Don’t forget the “hidden” forms of bullying

We have recently published a paper titled “Association between experiencing relational bullying and adolescent health-related quality of life” in the Journal of School Health.

Bullying is a widespread concern across schools, with around 1 in 3 young people being victimised¹. It is widely viewed as a public health issue. Longitudinal research has shown the detrimental and long lasting effects of bullying on young people’s health and wellbeing², with negative outcomes reported for both the victim and the perpetrator³.

Bullying behaviours can be broadly broken down into physical, verbal, cyber and relational bullying. Relational bullying behaviours upset the victim by damaging their peer relationships, friendships and social status⁴. Sometimes it is described as “indirect bullying” and can include actions which are harder to spot like social exclusion and the spreading of rumours.

The study of relational bullying specifically is warranted because it is the least understood form of bullying, and has seen little attention in a UK context. Also, teachers have been shown to respond with less empathy and concern to instances of relational bullying among students⁵.

The study examined the association between relational bullying specifically and adolescent health related quality of life, whilst controlling for the effect of demographic variables and other forms of bullying. Health related quality of life was measured with KIDSCREEN-10 – a measure created for young people which provides an overall score.

Young people who experienced relational bullying had lower KIDSCREEN-10 scores than those who were not bullied. Interestingly, the decrease in score which was linked to relational bullying was larger than the decrease for physical or verbal bullying.

The full paper can be found by clicking here. If you are interested in the topic of bullying you may also like to read our publications on cyberbullying and cross-national trends in bullying victimisation.

References

1.       Chester KL, Callaghan M, Cosma A, et al. Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 to 2010. Eur J Public Health. 2015;25(suppl 2):61-64. doi:10.1093/eurpub/ckv029.

2.       Bowes L, Joinson C, Wolke D, Lewis G. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ. 2015;350(January 2016):h2469. doi:10.1136/bmj.h2469.

3.       Wolke D, Copeland WE, Angold A, Costello EJ. Impact of bullying in childhood on adult health, wealth, crime, and social outcomes. Psychol Sci. 2013;24:1958-70. doi:10.1177/0956797613481608.

4.       Crick NR. The role of overt aggression, relational aggression, and prosocial behavior in the prediction of children’s future social adjustment. Child Dev. 1996;67(5):2317-2327. doi:10.2307/1131625.

5.       Kahn JH, Jones JL, Wieland AL. Preservice teachers’ coping styles and their responses to bullying. Psychol Sch. 2012;49(8):784-793. doi:10.1002/pits.21632.

#2018TeenHealth

Next week (18-24 March) is Teen Health Week!!!

Teen Health Week is an initiative to raise awareness of the unique health issues facing teenagers. 2018 marks the first year of this initiative going global - bringing together young people across the world to increase recognition of the health and wellbeing concerns of teenagers today. 

During Teen Health Week each day has a specific theme:

Sunday, March 18: Violence Prevention

Monday, March 19: Preventive Care and Vaccines

Tuesday, March 20: Healthy Diet and Exercise

Wednesday, March 21: Mental Health

Thursday, March 22: Sexual Development and Health

Friday, March 23: Substance Use and Abuse

Saturday, March 24: Oral Health 

The HBSC England team will be raising awareness of Teen Health Week with lots of tweeting and blogging! We will be sharing data and key findings from the latest HBSC survey carried out in England. We will also share key messages from other projects within our department, including The Teacher Connectedness Project and Beyond the School Gate, which focus on teen health.

We hope Teen Health Week will help raise the profile of adolescent health!

Remember to follow us on twitter @HBSCEngland, and join the conversation using #2018TeenHealth. 

Young people’s experience of visiting their GP: Summary of our publication in the Journal of Adolescent Health

Our recent publication is based on a collaborative project between researchers and practitioners to explore the health measures associated with young people’s use of general practitioner (GP) services in England. The findings have been published in the Journal of Adolescent Health in a paper entitled “Experience of primary care services among early adolescents in England and association with health measures”.

There is a gap in knowledge surrounding young people’s experience of GP services in England, with national surveys limited to capturing the experience of patients aged 18 years and over¹. For that reason, questions on young people’s use of GP services were added to the 2014 HBSC England survey. The survey initially asks a question on service use – identifying whether young people have had visited their GP in the last year. This is followed up with a number of questions which concern young people’s experience of their last visit to their GP (Figure 1). 

