Bullying and its Relationship to Suicidal Ideation or Behaviours
It has been reported that there were 12 suicide deaths for every 100,000 people in the United States in 2010 (Nielsen et.al., p.e23). As such, it is understandable why this is an active area of research. In general, suicidal‑behaviours can be divided into at least two groups, i.e., suicidal ideation (thoughts about suicide) and suicidal behaviour (attempts), (Leach, et. al., 2016, p. 72 &74). The Leach review suggests that workplace bullying is strongly associated with poor mental health, in addition to other workplace stressors that could cause poor mental health (Leach et. al., p.72). The review reports finding from studies that suggest that there is a strong link between workplace bullying and mental health, and as well, there is a strong link between poor mental health and suicide (Leach, et. al., p.78, references cited therein). This provides for a foundational basis for the subject area.
Thus, it is not surprising that eight research publications have found a significant positive association between workplace bullying and suicidal ideation (Leach, et. al., 2016). The report by Feldman, specifically relating to this issue with youths (i.e., in schools) and comprised of research from experts at the CDC (Centers for Disease Control and Prevention), make a similar suggestion, i.e., there is a correlation between being bullied and poor mental and physical health (Feldman et.al., p.2, para.2). As well as, there is an association between bullying behaviours and suicide related‑behaviours (Feldman et. al., p.2, para.4). Thus, in my opinion, the aspect of poor mental health is apparently a common factor related to the issue of suicidal-behaviours that occur in both adults (in the workplace) and youths (in schools).
The review done by Leach started out with 228 articles on the subject of suicidal‑behaviours. Then studies were selected using four criteria for indication of study quality based on: (i) study showed an association (or correlation), (ii) study was adjusted for covariate factors, (iii) was representative of the population and (iv) study used longitudinal data. The selection process yielded eight studies, two of which had 4 of the criteria, two of which had 3 of the criteria, two of which had 2 of the criteria and two of which had 1 of the criteria. This selection process represented the best possible literature on the subject. These studies showed that there was a strong positive association between workplace bullying and suicidal ideation (Leach et. al., p.76). In spite of these finding, the reviewers point out that some of studies did not account for potential covariates (other variables) that could potentially influence the association between workplace bullying and suicidal‑behaviours (Leach et. al., p. 77). Thus, it is suggested that there is not a complete understanding of the other factors that may affect the association, e.g., moderators (factors that may influence the relationship between two variables). Nielsen suggests that a potential moderator is the “opportunity for interaction with others” (Nielsen et. al., p.e28). Similarly, Feldman suggests that family and school social support are protective factors for suicide prevention, as well as individual coping skills and supportive school environments (Feldman et. al., p.4). These might be considered to be additional moderators. One could also envision these same factors as being preventative for workplace environments.
The Leach and Feldman papers each suggest that there is an association between workplace bullying and suicidal ideation or between bullying and suicide‑related behaviours respectively (Leach et.al.; Feldman et.al.). Thus, these are correlational relationships (as one variable changes, another variable changes) and not causal relationships (wherein one variable causes another variable to change, i.e., a cause and effect relationship). Having said that, Nielsen reports a study that suggests that severely bullied workers are six times more likely to report suicidal ideations than were non-bullied workers (Einarsen et. al., as referenced in Nielsen, p.e23) and Feldman reports a study with school children wherein suicidal ideation and suicidal‑behaviour (attempts) were higher that non-involved youths, at a rate of three to five times higher (Feldman et.al., p.2). Thus, it is not surprising that at least two publications make the following comments: (i) having established a significant correlation between bullying and suicidal ideation suggests that bullying may be a cause of suicidal ideation (Nielsen et. al., p.e27) and (ii) bullying and peer victimization constitute more than correlates of suicidality (Klomek et. al., p.282). Both of these statements suggest that not only does bullying and suicidal behaviours have a correlational relationship, but that they have a causal relationship.
Thus, the need to define the mediators that are involved in the relationship between bullying and suicidal‑behaviours. As suggested by Nielsen, potential mediators are “psychological distress, hopelessness and alienations” (Nielsen et. al., p.e27), [alienations – being socially alienated from others]. Furthermore, Feldman suggest that depression is a mediating factor (Feldman et. al., p.1). As well, they also suggest that emotional distress (e.g., feelings of sadness, hopelessness, worry and stress) may also be risk factors for suicide (Feldman et. al., p.3). I would suggest that all of these potentially could be mediators. Therefore, I agree that fully understanding the mediators and moderators would allow for the development of effective evidence based therapies that could be preventative for suicidal ideation and suicidal‑behaviours.
The Leach review reported one study by Lac et. al., which showed an association between bullying and suicidal ideation or suicide‑behaviours (i.e., bullied group – 66% ideation and 7% attempts); although, the Leach authors suggest that one should not draw conclusions from only one study, with respect to suicidal attempts (Leach et. al., p.78). The Feldman paper reports research which indicates that 25% of young suicide victims had problems in school and of that number, 12.4% of the problems in school were attributed to bullying (Feldman et. al., p.3); thus, 0.25 x 0.124 = 0.031. This suggests that 3.1% of the suicidal‑behaviours were attributed to bullying.
Because there is a fundamental relationship between bullying and suicidal‑behaviours, i.e., bullying – poor mental health – suicide, in addition to a strong correlation that is observed between bullying and suicidal‑behaviours, these strengthen the assertion that bullying is an important public health issue, regardless if we do not fully understand all of the intervening factors. In that respect, it is important for the current findings in the literature research to be disseminated into the public domain, i.e., HR departments, school boards, social workers and counsellors. One of the moderators that has been described is—”opportunity for interaction with others” (Nielsen), which might be considered to be a preventative measure. As well, connectedness with others – connections between youth and school and home environments has been described as a preventative measure
(Feldman, p.4). This also relates to ostracism or isolation, whether in the workplace or in schools. Furthermore, this suggests that others, e.g., bystanders, who could step in to help those that have become alienated, could also be a preventative measure. An additional and basic suggestion relates to the “acceptability of seeking help” (Feldman, p.4, reference cited therein). It should be made known that there is no shame in asking for help. As well, as suggested by the research reviewed by Leach, a reduction in workplace bullying could lead to a reduction in suicidal ideation (Romeo, as cited in Leach, p.76). These three preventative measures in themselves could have the potential to reduce suicidal‑behaviours and currently should be the focus of dissemination to the public domain and subsequent training for those specifically in the field. Finally, I agree that defining the mediators and moderatos will allow for the development of more effective preventative measures.
Terrance (Terry) Sereda
Feldman, Donato and Wright, (2013), Bullying and Suicide: A Public Health Approach, J. Adolesc. Health, 53(10), S1-S3. doi:10.1016/j.adohealth.2013.05.002.
Klomek, Sourander and Gould, (2010), The association of Suicide and Bullying in Childhood to Young Adulthood: A review of cross-sectional and longitudinal research findings, Canadian Journal of Psychiatry, 55(5), p.282-288.
Leach, Poyser and Butterworth, (2016), Workplace bullying and the association with suicidal ideation/thoughts and behaviour: a systematic review, Occupational & Environmental Medicine, p.72-79.
Nielsen, M., Nielsen, G., Notelaers, G. and Einarsen, S., (2015), Workplace bullying and suicidal ideation: A 3-wave longitudinal Norwegian study, American Journal of Public Health, 105 (11), p. e23 – e28.