Psychological Medicine (2017), 47, 127–135.

© Cambridge University Press 2016 OR I G I N A L A R T I C L E

doi:10.1017/S0033291716001719

Childhood bullying victimization is associated with

use of mental health services over five decades: a
longitudinal nationally representative cohort study

S. Evans-Lacko1,2*, R. Takizawa3,4, N. Brimblecombe1, D. King1, M. Knapp1, B. Maughan4 and

L. Arseneault4
1
Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
2
Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny
Park, London SE5 8AF, UK
3
Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
4
SGDP Research Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK

Background. Research supports robust associations between childhood bullying victimization and mental health pro-
blems in childhood/adolescence and emerging evidence shows that the impact can persist into adulthood. We examined
the impact of bullying victimization on mental health service use from childhood to midlife.

Method. We performed secondary analysis using the National Child Development Study, the 1958 British Birth Cohort
Study. We conducted analyses on 9242 participants with complete data on childhood bullying victimization and service
use at midlife. We used multivariable logistic regression models to examine associations between childhood bullying vic-
timization and mental health service use at the ages of 16, 23, 33, 42 and 50 years. We estimated incidence and persistence
of mental health service use over time to the age of 50 years.

Results. Compared with participants who were not bullied in childhood, those who were frequently bullied were more
likely to use mental health services in childhood and adolescence [odds ratio (OR) 2.53, 95% confidence interval (CI)
1.88–3.40] and also in midlife (OR 1.30, 95% CI 1.10–1.55). Disparity in service use associated with childhood bullying
victimization was accounted for by both incident service use through to age 33 years by a subgroup of participants,
and by persistent use up to midlife.

Conclusions. Childhood bullying victimization adds to the pressure on an already stretched health care system. Policy
and practice efforts providing support for victims of bullying could help contain public sector costs. Given constrained
budgets and the long-term mental health impact on victims of bullying, early prevention strategies could be effective at
limiting both individual distress and later costs.

Received 19 January 2016; Revised 20 June 2016; Accepted 21 June 2016; First published online 28 September 2016

Key words: Adolescents, bullying, children, health service, mental health.

Introduction victimization is associated with persisting problems

in early adulthood (Copeland et al. 2013) and even
Early adverse experiences can increase vulnerabilities
up to midlife (Takizawa et al. 2014). We hypothesized
to mental health problems across the life course
that bullying victimization might have an effect on
(Shonkoff et al. 2009); in turn, these may have implica-
mental health service use, not only during childhood
tions for mental health service use. Childhood bullying
and adolescence, but also across the life course.
victimization is one such adverse experience and is in-
Some evidence indeed points in that direction. A
creasingly recognized as a public health concern
registry-based study of a nationwide Finnish birth co-
(Gilbert et al. 2009). Empirical evidence supports strong
hort indicated that childhood bullying victimization
and robust associations with mental health symptoms
was associated with greater use of psychotropic medi-
in childhood and adolescence (Arseneault et al. 2010).
cation and psychiatric hospitalizations during early
Studies have also shown that childhood bullying
adulthood, over and above psychopathology prior to
bullying (Sourander et al. 2009, 2016). This is important
as it also indicates that early childhood bullying vic-
* Address for correspondence: S. Evans-Lacko, Ph.D., Personal
Social Services Research Unit, London School of Economics and
timization can have important implications for health-
Political Science, Houghton Street, London WC2A 2AE, UK. care systems. At this stage, however, little is known
(Email: [email protected]) about broader patterns of mental health-related service

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 128 S. Evans-Lacko et al.

use, and whether such an impact is persistent over 16 years) were recorded in the course of an examin-
time. We examine the impact of childhood bullying ation by a local authority medical officer, who con-
victimization on mental health service use in child- sulted available records and interviewed the young
hood and adolescence, early adulthood, and up to people and their parents. Cohort members’ own
midlife in a nationally representative UK birth cohort reports of adult service use related to the intervals be-
followed to the age of 50 years. To further contextual- tween adult survey sweeps, which varied between 1
ize our results, we compare the association between and 10 years. This allowed for assessment of the im-
childhood bullying victimization and ever being ‘in pact of bullying in relation to a range of services and
care’ on mental health service use, as being in care is settings at different life stages. Because absolute rates
a known marker of later mental health problems of reported service use inevitably vary for different
(Odgers & Jaffee, 2013). providers (e.g. general practitioners v. specialist mental
health professionals) and for different observation per-
iods, we focused predominantly on the ratios between
Method
groups according to bullying victimization rather than
Participants absolute rates of service use.