Figure 1. Questions measuring GP service use in the 2014 HBSC England survey

The majority (80%) of young people said they had visited their GP in the last year. Respondents reported a largely positive experience of GP service use; 75% of respondents felt at ease with the GP during their last visit, 89% felt their GP treated them with respect from GP and 83% reported they were satisfied with the explanations their GP provided. However, only just over half (52%) of respondents stated they felt comfortable talking to their GP about personal things, a finding which seemed fairly consistent across gender and age (Figure 2). The 2014 HBSC England national report provides a comprehensive account of data on GP service use².

 Figure 2. Young people who reported they were able to talk to their GP about personal things, by age and gender (graph originates from Brooks et al. 2015)

One of the aims of our recent analysis sought to explore whether young people’s perception of GP visits is related to different health measures; is poor experience of GP service use associated with worse reports of emotional wellbeing and physical health? The paper examined five health measures: headaches, sleeping problems, low mood, general self-rated health and self-harm (among 15 year olds only).

The analysis focussed on the 80% (4149) young people who reported visiting their GP in the last year. Binary logistic regression identified respondents who reported poor GP experience were more likely to report poor health measures, whilst controlling for ethnicity, age, gender and family affluence. For example, poor ratings on all indicators of GP experience (Figure 1) were significantly associated with an increased risk of self-harm, feeling low and sleep problems among young people.

The data collected through HBSC surveys is cross-sectional and as such we cannot determine the direction of this relationship. Having poor health may result in a more negative perception of GP services, or it could be that a poor perception of GP services influences young people’s health through disengagement and a reduction in use of health care services.

The findings highlight the important role GPs may play in young people’s health and wellbeing, and emphasise the need for health care services to be understanding of the different skills required for working with young people.

For a through discussion of our findings the full paper can be accessed by clicking here.

References

1. Ipsos_Mori (2016). GP Patient Survey - National summary report. NHS England. Retrieved October, 12, 2016 from http://gp-survey production.s3.amazonaws.com/archive/2016/July/July2016NationalSummaryReport.pdf 

1. Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N., & Smeeton, N. (2015). HBSC England national report: Findings from the 2014 HBSC study for England. Hatfield, UK: University of Hertfordshire. Retrieved October, 12, 2016 from http://www.hbscengland.com/wp-content/uploads/2015/10/National-Report-2015.pdf

The Teacher Connectedness Project

The Teacher Connectedness Project started on 4^th July 2016 and represents a very exciting collaboration between the HBSC Spain and HBSC England teams. During the next 2 years, the Teacher Connectedness Project team will work to get a better understanding of relationships between young people and their teachers and how they can improve young people’s wellbeing.

But what does connectedness mean and why should we pay attention to it? Connectedness comes from the word ‘connection’ and therefore we used the term teacher connectedness to refer to meaningful relationships with teachers. Previous research shows that supportive and trusting relationships with teachers have very positive effects on young people’s wellbeing in and outside the school ^1,2. In an earlier study we found that teacher connectedness is very important for the emotional wellbeing of both Spanish and English adolescents of all ages and regardless of how well or not so well they thought they did at school³ (read our earlier blog post for a summary). Unfortunately, research also shows that relationships with teachers tend to become more distant during secondary school – HBSC data below can serve to illustrate this.

Figure 1. Percentage of adolescents who agree or strongly agree with the statement "teachers care about me as a person".

Source: HBSC England and HBSC Spain, 2014

In the Teacher Connectedness Project, we want to know more about what the key ingredients are that make it possible to establish and maintain meaningful student-teacher connections.

And because nobody can know better about teacher-student relationships than teachers and students themselves we are looking forward to having the opportunity to hear from them directly. We will be going to schools in Hertfordshire to have chats with groups of young people and interviews with their teachers from January 2017 onwards, so any local secondary school that want to share their views with us is more than welcome. Just let us know!

If you’d like, you can find further information about the project and its team at our website. You can also follow us on Twitter @TeachConProject to keep track of all the new findings and activities linked to the Teacher Connectedness Project.

