Systematic Review: Bullying Involvement of Children With and Without Chronic Physical Illness and/or Physical/Sensory Disability-a Meta-Analytic Comparison With Healthy/Nondisabled Peers

Discrimination against adolescents with chronic diseases: a systematic review

Discrimination is a social construct that discredits individuals based on attributes deemed socially undesirable. Adolescence is a period of transition where individuals acquire skills, values, and experiences that prepare them for adulthood. Adverse experiences during adolescence could particularly affect these acquisitions. For adolescents, discrimination is an experience that can lead to social and health consequences. Our hypothesis is that adolescents with chronic disease are more likely to be exposed to discrimination than their healthy peers. This systematic review aimed to study the prevalence, nature, and the additional risk of discrimination in adolescents with chronic disease compared to their healthy peers. A systematic review was conducted following PRISMA guidelines, including both quantitative and qualitative studies, published between January 2000 and December 2022. Searches were conducted using several electronic databases, including PubMed, COCHRANE, PsycINFO, EMBASE, CAIRN, and CINAHL. Included articles studied adolescents between 12 and 18 years old affected by one of the most prevalent chronic diseases (obesity, epilepsy, diabetes, respiratory diseases including asthma and cystic fibrosis, cancer, and cardiovascular disease). Those articles reported discrimination from the adolescents' perspective and studied the association between discrimination and disease. We identified 27 studies conducted across almost all continents, including a total of 3,290,446 adolescents. Most of the studies are cross-sectional and recent (published after 2017). They are mainly focused on obesity and epilepsy. All types of discrimination were studied, although cyberbullying was explored in only one study. The prevalence of discrimination was reported in 11 studies and varies depending on the type of chronic disease and contexts (from 14% in adolescents with cystic fibrosis to 99% in adolescents with diabetes). Discrimination was mostly self-reported by the adolescents and it came from multiple sources: peers, parents, or educational and healthcare professionals. It seems that the presence of a chronic disease exposes individuals to an additional risk of discrimination, even though quantifying this risk was not possible due to the diversity of methods.

CONCLUSION

Discrimination against adolescents with chronic diseases has received poorly studied in literature even though they appear to be more vulnerable than their peers. The phenomenon is complex since discrimination occurs through several forms and originates from diverse sources. Given the multiple repercussions of discrimination on all aspects of adolescents' life and development, it is essential to study it further. Awareness of discrimination's diversity will allow to establish preventing actions. Early screening could help limit discrimination's prejudice on adolescents' quality of life.

WHAT IS KNOWN

• Discrimination has a significant impact on the life of individuals who experienced it. • Some risk factors of discrimination are already known, e.g., age, gender, disability, ethnic origin. • There is no strong evidence that having a chronic disease at adolescence increases the risk of discrimination.

WHAT IS NEW

• Adolescents with chronic disease have an additional risk of discrimination coming from their peers, their parents, and professionals. • The discrimination could be explained by the permanent physical difference, the occasional visibility of the symptoms or physical limitations, and the sociocultural constructs of the disease.

Bias-Based Bullying Among Sexual and Gender Minority Youth Living With Disabilities

Both sexual and gender minority youth (SGMY) and youth living with disabilities are disproportionately impacted by bias-based bullying in school settings. While research has separately examined how sexual and gender minority status and disability status are associated with experiences of bullying, very little research has explored the experiences of youth living with these identities simultaneously. This study examined to what extent SGMY report differential experiences of bias-based bullying depending on various identities and the type of disability an individual reports. Utilizing a diverse sample of SGMY aged 13-17 (N = 2,239), multinomial logistic regression analyses were conducted to test whether there were differences in the likelihood of being bullied for having specific identities, based on disability type, among SGMY. Results indicated a variety of differences in bullying based on gender expression, gender identity, sexual orientation, sexual and gender minority identity, and disability. Participants who reported having a mental disability were more likely to experience multiple forms of bias-based bullying surrounding their gender identity, gender expression, sexual orientation, sexual and gender minority status, and disability type when compared with other gender minority youth with disabilities. These findings may help to inform supportive services in school settings.

Types and factors affecting and impact of ableism among Asian children and youth with disabilities and their caregivers: a systematic review of quantitative studies

PURPOSE

Asian children and youth with disabilities often experience multiple barriers and discrimination in education, healthcare, and social settings, which influence their well-being, especially the transition to adulthood. This review aims to explore the types, factors affecting and impact of ableism on Asian children and youth with disabilities and their caregivers.

METHODS

We conducted a systematic review and a narrative synthesis whereby we searched the literature from six international databases, including Healthstar, Ovid Medline, Embase, PsycInfo, Scopus, and Web of Science.

RESULTS

Twenty-nine studies were included in the review, and three themes were identified that related to ableism: (1) types and rates of ableism (i.e., stigma, bullying and victimization, and discrimination and inequalities); (2) factors affecting ableism (i.e. sociodemographic factors, familial factors, and societal factors); and (3) impacts of ableism (i.e. mental health, family impacts, and societal impacts).