Data came from the National Child Development Study

(NCDS), the 1958 British Birth Cohort Study (Power & Childhood sociodemographic and clinical characteristics
Elliott, 2006). Information was collected on 98% of all
Childhood intelligence quotient (IQ) was assessed at
births in 1 week in 1958 in England, Scotland and
age 11 years using a standardized 80-item general abil-
Wales (17 638 participants). Subsequent follow-ups
ity test (Douglas, 1964). Scales of childhood emotional
took place at ages 7 (1965), 11 (1969) and 16 years
and behavioural problems were derived from teacher
(1974) in childhood, and at ages 23 (1981), 33 (1991),
ratings on the Bristol Social Adjustment Guides
42 (2000), 45 (2003) and 50 years (2008) in adult life.
(Stott, 1969) (precursors to more recent behaviour rat-
During the childhood surveys the sample was augmen-
ings) at ages 7 and 11 years. These scales show ad-
ted by 920 immigrants to the UK who were born in the
equate reliability, and predict psychiatric morbidity
study week, for a total of 18 558 cohort members.
in adult life (Clark et al. 2007). We used the mean of
scores across the ages of 7 and 11 years where both
Measures
measures were available (n = 12 781), and single-age
Assessment of bullying measures for the remainder of the sample (n = 3522).
Family social class in childhood was classified on the
Exposure to bullying was assessed via parental inter-
basis of the father’s occupation at age 7 years, and cate-
views when participants were aged 7 and 11 years.
gorized as ‘I and II’ (professional/managerial/technical),
At each age, parents were asked if their child was bul-
‘IIINM’ (other non-manual), ‘IIIM’ (skilled manual) and
lied by other children never, sometimes or frequently.
‘IV and V’ (unskilled manual) (Office of Population
We combined responses from both interviews (n = 11
Censuses and Surveys, 1980). Childhood adversity was
872) to create a three-level indicator of exposure to
assessed from both prospective and retrospective reports.
childhood bullying: 0 = never bullied (never at both 7
Prospectively, parents/caretakers reported at the age-11
and 11 years); 1 = occasionally bullied (sometimes at ei-
years contact whether the child had ever been in the
ther 7 or 11 years); 2 = frequently bullied (frequently at
care of a local authority or voluntary agency. In addition,
either 7 or 11 years, or sometimes at both ages). Where
information collected from parents and teachers was
only one parental interview was available (n = 2511 at
used to create an eight-item scale of low parental involve-
age 7 years, n = 1563 at age 11 years), responses from
ment, including indicators of the child’s physical appear-
that interview were used, providing bullying assess-
ance and the parents’ activities with the child at the ages
ments for 86% of cohort members.
of 7 and 11 years (Power et al. 2012). Parents and care-
takers reported at the age-11 years contact whether the
Mental health service use
child had ever been in the care of the local authority or
The NCDS collects data on use of health services in re- a voluntary agency. Retrospectively at age 45 years, par-
lation to a range of medical conditions. For this study, ticipants completed a 16-item questionnaire about their
we focused on health service use reported specifically exposure to a range of childhood adversities including
in relation to mental health problems. The exact ques- poverty, parental mental health and drug/alcohol pro-
tions about mental health service use, the providers blems, family conflict, and physical and sexual abuse
involved and the time-frames covered are presented (Rosenman & Rodgers, 2004). We grouped responses
in online Supplementary Appendix S1. Reports of ser- into those reporting no (47%), one (25%) and two or
vice use in childhood and adolescence (from ages 11 to more adversities (28%).

