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Eur Child Adolesc Psychiatry. 2016 Nov;25(11):1183-1193. Epub 2016 Mar 24.

Association between victimization by bullying and direct self injurious behavior among adolescence in Europe: a ten-country study.

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Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), P.O. Box 167, Herzliya, 46150, Israel.
Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden.
Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA.
Department of Health Sciences, University of Molise, Campobasso, Italy.
National Institute for Health, Migration and Poverty, Rome, Italy.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
Vadaskert Child Psychiatry Hospital, Lipótmezei str. 1-5, 1021, Budapest, Hungary.
Institute of Psychology Eötvös Loránd University, Izabella str. 46, 1064, Budapest, Hungary.
Department of Psychiatry, School of Medicine, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, University of Oviedo, Oviedo, Spain.
Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
National Suicide Research Foundation, Cork, Ireland.
Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Research Division for Mental Health, University for Medical Information Technology (UMIT), Hall in Tirol, Austria.
Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire (CHU) de Nancy, Universite de Lorraine, Nancy, France.
Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper, Slovenia.
Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia.
Institute of Social Work, Tallinn University, Tallinn, Estonia.


Previous studies have examined the association between victimization by bullying and both suicide ideation and suicide attempts. The current study examined the association between victimization by bullying and direct-self-injurious behavior (D-SIB) among a large representative sample of male and female adolescents in Europe. This study is part of the Saving and Empowering Young Lives in Europe (SEYLE) study and includes 168 schools, with 11,110 students (mean age = 14.9, SD = 0.89). Students were administered a self-report survey within the classroom, in which they were asked about three types of victimization by bullying (physical, verbal and relational) as well as direct self-injurious behavior (D-SIB). Additional risk factors (symptoms of depression and anxiety, suicide ideation, suicide attempts, loneliness, alcohol consumption, drug consumption), and protective factors (parent support, peer support, pro-social behavior) were included. The three types of victimization examined were associated with D-SIB. Examination of gender as moderator of the association between victimization (relational, verbal, and physical) and D-SIB yielded no significant results. As for the risk factors, depression, but not anxiety, partially mediated the effect of relational victimization and verbal victimization on D-SIB. As for the protective factors, students with parent and peer support and those with pro-social behaviors were at significantly lower risk of engaging in D-SIB after being victimized compared to students without support/pro-social behaviors. This large-scale study has clearly demonstrated the cross-sectional association between specific types of victimization with self-injurious behavior among adolescents and what may be part of the risk and protective factors in this complex association.


Adolescents; Bullying; Direct self-injurious behavior; Victimization

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