Teachers, students, your views and feedback are very much appreciated!

1.  Kidger, J., Araya, R., Donovab, J., & Gunnel, D. (2012). The effect of the school environment on the emotional health of adolescents: A systematic review. Pediatrics 129(5): 925-949. DOI: 10.1542/peds.2011-2248

2. Shochet, I. M., Dadds, M. R., Ham, D. & Montague, R. (2006). School connectedness is an underemphasized parameter in adolescent mental health: Results of a community prediction study. Journal of Clinical Child and Adolescent Psychology 35(2): 170-179. doi: 10.1207/s15374424jccp3502_1

3. García-Moya, I., Brooks, F., Morgan, A., & Moreno, C. (2015). Subjective well-being in adolescence and teacher connectedness. A health asset analysis. Health Education Journal, 74(6), 641-654. doi: 10.1177/0017896914555039.

                                                                       

A Nuffield Foundation placement student joined HBSC England

During summer 2016 the Centre for Research in Primary and Community Care (CRIPACC) at the University of Hertfordshire hosted two Nuffield Foundation research placements. Nuffield Foundation placements are awarded to gifted and talented students who have just finished their AS levels and are interested in pursuing careers in STEMM subjects. The placement allows the student to undertake an independent research project. La-Dantai joined the HBSC England team to conduct her research project on self-harm in adolescence, while Umme's research evaluated online dietary information available for people with type 2 diabetes.

We are pleased to report that both La-Dantai and Umme were awarded Gold Crest 1 awards for their independent research projects. Many congratulations to both of them! 

La-Dantai has written the following blog post reflecting on her time in the department...

I would first like to start by showing a great appreciation towards everybody in the CRIPACC department of the University of Hertfordshire. Not only were they really welcoming, but they also offered a hand whenever I required a little bit of help to make this project even better

My project included research into associated factors with self-harming in adolescence, this involved identifying both protective and risk factors, as well as using the HBSC survey that is produced nationally to gather data.

Immediately I was introduced to new concepts, such as a literature search - it may sound easy, but there are a few minute details that you must really remember to find the best sources of literature - and literature reviews. Thankfully my mentor was extremely helpful when she saw me struggling and, after helping, set up for me to have a meeting with someone who could show me in the in’s and out’s of literature reviews.

After that, reviewing and structuring my report was fairly easy. There was a hiccup when I was required to process the data, as the program that University of Hertfordshire uses in this department to analyse data, I hadn’t used before. Again, my mentor was very helpful and took me through step by step on how to get the most accurate and reliable results from the data.

The placement, which took place over 4 weeks in the summer, was a very informative and fun experience. Not only was there a picnic within the department - I was super happy about that - but it exposed me to what research is, how aims and hypothesises are produced, the work required to find literature to support or disprove a statement. It gave me a look into what being a researcher is and has contributed towards my decision on the degree I wish to do.

These skills I have gained - the ability to literature search, to analyse data with great accuracy, being able to produce a standardised method to carry out research to form reliable results and writing a report (the most important one!) - will be ever so important in University.

I am very grateful for the testing of my time management skills by having to be on time every morning and complete tasks by a specific time and date - for example, meetings with my mentor would be planned and a specific task such as my introduction would have to be completed by then.

Alongside this, my organisational skills and communication skills were tested, it was important to be clear when asking a question and important to write fluently, as well as have all my information designated to a specific folder in order to not get confused!

The placement has contributed to my development by testing my abilities and proving that I am capable of anything new if I put my mind to it. I am very grateful for that.

 

CRIPACC has hosted a number of Nuffield Foundation placements since 2013. Chelsea, Marium and Susanna have each written a blog post about their placements during summer 2015.

Cyberbullying: Summary of our publication in Youth & Society

We have recently published a paper titled “The mitigating role of ecological health assets in adolescent cyberbullying victimization” in Youth & Society.

Cyberbullying can be defined as bullying which take place in the virtual world (for example via messaging services, social networking sites, emails and gaming websites), and can include a number of behaviours such as sending abusive messages, posting embarrassing or altered photographs, purposely excluding people from online groups and setting up fake online profiles¹.