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 Childhood bullying victimization and use of mental health services 129

Statistical analysis institutional committees on human experimentation

and with the Helsinki Declaration of 1975, as revised
First, we calculated the frequency of mental health ser-
in 2008.
vice use by childhood bullying victimization, overall
and by gender for each assessment. Next, five separate
multivariable logistic regression models examined the Results
impact of childhood bullying victimization on mental
Frequency of mental health service use over the
health service use at each interview time point. Each
lifespan by bullying victimization
multivariable model adjusted for all confounders
described previously. As it was not possible to directly The prevalence of mental health service use for indivi-
compare the absolute prevalence estimates of service duals who were frequently or occasionally bullied in
use over time given the differences in how questions childhood was greater than for those who were not
were asked at each survey year, we compared the bullied (Table 1). This trend was evident when looking
odds ratio (OR) associated with service use for those at general, specialty and child and adolescent mental
who were frequently bullied v. never and occasionally health service use. However, even those who were oc-
bullied v. never bullied. To provide an estimate of the casionally bullied in childhood had greater use of men-
magnitude of the association between bullying and tal health services compared with those who were not
mental health service use, in a separate model, we bullied (except for specialist out-patient and in-patient
investigated the link between ever being ‘in care’ and services at age 16 years and mental health specialty
mental health service use. service use at age 33 years). The associations between
Second, we examined patterns of mental health ser- bullying victimization and service use were character-
vice use over time and whether the same group of indi- ized by an age-related gradient: we observed greater
viduals accounted for the majority of service use across disparity in service use associated with bullying vic-
age, or whether different individuals were using ser- timization at younger ages compared with later,
vices at each time point. For this analysis, we assessed when individuals were farther away from the exposure
(i) incidence of mental health service use at each time of interest. Except for age 16 years, there was no differ-
point (i.e. new ‘cases’ who had not reported any previ- ence in service use between those who were occasion-
ous mental health service use), and (ii) the persistence ally v. frequently bullied. Rates of service use varied by
of mental health service use across time (by adding to- gender, with females having higher rates of mental
gether the number of reported service use contacts health service use in adulthood and males having
from childhood through to age 50 years). higher rates of service use in childhood and adoles-
All statistical models built on the analyses from cence. Prevalence of service use according to bullying
our past research which investigated midlife mental victimization is presented separately for males and
health outcomes of childhood bullying victimization females and the associations between bullying and ser-
(Takizawa et al. 2014), and included the same covari- vice use were consistent within each gender (Table 1).
ates. The analyses incorporated inverse probability
weights to address sample attrition; these were derived Longitudinal trends of mental health service use
from logistic regression analyses predicting availability according to bullying victimization
of complete data on childhood bullying and service
Bullying victimization was associated with mental
use at age 50 years. As a conservative approach, we re-
health service use from age 16 up to age 50 years
port on individuals who had complete data on bully-
(Table 2): participants who were bullied, either occa-
ing in childhood and service use at age 50 years (n =
sionally or frequently, had a higher risk of using men-
9242). Sensitivity analysis did not identify differences
tal health services up to midlife compared with those
in mental health service use between those with and
who were not bullied. Fig. 1 also illustrates that the dis-
without complete data. As participants were based
parity between those participants who had been bul-
across the UK, we examined whether region of resi-
lied or not in childhood was greatest at age 16 years,
dence was related to use of mental health services.
suggesting that the impact of bullying victimization
As no significant association was identified, we did
on mental health service use was most pronounced at
not include this variable in our subsequent analyses.
the time point closest to the exposure, and particularly
Analyses were carried out using SAS version 9.3
for those who were frequently bullied. The higher risk
(USA) and Stata version 11.2 (USA).
of use of mental health services for individuals who
were occasionally or frequently bullied in childhood
Ethical standards
decreased with age, but remained significant up to
All procedures contributing to this work comply with the age of 50 years. This association was also robust
the ethical standards of the relevant national and to controls for the potentially confounding effects of

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130
S. Evans-Lacko et al.
Table 1. Prevalence of health service use for mental health problems, by gender (unadjusted)

Bullied at age 7 or 11 years, % (95% confidence interval)

Total sample Male Female

Age at
interview, Occasionally Frequently Occasionally Frequently Occasionally Frequently
years Service type Never bullied bullied bullied Never bullied bullied bullied Never bullied bullied bullied

