Tackling bullying in the medical arena

Laura Stewart, Member-at-Large and Board Member of SPAP, received her Bachelor of Arts degree in Biology from Baylor University and Masters of Science degree in Communication Sciences and Disorders. Following a 9 year career as a Speech Therapist, she then sought a Masters degree in Physician Assistant Studies at UT Southwestern which she completed in 2017.  Ms Stewart is now a Physician Assistant member of the Inpatient Pulmonary Team at Children's Medical Center of Dallas.

The article "How to identify and treat bullying" in the June 2019 issue of Contemporary Pediatrics discusses the issues of bullying and highlights evidence- based recommendations for both prevention and identification of affected children and seeks to help us maximize the impact of the care we give.

The power differential

Bullying has been identified in relatively recent years as a medical problem in addition to being a social problem. The article’s authors, Drs. Bass, Scholer, Flannery, and Lichtenstein, begin by providing us with a definition of bullying from the Centers for Disease Control and Prevention (CDC).  Not only has the CDC provided a definition of “traditional” bullying, but it also differentiates this from cyberbullying, which has become all too prevalent in our social-media frenzied culture.  In short, both types of bullying come down to a real or perceived power imbalance.

The article goes on to describe the catastrophic effects bullying has had on our culture and highlights the importance of our awareness, as providers of pediatric medicine, of this issue.

The making of a bully

The potential consequences of bullying are discussed including depression, anxiety, poor overall health, as well as academic performance and suicidality. Working in an inpatient acute-care setting, it is all too often that we see these effects play themselves out in suicide attempts.  The authors describe one way in which bullying becomes a vicious cycle wherein the once-bullied child then becomes a bully as well. This second at-risk group has been shown to have even worse outcomes lasting into adulthood including thoughts of self-harm and suicidality, anxiety/depression, smoking, substance abuse, as well as less likelihood of graduating from high school.

Risk and protective factors

Risk factors associated with both bullying and being bullied are described. According to the authors, certain groups are at elevated risk of being bullied including ethnic and religious minorities as well as those with health conditions such as obesity, food allergies, and learning disabilities.  They emphasize that LGBTQ adolescents are bullied as much as 2 times more than their heterosexual counterparts. Negative parenting styles and low socioeconomic status are 2 additional factors described as risk factors for being bullied.

Protective factors against both bullying and being bullied are expressed in the article such as parental connectedness, peer connectedness, and positive parenting.

Provider imperatives

In terms of the provider role, the authors provide suggestions of how to both screen for bullying and to provide support. These strategies include identifying the problem itself, getting more information, and finally, assisting with support of the at- risk patients.

The gravity of this subject is heavy. Suicidality, anxiety, depression, and obesity are escalating quickly and quietly among our adolescent population.  This article outlines helpful strategies to assist providers in caring for our patients to provide a sense of safety, help build interpersonal skills, and refer for additional outside care.

Ultimately, it is clear that bullying is a medical problem that requires adequate intervention for the well-being of our patients’ mental and physical health. This article provides both primary and secondary providers with practical ways to address and facilitate health in the adolescent population for which we care.