Cyberbullying has been shown to have a detrimental effect on young people’s health and wellbeing and their social outcomes. Young people who are cyberbullied are more likely to experience depression, anxiety, feelings of loneliness and low self-esteem^2,3; research has also identified a link between being cyberbullied and poorer outcomes at school³.

Questions to measure cyberbullying were first added to the HBSC survey in 2014. You can read our previous blog post which describes why cyberbullying warranted attention in the HBSC study by clicking here. Cyberbullying was measured by two questions which addressed different forms of cyberbullying (Figure 1).

Figure 1. Questions measuring cyberbullying in the 2014 HBSC survey

The prevalence of cyberbullying, and bullying more broadly, has been reported extensively in the 2014 HBSC England national report⁴.  Of the young people who participated in the 2014 HBSC survey in England, 18% reporting experiencing some form of cyberbullying in the past two months. Reporting cyberbullying was more common among girls than boys, and the likelihood of being victimised in this was appeared to increase with age for all young people (Figure 2).

Figure 2. Prevalence of cyberbullying (graph original published in Brooks et al. (2015))

Traditionally the health and wellbeing of young people has been approached from a deficit perspective; this approach asks why young people are ill and has often focussed on risk factors such as substance use⁵.  However more recently asset based approaches have begun to emerge; asking what makes young people healthy and identifying protective factors which sustain health⁶. The HBSC England team are keen to take a positive rather the deficit approach to young people’s health.

The data collected from the HBSC study is ideal for approaching health in this manner as it situates young people’s health in its social context, with the HBSC England survey asking young people about their family, friends, peers, school and neighbourhood. Work from the research team has explored protective factors of young people’s health in relation to risk behaviours⁷, body image⁸ and self-harm⁹. (Check out our recent blog post summarising our self-harm publication by clicking here).

Our latest paper on cyberbullying uses a similar positive perspective, and sought to identify elements from the different domains in young people’s lives, including family, school and neighbourhood, which may protect against cyberbullying.

The analysis highlighted eight key factors which were associated with cyberbullying. Factors were identified at the individual level (gender, age, autonomy), family (family affluence, family communication), school (sense of belonging to school, teacher support) and neighbourhood environments (perception of local area). Unlike the more traditional forms of bullying which are often restricted to the school grounds cyberbullying can continue beyond the school environment and school hours. Despite this, our recent paper emphasises the important role the school may play in preventing cyberbullying; young people who reported positive perceptions of the school environment and supportive teacher-student relationships were significantly less likely to say they had been cyberbullied.

The full paper can be found by clicking here. If you are interested in the topic of bullying you may also like to read our international collaborative paper presenting cross-cultural trends in bullying victimization between 2002-2010 by clicking here.  

References

1.    Bullying UK. What is cyberbullying? Retrieved October, 12, 2016 from http://www.bullying.co.uk/cyberbullying/what-is-cyberbullying/ 

2.    Wang, J., Nansel, T. R., & Iannotti, R. J. (2011). Cyber and traditional bullying: Differential association with depression. Journal of Adolescent Health, 48(4), 415–417.

3.    Tsitsika, A., Janikian, M., Wójcik, S., Makaruk, K., Tzavela, E., Tzavara, C., … Richardson, C. (2015). Cyberbullying victimization prevalence and associations with internalizing and externalizing problems among adolescents in six European countries. Computers in Human Behavior, 51, 1–7.

4.   Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N., & Smeeton, N. (2015). HBSC England national report: Findings from the 2014 HBSC study for England. Hatfield, UK: University of Hertfordshire. Retrieved October, 12, 2016 from http://www.hbscengland.com/wp-content/uploads/2015/10/National-Report-2015.pdf

5.   Department of Health. 92010). Health lives, healthy people: our strategy for public health in England. Retrieved October, 12, 216 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216096/dh_127424.pdf

6.   Whiting, L., Kendall, S., & Wills, W. (2012). An asset-based approach: An alternative health promotion strategy? Community Practitioner, 85(1), 25–28.

7.   Brooks, F., Magnusson, J., Spencer, N., & Morgan, A. (2012). Adolescent multiple risk behaviour: An asset approach to the role of family, school and community. Journal of Public Health, 34(S1), 48–56

8.   Fenton, C., Brooks, F., Spencer, N. H., & Morgan, A. (2010). Sustaining a positive body image in adolescence: An assets-based analysis. Health and Social Care in the Community, 18(2), 189–198.