16 Specialist out- 2.0 (1.5–2.5) 3.1 (2.2–3.9) 5.9 (4.2–7.5) 2.7 (1.9–3.6) 3.6 (2.3–4.9) 7.0 (4.6–9.4) 1.3 (0.8–1.8) 2.4 (1.4–3.6) 4.2 (2.2–6.3)
patient
Specialist 1.1 (0.7–1.3) 1.6 (1.0–2.2) 2.2 (1.3–3.2) 1.3 (0.7–2.9) 1.5 (0.7–2.3) 2.7 (1.2–4.2) 0.8 (0.4–1.2) 1.7 (0.8–2.6) 1.5 (0.2–2.7)
in-patient
Primary care 1.2 (0.8–1.6) 3.3 (2.4–4.3) 4.0 (2.6–5.3) 1.7 (1.0–2.4) 4.5 (3.0–6.1) 4.7 (2.7–6.8) 0.7 (0.3–1.1) 2.0 (1.0–3.0) 2.9 (1.2–4.6)
Specialist any 3.7 (3.1–4.4) 6.5 (5.3–7.8) 11.0 (8.8–13.1) 4.9 (3.8–6.0) 8.2 (6.2–10.1) 13.1 (9.9–16.2) 2.6 (1.8–3.3) 4.7 (3.2–6.2) 8.0 (5.2–10.7)
23 Specialist 2.7 (2.2–3.2) 4.1 (3.2–5.0) 4.4 (3.2–5.6) 1.2 (0.7–1.7) 2.9 (1.8–3.9) 2.9 (1.5–4.3) 4.1 (3.2–4.9) 5.5 (4.1–7.0) 6.3 (4.1–8.5)
33 Primary care 19.2 (18.0–20.4) 23.1 (21.3–25.0) 23.3 (20.7–25.9) 11.7 (10.3–13.2) 13.8 (11.7–16.0) 15.5 (12.5–18.5) 26.3 (24.5–28.1) 33.4 (30.5–36.4) 33.5 (29.2–37.8)
Specialist 7.6 (6.8–8.1) 9.2 (7.9–10.4) 9.9 (8.1–11.7) 5.6 (4.6–6.7) 6.1 (4.6–7.6) 7.0 (4.9–9.2) 9.5 (8.2–10.7) 12.6 (10.5–14.7) 13.6 (10.5–16.8)
42 Primary care/ 3.9 (3.3–4.4) 5.8 (4.7–6.8) 5.7 (4.4–6.8) 2.8 (2.1–3.5) 5.0 (3.7–6.4) 4.0 (3.5–6.4) 4.8 (3.9–5.7) 6.6 (5.0–8.1) 5.8 (3.8–7.8)
specialist
50 Primary care/ 12.3 (11.3–13.2) 15.1 (13.5–16.6) 15.8 (13.7–17.9) 8.6 (7.5–9.7) 9.4 (7.8–11.0) 10.8 (8.5–13.1) 15.2 (13.9–16.5) 19.6 (17.4–21.8) 20.9 (17.6–24.3)
specialist
 Childhood bullying victimization and use of mental health services 131

0.003
0.03

Each logistic regression model controls for the following covariates which are also described in the Method and reported in online Supplementary Appendix S2: childhood intelli-
p

1.30 (1.10–1.55)
1.17 (1.02–1.34)
Age 50 years

OR (95% CI)

gence quotient, socio-economic status of parents, low parental involvement, childhood emotional and behavioural problems in childhood and childhood adversity.
1.00

Where we have more than one measure of service use (ages 16 and 33 years), we included the measure indicating specialty mental health service use.
0.04
0.02
p

1.35 (1.00–1.85)
1.21 (0.93–1.56)
Age 42 years

OR (95% CI)

Fig. 1. Odds ratio of the prevalence of specialty mental

1.00

health (spec mh) service use for individuals who were

frequently v. never bullied (freq/never) and occasionally v.
never bullied (occasional/never).
Table 2. Likelihood of health service usea for mental health problems over time, adjusted results based on logistic regression modelb

<0.0001
0.002

childhood IQ, socio-economic status of parents, low

p

parental involvement, childhood emotional and behav-

ioural problems, and childhood adversity (see online
1.41 (1.19–1.68)
1.24 (1.08–1.43)

Supplementary Appendix S2 for details of the full

Age 33 years

OR (95% CI)

model and adjusted OR for each covariate). Reassuringly,

associations between covariates and service use iden-
1.00

tified here were similar to those found in the broader

mental health literature in that females and those who
experienced childhood adversity were more likely to
use mental health services.
0.02
0.01
p

To provide an estimate of the magnitude of the asso-

ciation between bullying and mental health service
use, in a separate model, we investigated the link be-
1.54 (1.08–2.21)
1.47 (1.09–1.98)

tween ever being ‘in care’ and mental health service

Age 23 years

OR (95% CI)

use. The odds of mental health service use at age 50

years for individuals who were in care in childhood
1.00

[OR 1.40, 95% confidence interval (CI) 1.02–1.94]

were significantly greater than for individuals who
had not been in care, but not significantly different in
<0.0001

magnitude than for those who were bullied either oc-

0.02

casionally or frequently (for example, frequently bul-

p

lied v. not bullied: OR 1.30, 95% CI 1.10–1.55).

