Student Nurse Perspective: The social price of bullying.

After writing about the emotional impact that bullying had on my life I got some really nice feedback. I thought that maybe I had actually laid some ghosts back to rest after that but unfortunately my brain kept on noticing all these interesting articles on bullying and what potential and actual social impact it has. There was one particular article in The Conversation that got my attention. It included a rather long and time consuming study following 1420 kids into adulthood. What it largely said was that being bullied at school was a major indicator in decreased quality of aspects of life. With general poorer outcomes of physical and psychological health for victims and bullies. But the biggest difference was for kids who were "bully-victims". Bully-victims were at even higher risk of suffering from diabetes, asthma, anxiety, depression and more likely to pick up smoking. So in other words bullying can potentially destroy someone's life. And all for what some people seem to think is a normal part of childhood. What this study also points out, which had been said in previous studies, that pure bullies are not some emotionally scarred individuals from broken backgrounds but. They have better social understanding, can read emotional situations better and knowledge of how to manipulate others for their own purposes. They also tend to be the paradoxically both the most popular and the most hated kids in school, as everyone wants to be with them but they don't particularly like them. But in adulthood they are also at an increased risk of being on the wrong side of the law. But the bully-victims on the other hand do tend to be more socially awkward with pre-existing emotional and behavioral problems and from dysfunctional family background.

Being bullied is not a harmless rite of passage but throws a long shadow over affected people’s lives.

The biggest impact generally though was that bullying affected negatively on all groups. As you can see from the chart below the only group unaffected were the ones who had not been involved in bullying. But in a separate chart in the same study they also show how big an impact long term bullying has as opposed to  short term bullying, with the biggest difference being in future social behaviour. Bullies, bully-victims and chronic victims had difficulties in present and future educational settings, meaning that they will most likely have left before attaining any qualifications. But all three groups had problems in retaining jobs. Now I'd like to make this clear and say that no this does not happen to every one who has bullied or been bullied. But that does not mean that we can just sit back, do nothing and yes calmly say "Well kids will be kids." Just to hope that they'll be fine and remain unaffected later in life. This is a social issue that everyone has to help with and as this research suggests we shouldn't only focus on the victims, but we should also help bullies. Which means that some parents have to come to terms with that they're children are bullies. Not only come to terms with it, but to deal with it.

There was a period not that long ago when I was really set up in setting up a support/educational group for victims of bullying and their close ones. Unfortunately I ran out of steam before that ever happened, but I did do an awful lot of research while I had this fire in my belly. I read books and papers, even phoned up some organizations in the capital. I had collected quite a lot of info, which I had dumped into what was at the time the only anti-bullying site in Icelandic at the time but which is now lost in the etherworld(now if anyone could find it I'd be much obliged). I still got a lot of it somewhere on paper. I think... I hope anyway. The best thing though since turning into adulthood and with the advances of the internet and going to University now, I've been able to hunt down more actual university papers on the effects of bullying. Like the ones I linked earlier.

The author that seemed to have done the biggest and best research was a Swede who did most of his work in Norway named Dan Olweus. He wrote a seminal book called Bullying at School. Through his research in Norway in how to combat bullying at school, he established the phenomenally successful "Bullying Prevention Programme". Which in turn has developed into "Violence Prevention Works", that website does provide some excellent resources for everyone to use.  He provides probably the best definition of bullying that I know of, and sweet Jebus I've heard people try to shoehorn so many aspects into bullying. Essentially you will find people who dislike some certain behaviours will try and class those as bullying.

Bullying is systematic abuse of power and refers to repeated aggression against another person that is intentional and involves an imbalance of power.

