title: Bullying behavior is related to suicide attempts but not to self-mutilation among psychiatric inpatient adolescents.
abstract: BACKGROUND
  To investigate the association of bullying behavior with suicide attempts and self-mutilation among adolescents.
  
  
  METHODS
  The study sample consisted of 508 Finnish adolescents (age 12-17 years) admitted to psychiatric inpatient care between April 2001 and March 2006. DSM-IV psychiatric diagnoses and variables measuring suicidal behavior (i.e. suicide attempts and self-mutilation) and bullying behavior (i.e. a victim, a bully or a bully-victim) were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL). Logistic regression analyses were conducted to examine the impact of being a victim, a bully or both a bully and a victim on suicide attempts and self-mutilation.
  
  
  RESULTS
  After adjusting for age, school factors, family factors and psychiatric disorders, there was a higher risk of suicide attempts in girls who were victims of bullying (OR=2.07, CI=1.04-4.11, p=0.037) or who bullied others (OR=3.27, CI=1.08-9.95, p=0.037). Corresponding associations were not found for boys; nor was any association of bullying behavior with self-mutilation found among either sex.
  
  
  CONCLUSIONS
  Among girls, being bullied or bullying others are both potential risk factors for suicidal behavior. Psychiatric assessment and treatment should thus be considered not only for victims of bullying, but also for bullies. Suicide-prevention programs should also routinely include interventions to reduce bullying. However, the generalization of our findings to all adolescents is limited because our study sample consisted of psychiatric adolescent patients. In addition, some of the possible findings might have remained statistically insignificant due to the small sample size among adolescents who had performed suicide attempts or self-mutilation.
authors.affiliation: Department of Psychiatry, University of Oulu, Oulu, Finland. anuhelmi@paju.oulu.fi
authors.forename: Anu-Helmi
authors.initials: AH
authors.lastname: Luukkonen
authors.forename: Pirkko
authors.initials: P
authors.lastname: Räsänen
authors.forename: Helinä
authors.initials: H
authors.lastname: Hakko
authors.forename: Kaisa
authors.initials: K
authors.lastname: Riala
mesh_terms: D000293:Adolescent; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data*