Research report
Testing sex-specific pathways from peer victimization to anxiety and depression in early adolescents through a randomized intervention trial

https://doi.org/10.1016/j.jad.2006.11.003Get rights and content

Abstract

The aim of this study was to test for sex differences in the role of physical and relational victimization in anxiety and depression development through a randomized prevention trial. 448 seven-year-old boys and girls were randomly assigned to the Good Behavior Game intervention, a two-year universal classroom based intervention aimed at reducing disruptive behavior problems and creating a safe and predictable classroom environment, or to a control condition. Assessments of self-reported physical and relational victimization at age 10 years, and self-reported major depressive disorder, generalized anxiety, social anxiety, and panic/agoraphobia symptoms at age 13 years were available. Reductions in anxiety/depression were mediated by reduced rates of relational victimization in girls, whereas reductions in physical victimization accounted for the reduced anxiety/depression scores among boys. The results support sex-specific pathways of victimization leading to anxiety and depression.

Introduction

Prevalence rates of clinically elevated levels of anxiety and depression in children and early adolescents range from 2% to 4% (Costello et al., 2003, Ford et al., 2003). Anxiety or depression in early adolescence confers a strong risk for anxiety and depressive disorders during adulthood (Bittner et al., 2004, Pine et al., 1998, Woodward and Fergusson, 2001), and has been associated with suicide attempts, completed suicide (e.g., Apter and Wasserman, 2003), and illicit drug dependence (Woodward and Fergusson, 2001).

Victimization by peers has been hypothesized to cause symptoms of anxiety and depression (for a review, see Hawker and Boulton, 2000). Victimization experiences may result in negative self-evaluations and low self-efficacy in achieving social goals, leading to anxiety and depression (Prinstein et al., 2005, Troop-Gordon and Ladd, 2005. In studying the link between victimization and internalizing outcomes, it should be noted that different forms of victimization exist. In addition to physical victimization (i.e., being the victim of physically aggressive acts or threats), children can also be relationally victimized (i.e., being the target of peers’ attempts to harm or control their relationship with others, for instance through hostile rumor, or being excluded from activities with peers; Crick et al., 2001).

The child's gender may be the key variable in both the exposure to forms of victimization and its link with anxiety and depression. Indeed, boys may experience more physical victimization, whereas girls may experience relational victimization (e.g., Crick and Bigbee, 1998, Cullerton-Sen and Crick, 2005, Schäfer et al., 2002), although such results are not unequivocal (see Nishina et al., 2005, Storch et al., 2005). Moreover, girls’ pathways to internalizing problems have been related to relational victimization, (Crick et al., 2002a, Crick et al., 2002b, Storch et al., 2003, Sullivan et al., 2006), whereas boys’ pathways have been linked to physical victimization (Prinstein et al., 2001). However, again, these findings are not unequivocal, as no sex differences in the link between forms of victimization and internalizing outcomes have also been reported (e.g., La Greca and Harrison, 2005, Prinstein et al., 2001, Storch et al., 2003, Storch et al., 2002).

Randomized controlled trials (RCTs) may be very effective in studying the link between victimization and internalizing outcomes. This because RCTs provide the opportunity to test whether the reduction in the manifestation of the risk variable, due to a controlled influence – the intervention – mediates the distal impact of the program on reductions in the outcome variable (see also Coie et al., 1993, Kellam and Rebok, 1992, Kraemer et al., 2001, Rutter et al., 2001), while the randomization controls for possible sources of confounding. In the present study, we aimed to test whether reductions in physical and relational victimization at age 10, due to the Good Behavior Game intervention (GBG, Barrish et al., 1969, Dolan et al., 1989), mediated the reductions in anxiety and depression at age 13 years. The GBG aims to create a safe and predictable classroom environment by promoting prosocial behavior and reducing aggressive and disruptive behavior. Indeed, the GBG demonstrated to reduce aggressive, oppositional, inattentive, and antisocial behavior (Ialongo et al., 2001, Ialongo et al., 1999, Reid et al., 1999, Van Lier et al., 2004, Van Lier et al., 2005). Given these reductions we hypothesized to find reduced rates of physical victimization due to the intervention. Moreover, because the GBG facilitates positive interactions between children, we hypothesized to find reductions in relational victimization.

Section snippets

Participants

Thirteen elementary schools in Rotterdam and Amsterdam, the Netherlands, were recruited in 1999. In these schools, 744 children were eligible for inclusion, of which for 677 (51% male) informed consent by parents or parent substitutes was obtained (90% participation rate). The mean age of these children was 6.9 years (SD = 0.6) at baseline (for more details about the sample, see van Lier et al., 2004).

Assessments of victimization at age 10 years and ratings of anxiety and depression symptoms at

Results

Boys had higher levels of physical victimization at age 10 years (β =  0.71, p < 0.05). No sex difference was found in relational victimization (β =  0.38, p > 0.05). Girls reported higher levels of major depressive disorder (β = 1.34, p < 0.01), generalized anxiety (β = 2.70, p < 0.01), social anxiety (β = 0.93, p < 0.01), and panic/agoraphobia (β = 0.40, p < 0.05), than boys at age 13 years.

Discussion

Our results underscore the importance of distinguishing between relational and physical victimization for two reasons. First, we demonstrated that physical and relational victimization were differentially related to indices of anxiety and depression. Second, we demonstrated that associations between specific forms of victimization and internalizing problems were sex-specific. Among girls, reductions in relational victimization mediated the reduced levels of anxiety and depression. In contrast,

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