There have been a few meta-analysis done regarding the effectiveness of bullying prevention programmes. The most comprehensive I came across was done for the Journal of Experimental Criminology. But essentially what they did find was that the on average Bullying Prevention Programmes decreased incidents of bullying by up to 23%. Not the world, but it's a start. The most effective ones were it the ones that had the most intense programmes, including those that had formal parenting meetings, increased break-time supervision and disciplinary methods(Just to make it clear disciplinary here is not in the form of physical or mental aggression, like keel-hauling, but rather loss of privileges and the like). The least effective ones, in fact the ones that lead to an increase of bullying were the peer support groups. It would appear that the Olweus Bullying Prevention Programme is the best there is. Along with that there are some excellent institutions out there that help like Red Balloon this organization provide a safe haven for kids who've been chronically bullied. What they offer is a sort of intensive care with full time education in order to assist kids, with the aim that they'll be able to return to mainstream education. According to them "At least half of the students we take have attempted or seriously considered suicide.". They also oversaw the publication of Rising Above Bullying, one the most inspirational books I've read in recent years. Currently there are only 5 Red Balloon centres in the UK, it would be great to see that number increase along with a nationwide roll-out of Olweus Bullying Prevention Programme.

What a lot of people don't realise is how big an impact bullying has. The said thing is that sometimes what it takes for people to be aware of it is somebody committing suicide. With as high as 44% of suicide committed by 10-14 year old being due to persistent bullying, and for every actual suicide there are as many as 100 suicide attempts. And all for "a harmless rite of passage". This of course is not just confined to school bullying, this can also be related to cyber-bullying and workplace bullying. Though work-bullying is not the focus here, it is still good to mention that even adults still behave in this way, if just a bit more subtly than kids in school.

*Added 19/04/14*

American Journal of Psychiatry did a study that followed people over a 50 year period.  The idea was to find out of course the long term problems that constant bullying has on people's mental and social health. The population of the cohort was 7771, questionnaires were sent on a regular basis and the subjects were met at 23 years of age and 50 years. The results were quite striking:

Participants who were bullied in childhood had increased levels of psychological distress at ages 23 and 50. Victims of frequent bullying had higher rates of depression, anxiety disorders, and suicidality than their nonvictimized peers.

Essentially childhood bullying is not something that is just confined to childhood. Being bullied on a frequent basis has very serious long term effects, and not just on the individual who has been bullied. The effect will be felt by the parents, future partners, children, friends, the local health and social care network and so on and so forth.

A similar study had been done in Finland which was published in 2009. Interestingly this study showed that boys who bullied were in greater need of psychiatric assistance for depression and anxiety as they grew older but girls who were bullied were in greater need psychiatric hospital assistance.


The focus shouldn't only be on the bullying victim, the bully very often ends up being a victim as time passes. We need to exterminate this idea that bullying is normal part of childhood and that we should just let it run it's course. Because the course is lifelong, for some that life will be shorter because of bullying. This is a social problem that affects all of us one way or the other whether we like to admit to it or not. And it's a problem that everyone should help to tackle. The local authorities, to the teachers and parents.

Student Nurse Perspective: Put your bloody helmet on.

For a moment I'm going to put myself on a higher horse than usual. I've been on placement in the community lately which gives me an excuse to use my bike more often than I otherwise would. Today (27.11) I decided to do a little observational survey, now this is anecdotal but it highlighted something that I am slightly passionate about. Helmets, cyclists without helmets. In the morning I observed 30 cyclists, 14 of them had a helmet. There was one pre-teen girl who did have a helmet, just not attached to her head. In the late afternoon on the way home I observed 40 cyclists and only 10 of them had a helmet! There was even a fellow parent without a helmet, but his child had one.

Quite a few of them had some other safety equipments like hi-vis and/or reflective jackets, flashing lights and reflective badges. Now of course those are very important as well. But none of those will prevent you from suffering from head trauma. And those precautions are more relevant for when you are on the road cycling, not a special pedestrian/cycling path. But at some point you have to go on a road to cycle.

"We found that crashes disproportionately occurred during low-light conditions such as at dawn, dusk or at night. Only 34 per cent of cyclists in these low-light crashes were wearing reflective clothing and 19 per cent of them said they weren't using bicycle lights at the time of the crash."

Well as you might have noticed, with my little observational study the higher portion of cyclists without a helmet was in the late afternoon. So that is just a little bit more frightening. And frustrating. Hence this blog. So I decided to cherry pick some safety studies that have been done regarding the use of helmets. Most of the ones I found were done in Australia and the US, not sure why I mentioned that but it would be nice to see something similar being done in the UK considering that the UK has not got as extensive bicycle network as Australia. Though there are some great places for cyclists of course like Lancaster where I live. Of course it is difficult to make a proper ethical double blind study of the effectiveness of helmets. And I would hope that no one would actually suggest that, it would be like suggesting to have a randomized controlled trial on effectiveness of parachutes in prevent death and major trauma.