9.   Klemera, E., Brooks, F. M., Chester, K. L., Magnusson, J., & Spencer, N. (2016). Self-harm in adolescence: protective health assets in the family, school and community. International Journal of Public Health. doi:10.1007/s00038-016-0900-2

Adolescent self-harm: Summary of our publication in the International Journal of Public Health

We have recently published an article in the International Journal of Public Health entitled “Self-harm in adolescence: protective health assets in the family, school and community".

Self-harm can be defined as the act of deliberately causing harm to oneself, and may include a number of behaviours such as cutting, burning, hitting, scratching and self-poisoning¹. The behaviour is thought to be most common among teenagers², and self-harming during adolescence has been associated with an increased risk of mental health problems in adulthood³.

Questions on self-harm were added to the HBSC England survey for the first time in 2014, motivated by reports poor emotional wellbeing and self-harm were on the increase among young people^4,5. Furthermore, a review conducted in 2013 by the Association for Young People’s Health (AYPH) identified a lack of research on young people who self-harm but do not attend hospital with their injuries⁶. We have blogged previously about the motivation to include the topic of self-harm in the HBSC England survey, for further details have a read of our blog post here. 

Analysis of the 2014 HBSC England data identified around a fifth (21.5%) of 15 year old respondents reported having self-harmed (data published previously in articles by the Guardian and BBC). Fifteen year old girls were nearly three times as likely as boys to report having self-harmed; 31.9% of girls compared with 11.4% of boys. Figure 1 illustrates how often young people were self-harming; the majority of those who self-harmed reported self-harming around once a month.

Note: Figure 1 originates from Brooks et al. (2015)

Given that this is the first time self-harm has been added to the HBSC England survey our data alone cannot tell us whether self-harm has changed over time. However, comparing our data to a similar school based study conducted in England during 2000/01⁷ suggests self-harm rates may have nearly tripled over the past decade. Questions on self-harm will be included in the HBSC England survey during the next round, allowing us to observe any changes between 2014 and 2018. 

While it was important to gain new insight into prevalence rates of self-harm, particularly for those young people who do not present at hospital with their injuries, the HBSC study also allows us to examine the relationship between self-harm and different elements of young people’s lives.

Our recent article sought to identify factors from the family, school and community which may help protect young people against self-harming. The study utilised data from a total of 1519 15 year olds who participated in the 2014 HBSC England survey. Self-harm was measured via the question “Have you ever deliberately hurt yourself in some way, such as cut or hit yourself on purpose or taken an overdose?”

The analysis identified key elements which were associated with self-harming including gender, family communication and a positive perception of the school and neighbourhood environments. In line with existing research⁶, the analysis identified girls were at a greater risk of self-harming compared to boys. The paper highlights the important role parents may play in preventing self-harm, as young people who found it difficult to talk to their mother and father had a greater chance of reporting self-harm than those who described family communication as easy.

For a more thorough discussion of our latest findings the full paper can be found by clicking here. The International Journal of Public Health have also created a useful visual summary of this paper which you can access here. 

References

1. National Self Harm Network. What is self harm? NSHM. Retrieved October, 5, 2016 from http://www.nshn.co.uk/whatis.html

2. Hawton, K., Saunders, K. & O’Connor, R, (2012). Self-harm and suicide in adolescents. The Lancet, 379, 2373-82.

3. Kidger, J., Heron, J., Lewis, G., Evans, J. & Gunnel, D. (2012). Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England. BMC Psyhiatry, 12, 69.

4. Collishaw, S., Maughan, B., Goodman, R. & Pickles, A. (2004). Time trends in adolescent mental health. Journal of Child Psychology and Psychiatry, 45(8), 1350-62.

5. ChildLine. (2012). Saying the unsayable: What’s affecting children in 2012.

6. Hagell, A. (2013). Adolescent self-harm: AYPH Research Summary No. 13. Association for Young People's Health (AYPH) & ChiMat.

7. Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self-harm in adolescents: self-report survey in schools in England. BMJ, 325, 1207–11.