OR, Odds ratio; CI, confidence interval.
2.53 (1.88–3.40)
1.49 (1.11–2.00)
Age 16 years

OR (95% CI)

Incidence and persistence of mental health service

use over the lifespan
1.00

The persisting association between bullying victimiza-

tion and mental health service use was not simply due
to the same individuals using mental health services
over time (Fig. 2); we observed new cases of mental
Occasionally
Frequently
Total sample

health service use after childhood. There was a dispar-

ity in mental health service use at age 16 years accord-
Never
Bullied

ing to bullying victimization, when the risk is greatest,

b
a

but also at the ages of 23 and 33 years. By age 42 years,

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 132 S. Evans-Lacko et al.

Fig. 2. Incidence of service use (%) over time by bullying victimization; where we have more than one measure of service use
(ages 16 and 33 years), we included the measure indicating specialty mental health service use.* Statistical significance (p <
0.05), relative to never bullied.

Fig. 3. Persistence (%) of mental health service use encounters (0, 1, 2, 3 or 4+) over the lifespan by bullying victimization.
* Statistical significance (p < 0.05), relative to never bullied.

there were no differences in incidence of service use by Discussion

bullying victimization and no new mental health ser-
vice use was reported at age 50 years. Individuals Being bullied in childhood has previously been shown
who were occasionally or frequently bullied also to be associated with poor mental health up to midlife.
showed more persistent service use over time than In this study, using a large prospective British birth
those who were not bullied, as indicated by the total cohort, we show that childhood bullying victimization
number of reported mental health service use encoun- is also associated with a long-term impact on mental
ters across assessment periods (Fig. 3). health service use through to midlife. This has

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 Childhood bullying victimization and use of mental health services 133