The main worry when you fall of a bicycle is head trauma, for obvious reasons. Yes, a broken arm and a broken leg will set you back for a few months and you might not make 100% full recovery of said limb but at least you'll be able to maintain a normal standard of living... mostly. Whereas a head trauma can be devastating. If you want to read up on Head Injuries there is a fantastic website called Headway which provides great sources and resources on head injuries, consequences and management of said injuries.

But just taking some chosen effects that head injury can affect:

• Communication problems after brain injury are very common.

• Everyone who has had a head injury can be left with some changes in emotional reaction and behaviour.

• Brain injury may occasionally cause damage to the hypothalamus and/or pituitary gland, which can lead to insufficient or increased release of one or more hormones.

Of course you don't have to believe me, but what about an emergency doctor who sees these kinds of accidents on a regular basis.

Severe head injuries were defined as any with significant brain haemorrhage, complex skull fracture or brain swelling. Some 70% of such patients end up on a ventilator in intensive care units; many patients with severe head injuries are left with permanent brain damage.

In this study done in 1989 in the US they comment on:

Seven percent of the case patients were wearing helmets at the time of their head injuries, as compared with 24 percent of the emergency room controls and 23 percent of the second control group. Of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, we found that riders with helmets had an 85 percent reduction in their risk of head injury (odds ratio, 0.15; 95 percent confidence interval, 0.07 to 0.29) and an 88 percent reduction in their risk of brain injury (odds ratio, 0.12; 95 percent confidence interval, 0.04 to 0.40).

85% reduction in their risk of head injury. That is pretty pretty significant.

Another study done in the US, this time 1996 concluded with that helmets had protective effect of 69% to 74%, in incidents that involved motor vehicles:

Bicycle helmets, regardless of type, provide substantial protection against head injuries for cyclists of all ages involved in crashes, including crashes involving motor vehicles.

This one done in Australia in 1994 had this to say:

Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%).

A meta analysis done in Australia also added in 2001:

Overall, these results provide clear evidence for the benefit of wearing helmets while cycling in terms of risk reduction for not only head and brain injury, but also facial injury and fatal injury. These results are applicable to riders of all ages, both in less severe crashes and in collisions with motor vehicles. These results confirm those published in initial studies in Australia and the US over a decade ago, although the more recent studies are confined to these two countries, Canada and the United Kingdom. Despite the mounting scientific evidence, the debate over the efficacy of cycle helmets still rages in some circles. How much more evidence is required before helmet use reaches the acceptance level of seat belts for motor vehicle occupants?

And of course the Cochrane Review got in on the game:

The review found that wearing a helmet reduced the risk of head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries. - See more at: http://summaries.cochrane.org/CD001855/wearing-a-helmet-dramatically-reduces-the-risk-of-head-and-facial-injuries-for-bicyclists-involved-in-a-crash-even-if-it-involves-a-motor-vehicle#sthash.mXIjmgEt.dpuf

 The review found that wearing a helmet reduced the risk of head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries.

So yeah. I am willing to take 65% - 85% and look like an overgrown flying mushroom, as opposed ending up as a mushroom.

Mr Robinson in Australia compiled another major study showing how the legislation in New Zealand came into effect.

Head injuries vs Helmet Use

The Canadians decided to check up on the impact of mandatory helmet use:

Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction).

So mandatory legislation would be the way to go. But then again there is no point in having a legislation if the education aspect is lacking. A study done in Ohio in 1994 showed that kids under 16 were more likely to were a helmet if there was legislation in place as well as a strong safety education. But the education shouldn't be just confined to schools, parents need to buckle up as well. It really shouldn't even be an issue. What often blows my mind is when I observe other parents stressing out the point to their kids why helmets and other safety gear are important then do not use the safety equipment themselves. Why the hell should the kid listen to a blatant hypocrite like that? Parents, don't just talk the talk, walk the walk as well. You are just as likely to collide, crash and suffer from head injury as your kids if you fall of that bike during those wondrous family cycling tours.

Helmets save lives. Just like seatbelts.