Abstract
Purpose: Our goal was to examine the association between peer victimization (PV) and suicidal ideation (SI), and the degree to which internal resilience moderates this association.
Materials and methods: We examined the independent associations between PV frequency and type (verbal, cyber, physical, and relational), internal resilience, and the risk of SI within the last 12 months among 9th and 11th grade students participating in the California Healthy Kids Survey (CHKS) (n=42,594; 55.2% female; 72.2% non-white).
Results: Odds ratios (OR) of SI associated with very low- (at least 1 PV type 1 time, but none more than 1 time), low- (at least 1 PV type 2–3 times, but none more than 2–3 times), and moderate/high- (at least 1 PV type 4 times or more) frequency PV compared with no PV were 1.30 (95% CI=1.15–1.45), 1.70 (95% CI=1.51–1.90) and 2.47 (95% CI=1.23–2.73), respectively. Any exposure to physical (OR=1.31; 95% CI=1.19–1.44), relational (OR=1.26; 95% CI=1.15–1.38), verbal (OR=1.38; 95% CI=1.27–1.50), or cyber (OR=1.26; 95% CI=1.15–1.39) PV was associated with increased odds of SI compared with no PV. Internal resilience was associated with lower odds of SI (OR=0.98, 95% CI=0.98–0.99), regardless of PV exposure. The slope between internal resilience and SI was significantly steeper for those subjects who experienced verbal PV (OR interaction=0.99; 95% CI=0.98–1.00).
Conclusion: Even infrequent PV was found to be associated with increased risk for SI. Internal resilience was associated with reduced SI, particularly for verbal forms of PV. Our results suggested that efforts to decrease SI among adolescents should be directed toward both preventing PV and strengthening internal resilience.
Acknowledgments
The authors wish to thank Kevin L. Delucchi, Ph.D., of the University of California, San Francisco (UCSF), for his statistical assistance. In addition, we appreciate the helpful feedback from Carol A. Mathews M.D., of UCSF, and Scott H. Frank, M.D., M.S., Erika S. Trapl, Ph.D., and Mendel E. Singer, Ph.D., all of Case Western Reserve University.
Funding Sources: This research was supported by a grant from the Doris Duke Charitable Foundation to MEH and by the National Institute of Mental Health of the National Institutes of Health under Award Number K01MH097978 to KZL. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This article was prepared while Anna E. Ordóñez was employed at the University of California, San Francisco. The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. The study sponsors had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication.
Implications and contributions: This study has two important implications for youth: 1) even infrequent peer victimization increases the risk of suicide ideation, and 2) internal resilience reduces risk of suicidal ideation in the context of PV. Improving internal resilience among PV youth should be considered as a preventive tool against suicidal ideation.
Conflict of interest statement: The authors have no conflicts of interest.
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