important implications for an already stretched health- In agreement with previous research, our study also
care system, given the durability of the impact we indicates higher rates of mental health service use
identified over time. The impact on mental health ser- among females compared with males in adulthood.
vices is most notable at an early age, as would perhaps This may be due to stigma associated with mental health
be expected, but the association remains significant at problems among men or their inability to recognize feel-
age 50 years, despite controlling for established corre- ings of distress and seek help (Wang et al. 2007; Mojtabai,
lates of bullying victimization and mental health 2010; Evans-Lacko et al. 2014).
problems. Increased service use among those who
experienced childhood bullying victimization resulted
Limitations
from individuals with early-onset mental health pro-
blems who continued to use services over their life- This study was based on a large nationally representa-
time, in addition to some new cases who started tive cohort with data from face-to-face interviews with
using mental health services in their 20s and 30s. As participants and their families across five decades. The
a result, our study suggests that, in addition to redu- impact of childhood bullying victimization on mental
cing suffering, actions to prevent bullying in childhood health service use at midlife was robust to controls
and adolescence could reduce some of the pressures on for a number of factors we know to be associated
healthcare resources. with mental health problems, and is consistent with
The persistence of the association between childhood our previous studies showing an association with men-
bullying victimization and mental health service use tal and physical health problems despite considering
across nearly four decades, although diminishing over the confounding effects of several key variables.
time, is surprising and deserves further attention. This Nevertheless, the study has a number of limitations.
long-term effect might reflect at least two different pro- First, attrition is notable over the 50-year assessment
cesses. First, half of the adult population with a psychi- period. It is unlikely that this affected our findings;
atric disorder already show signs of poor mental health however; we showed previously that dropout was un-
by the age of 15 years (Kim-Cohen et al. 2003). If un- related to bullying victimization (Takizawa et al. 2014)
noticed or untreated, early onset of mental health pro- and other observable attributes (Hawkes & Plewis,
blems could be the starting point of persistent 2006). Furthermore, we controlled for other effects of
disorders, especially those childhood and adolescent selective attrition by including inverse probability
mental health problems known to be associated with weights throughout the analyses. Second, the service
bullying victimization, including depression and anxiety use measures may be vulnerable to recall bias.
(Arseneault et al. 2008; Bowes et al. 2014), self-harm Although it was not possible to verify interview
(Fisher et al. 2012; Lereya et al. 2013), suicidality reports of service use with medical records, past re-
(Geoffroy et al. 2016), and psychotic disorders search has shown good agreement between self-
(Arseneault et al. 2011; van Dam et al. 2012). Second, reports and hospital and emergency service use over
bullying victimization may set the conditions for a the lifetime (Horwitz et al. 2001). Reliability of reports
cycle in which people become at risk of exposure to of out-patient visits is lower; however, moderate to
further abuse in later life (Dodge et al. 1990). The high agreement has been shown for reports of out-
cumulative effect of being repeatedly exposed to victim- patient visits over a 1-year period (Horwitz et al.
ization – and its detrimental effect on wellbeing – may 2001), and self-report is considered an acceptable
push some individuals to seek help for mental health method for collecting service use data (Patel et al.
problems only when they transition to early adulthood. 2005). Third, interview questions about service use var-
This pathway may also be exacerbated by the poor social ied across assessments (i.e. at different ages), rendering
outcomes associated with childhood bullying victimiza- direct comparisons of utilization over time difficult.
tion, such as marital failure and poor employment Nevertheless, the assessment of a variety of types of
outcomes (Goodman et al. 2011; Knapp et al. 2011). mental health service use at different ages allowed us
Overall, we did not find that bullying victimization to validate the impact of bullying victimization across
increased mental health service use more specifically mental health service settings and life stages. Service
for boys or girls. However, we observed that boys use for drug and alcohol problems, however, was only
showed higher levels of mental health service use at covered up to age 42 and not at age 50 years. Fourth,
age 16 years compared with girls. This difference prob- and by the same token, our assessment of service use
ably reflects the key role that adults play in recognizing, was not comprehensive and most probably did not cap-
referring and engaging with mental health services and ture all types of mental health service use – although we
the higher rates of externalizing symptoms among report on the most common ones. Moreover, we did not
young boys (Costello et al. 1998; Stiffman et al. 2004), have data on the intensity of mental health service use.
whereas, later on, men seek care on their own behalf. Finally, although participants were representative of UK

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 134 S. Evans-Lacko et al.

