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

Anat Brunstein Klomek, Avigal Snir, Alan Apter, Vladimir Carli, Camilla Wasserman, Gergö Hadlaczky, Christina W. Hoven, Marco Sarchiapone, Judit Balazs, Julio Bobes, Romuald Brunner, Paul Corcoran, Doina Cosman, Christian Haring, Jean Pierre Kahn, Michael Kaess, Vita Postuvan, Merike Sisask, Alexandra Tubiana, Airi VarnikJanina Žiberna, Danuta Wasserman

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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.

Original languageEnglish
Pages (from-to)1183-1193
Number of pages11
JournalEuropean Child and Adolescent Psychiatry
Issue number11
StatePublished - 1 Nov 2016

Bibliographical note

Funding Information:
The SEYLE project is supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), Grant agreement nr HEALTH-F2-2009-223091. The authors were independent of the funders in all aspects of study design, data analysis, and writing of this manuscript. The Project Leader and Coordinator of the SEYLE project is Professor in Psychiatry and Suicidology Danuta Wasserman, Karolinska Institute (KI), Head of the National Centre for Suicide Research and Prevention of Mental Ill-Health and Suicide (NASP), at KI, Stockholm, Sweden. Other members of the Executive Committee are Professor Marco Sarchiapone, Department of Health Sciences, University of Molise, Campobasso, Italy; Senior Lecturer Vladimir Carli, National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden; Professor Christina W. Hoven and Anthropologist Camilla Wasserman, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA. The SEYLE Consortium comprises centres in 12 European countries. Site leaders for each respective centre and country are: Danuta Wasserman (NASP, Karolinska Institute, Sweden, Coordinating Centre), Christian Haring (University for Medical Information Technology, Austria), Airi Varnik (Estonian Swedish Mental Health & Suicidology Institute, Estonia), Jean-Pierre Kahn (Université de Lorraine, France), Romuald Brunner (University of Heidelberg, Germany), Judit Balazs (Vadaskert Child and Adolescent Psychiatric Hospital, Hungary), Paul Corcoran (National Suicide Research Foundation, Ireland), Alan Apter (Schneider Children’s Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel), Marco Sarchiapone (University of Molise, Italy), Doina Cosman (Iuliu Hatieganu University of Medicine and Pharmacy, Romania), Vita Postuvan (University of Primorska, Slovenia) and Julio Bobes (University of Oviedo, Spain). Support for “Ethical Issues in Research with Minors and other Vulnerable Groups” was obtained by a grant from the Botnar Foundation, Basel, for Professor of Ethics, Dr. Stella Reiter-Theil, Psychiatric Clinic at Basel University, who served as the independent ethical consultant to the SEYLE project.

Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.


  • Adolescents
  • Bullying
  • Direct self-injurious behavior
  • Victimization


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