing prevention and intervention programs for bully–victims who experience physical child abuse. Our investigation had several limitations that deserve attention. First, the cross-sectional research design of this study limited our ability to draw conclusions regarding the causal relationships of physical child abuse and teacher harassment with bullying involvement and mental health problems. Second, the experiences of physical child abuse and teacher harassment were derived from participants’ self-reported answers to only two yes/no questions. The data were provided by the adolescents themselves, and further studies that apply other sources of information or measurement are necessary to replicate the results of this study. Third, in this study, teacher harassment was assessed using a single question, and thus, whether various types of teacher harassment, such as physical and verbal types, have distinct relationships with peer bullying is unknown. Fourth, further study is required to examine whether various types of bullying involvement, such as physical, social, and verbal bullying, have distinct relationships with physical child abuse and teacher harassment amongst adolescents.
Summary The results of this study indicated that adolescents who reported physical child abuse or teacher harassment had an
Child Psychiatry Hum Dev
increased risk of being bully–victims. Bully–victims who reported physical child abuse or teacher harassment reported poor mental health indicators in several dimensions. Gender exerted moderating effects on the association between physical child abuse and involvement in bullying victimisation and perpetration and suicidality. Physical child abuse and teacher harassment are essential environmental factors that should be considered when mental health and educational professionals develop preventive and intervention programs for adolescents who are involved in school bullying, particularly programmes targeted at bully–victims. Mental health conditions should also be carefully evaluated in bully–victims who experience physical child abuse or teacher harassment. Acknowledgments This study was supported by grants NSC 98-2410-H-037-005-MY3 and 99-2314-B-037-028-MY2 awarded by the National Science Council, Taiwan (ROC), and grant KMUH 100-0R48 awarded by Kaohsiung Medical University Hospital.
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