births in 1958, the cohort lacks the ethnic diversity current- Arseneault L, Cannon M, Fisher HF, Polanczyk G, Moffitt
ly found in the UK (Power & Elliott, 2006) and may not ac- TE, Caspi A (2011). Childhood trauma and children’s
curately represent patterns of service use today. emerging psychotic symptoms: a genetically sensitive
Bullying is widespread among primary and secondary longitudinal cohort study. American Journal of Psychiatry
168, 65–72.
school students (Gilbert et al. 2009; Finkelhor et al. 2015).
Arseneault L, Milne BJ, Taylor A, Adams F, Delgado K,
Attention to this issue has been growing in policy and
Caspi A, Moffitt TE (2008). Being bullied as an
related discussions; for example, bullying was referred
environmentally mediated contributing factor to children’s
to 72 times in the Chief Medical Officer’s report for internalizing problems: a study of twins discordant for
2013, highlighting it as an issue of particular importance victimization. Archives of Pediatrics and Adolescent Medicine
and in need of expert attention (Davies & Mehta, 2014). 162, 145–150.
Our study showed that childhood bullying victimization Beecham J, Byford S, Kwok C, Parsonage M (2011).
adds to the pressure on a healthcare system which is al- School-based interventions to reduce bullying. In Mental
ready stretched, as bullying victimization was associated Health Promotion and Mental Illness Prevention: the Economic
with long-term effects on service use through to age 50 Case (ed. M. Knapp, D. McDaid and M. Parsonage), pp. 12–13.
years. Anti-bullying initiatives are relatively inexpensive Department of Health: London.
and offer good value for money (Beecham et al. 2011). One Bowes L, Wolke D, Joinson C, Lereya ST, Lewis G (2014).
Sibling bullying and risk of depression, anxiety, and
model developed for the National Institute for Clinical
self-harm: a prospective cohort study. Pediatrics 134, e1032–
Excellence estimated that a school-based anti-bullying
e1039.
initiative costs around £15.50 per pupil, per year
Clark C, Rodgers B, Caldwell T, Stansfeld S (2007).
(Hummel et al. 2009). Given the tremendous current Childhood and adulthood psychological ill health as
strain on the healthcare system, specific policy and prac- predictors of midlife affective and anxiety disorders: the
tice efforts to prevent bullying could not only reduce indi- 1958 British Birth Cohort. Archives of General Psychiatry 64,
vidual suffering over many years, but also help to contain 668–678.
or even reduce costs. Copeland WE, Wolke D, Angold A, Costello EJ (2013).
Adult psychiatric outcomes of bullying and being bullied
Supplementary material by peers in childhood and adolescence. JAMA Psychiatry 70,
419–426.
The supplementary material for this article can be
Costello EJ, Pescosolido BA, Angold A, Burns B (1998). A
found at http://dx.doi.org/10.1017/S0033291716001719 family network-based model of access to child mental
health services. Research in Community Mental Health 9,
Acknowledgements 165–190.
Davies S, Mehta N (2014). Public Mental Health: Evidence Based
There was no funder which specifically supported this Priorities. The Annual Report of the Chief Medical Officer 2013:
paper, although N.B.’s time was funded from a Public Mental Health Priorities: Investing in the Evidence.
National Institute for Health Research Senior Department of Health: London.
Investigator award to M.K.; R.T. is a Newton Dodge K, Bates J, Pettit G (1990). Mechanisms in the cycle of
International Fellow Alumnus funded by the Royal violence. Science 250, 1678–1683.
Society, the British Academy and through a Grant-in- Douglas JWB (1964). The Home and the School. MacGibbon &
Aid for Scientific Research (B) (JSPS KAKENHI Grant Kee: London.
Number JP16H05653) from the Japanese Society for Evans-Lacko S, Corker E, Williams P, Henderson C,
the Promotion of Science (JSPS); S.E.-L. currently holds Thornicroft G (2014). Trends in mental illness related
a Starting Grant from the European Research Council public stigma among the English population in 2003–2013:
influence of the Time to Change anti-stigma campaign.
(337673). The authors had final responsibility for the de-
Lancet Psychiatry 1, 121–128.
cision to submit for publication. The funders played no
Finkelhor D, Turner HA, Shattuck A, Hamby SL (2015).
part in the design or conduct of the study, the analysis
Prevalence of childhood exposure to violence, crime,
or interpretation of data, or the writing of the article and and abuse: results from the National Survey of Children’s
the decision to submit it for publication. Exposure to Violence. JAMA Pediatrics 169, 746–754.
Fisher HL, Moffitt TE, Houts RM, Belsky DW, Arseneault L,
Declaration of Interest Caspi A (2012). Bullying victimisation and risk of self harm
in early adolescence: longitudinal cohort study. BMJ
None.
(Clinical Research ed.) 344, e2683.
Geoffroy MC, Boivin M, Arseneault L, Turecki G, Vitaro F,
References Brendgen M, Renaud J, Séguin JR, Tremblay RE, Côté SM
(2016). Associations between peer victimization and
Arseneault L, Bowes L, Shakoor S (2010). Bullying
suicidal ideation and suicide attempt during
victimization in youths and mental health problems: ‘much
adolescence: results from a prospective population-based
ado about nothing’? Psychological Medicine 40, 717–729.

Downloaded from https://www.cambridge.org/core. Pendlebury Library of Music, on 10 Jan 2021 at 09:57:53, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0033291716001719
 Childhood bullying victimization and use of mental health services 135

birth cohort. Journal of the American Academy of Child and Power C, Elliott J (2006). Cohort profile: 1958 British birth
Adolescent Psychiatry 55, 99–105. cohort (National Child Development Study). International
Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Journal of Epidemiology 35, 34–41.
Janson S (2009). Burden and consequences of child Power C, Thomas C, Li L, Hertzman C (2012). Childhood
maltreatment in high-income countries. Lancet 373, 68–81. psychosocial adversity and adult cortisol patterns. British
Goodman A, Joyce R, Smith JP (2011). The long shadow cast Journal of Psychiatry: the Journal of Mental Science 201,
by childhood physical and mental problems on adult life. 199–206.
Proceedings of the National Academy of Sciences of the United Rosenman S, Rodgers B (2004). Childhood adversity in an
States of America 108, 6032–6037. Australian population. Social Psychiatry and Psychiatric
Hawkes D, Plewis I (2006). Modelling non-response in the Epidemiology 39, 695–702.
National Child Development Study. Journal of the Royal Shonkoff JP, Boyce WT, McEwen BS (2009). Neuroscience,
Statistical Society, Series A 169, 479–491. molecular biology, and the childhood roots of health
Horwitz S, Hoagwood K, Stiffman AR, Summerfeld T, disparities: building a new framework for health promotion
Weisz JR, Costello EJ, Rost K, Bean DL, Cottler L, Leaf PJ, and disease prevention. JAMA 301, 2252–2259.
Roper M, Norquist G (2001). Reliability of the services Sourander A, Gyllenberg D, Brunstein Klomek A,
assessment for children and adolescents. Psychiatric Sillanmäki L, Ilola AM, Kumpulainen K (2016).
Services (Washington, D.C.) 52, 1088–1094. Association of bullying behavior at 8 years of age and use of
Hummel S, Naylor P, Chilcott J, Guillaume L, Wilkinson A, specialized services for psychiatric disorders by 29 years of
Blank L, Baxter S, Goyder E (2009). Cost-effectiveness of age. JAMA Psychiatry 73, 159–165.
Universal Interventions Which Aim to Promote Emotional and Sourander A, Ronning J, Brunstein Klomek A, Gyllenberg
Social Wellbeing in Secondary Schools. University of Sheffield: D, Kumpulainen K, Niemelä S, Helenius H, Sillanmäki L,
Sheffield. Ristkari T, Tamminen T, Moilanen I, Piha J, Almqvist F
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, (2009). Childhood bullying behavior and later psychiatric
Poulton R (2003). Prior juvenile diagnoses in adults with hospital and psychopharmacologic treatment: findings
mental disorder: developmental follow-back of a from the Finnish 1981 Birth Cohort Study. Archives of
prospective-longitudinal cohort. Archives of General General Psychiatry 66, 1005–1012.
Psychiatry 60, 709–717. Stiffman AR, Pescosolido B, Cabassa LJ (2004). Building a
Knapp M, King D, Healey A, Thomas C (2011). Economic model to understand youth service access: the gateway
outcomes in adulthood and their associations with provider model. Mental Health Services Research 6, 189–198.
antisocial conduct, attention deficit and anxiety problems in Stott DH (1969). The Social Adjustment of Children. University
childhood. Journal of Mental Health Policy and Economics 14, of London Press: London.
137–147. Takizawa R, Maughan B, Arseneault L (2014). Adult health
Lereya ST, Winsper C, Heron J, Lewis G, Gunnell D, Fisher outcomes of childhood bullying victimization: evidence
HL, Wolke D (2013). Being bullied during childhood and from a five-decade longitudinal British birth cohort.
the prospective pathways to self-harm in late adolescence. American Journal of Psychiatry 171, 777–784.
Journal of the American Academy of Child and Adolescent van Dam DS, van der Ven E, Velfhorst E, Selten JP, Morgan C,
Psychiatry 52, 608–618.e2. de Haan L (2012). Childhood bullying and the association
Mojtabai R (2010). Mental illness stigma and willingness to with psychosis in non-clinical and clinical samples: a
seek mental health care in the European Union. Social review and meta-analysis. Psychological Medicine 42,
Psychiatry and Psychiatric Epidemiology 45, 705–712. 2463–2474.
Odgers CL, Jaffee SR (2013). Routine versus catastrophic Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC,
influences on the developing child. Annual Review of Public Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de
Health 34, 29–48. Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC,
Office of Population Censuses and Surveys (OPCS) (1980). Kovess V, Lane MC, Lee S, Levinson D, Ono Y,
Classification of Occupations. HMSO: London. Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007).
Patel A, Rendu A, Moran P, Leese M, Mann A, Knapp M Use of mental health services for anxiety, mood, and
(2005). A comparison of two methods of collecting substance disorders in 17 countries in the WHO World
economic data in primary care. Family Practice 22, 323–327. Mental Health Surveys. Lancet 370, 841–850.

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