CONCLUSIONS

Our review highlights that ableism has various types and can be influenced by multiple factors, influencing social and health outcomes of Asian families with children and youth with disabilities. This review also emphasizes the importance of increasing the public's awareness regarding disabilities to reduce ableism among Asian families with children with disabilities.

Bullying Involvement and Subtypes of Disabilities: Who is Likely to be Affected by What?

The current study uses latent class analysis (LCA) and binary logistic regression analysis to explore profiles of bullying and how they might be associated with the types of disabilities. LCA was used to determine a categorization of involvement in bullying among youth with various types of disabilities. Binary logistic regression analysis was conducted to explore how profiles of bullying involvement might be associated with types of disabilities. The study uses the 2016 National Survey of Children's Health, a large-scale survey completed on children's health, ages 0-17, in the United States. A total of 139,923 households were screened for eligibility. The study participants consisted of 50,212 caregivers of a child who completed the survey. Findings revealed that among caregivers of children without disabilities, 79.5% reported that their child was uninvolved, and 20.5% reported that their child was a victim of bullying. Children in the developmental disabilities, speech and/or language disorders, and learning disabilities groups, showed significant odds of being in the bullying victim group compared to those without any disabilities. The study did not find that children in any disability groups were likely to be in the perpetrator group.

Bullying Involvement at the Intersection of Gender Identity/Modality, Sexual Identity, Race, Ethnicity, and Disability: Prevalence Disparities and the Role of School-Related Developmental Assets

Purpose: This study examines adolescents' self-reported school-based developmental assets and four intersecting social positions as they relate to prevalence of bullying involvement. Methods: Participants were 80,456 ninth and 11th grade students who participated in the 2019 Minnesota Student Survey (30.2% youth of color; 11% lesbian/gay/bisexual/pansexual/queer/questioning; 2.9% transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify school-based developmental assets (i.e., school safety, school adult support) and intersecting social positions (i.e., sexual identity; gender identity/modality; racial/ethnic identity; physical disabilities/chronic illness; and/or mental health/behavioral/emotional problems) associated with the highest prevalence of involvement as physical and relational bullies, victims, and bully-victims. Results: Adolescents with 2+ marginalized social positions who often lacked school-based developmental assets were part of nearly all the highest prevalence bullying involvement groups. TGD and gender questioning adolescents, Native American youth, and youth living with both physical disabilities/chronic illness and mental health/emotional/behavioral problems-most of whom had additional marginalized social positions and lacked school-based assets-were particularly overrepresented in high prevalence groups. For example, 31.1% of TGD or gender questioning youth of color living with both types of disabilities/health problems who did not feel strongly that school was safe reported involvement as physical bully-victims-nearly six times the sample average rate. Conclusion: Adolescents with multiple marginalized social positions and those lacking certain school-based assets-often overlapping categories-were involved in bullying at higher-than-average rates. Findings underscore the need for schools to address intersecting experiences of stigma and structural oppression that may perpetuate bullying involvement disparities.

Recurrent headache, stomachache, and backpain among adolescents: association with exposure to bullying and parents' socioeconomic status

OBJECTIVES

Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain.

METHODS

Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738.

RESULTS

The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11).

CONCLUSIONS

Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.

Asthma is associated with bullying victimization in rural adolescents

OBJECTIVE

We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization.

METHODS

Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted.

RESULTS

26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76-3.46 and AOR = 2.42; 95% CI = 1.87-3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45-4.71). Similar results were obtained with sensitivity analyses.

CONCLUSIONS

In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents.

A cross-sectional study on gaming intensity and social vulnerability in adolescents that have a chronic condition

Background

Adolescents growing up with a chronic condition might experience more social vulnerabilities compared to their healthy peers as an indirect result of their conditions. This can lead to a relatedness need frustration for these adolescents. Consequently, they might spend more time playing video games compared to their peers. Research shows that both social vulnerability and gaming intensity are predictors for problematic gaming. Therefore, we investigated if social vulnerability and gaming intensity are more pronounced in adolescents that have a chronic condition compared to the general population; and if these levels reflect the levels of a clinical group being treated for Internet Gaming Disorder (IGD).

Methods

Data on peer problems and gaming intensity were compared from three separate samples: a national representative sample of adolescents, a clinical sample of adolescents that are undergoing treatment for IGD, and a sample of adolescents diagnosed with a chronic condition.

Results

No differences were found on either peer problems or gaming intensity between the group of adolescents that have chronic conditions and the national representative group. The group with chronic conditions scored significantly lower on gaming intensity than the clinical group. No significant differences were found between these groups on peer problems. We repeated the analyses for boys only. Similar results were found for the group with chronic conditions compared to the national representative group. The group with chronic conditions now scored significantly lower on both peer problems and gaming intensity than the clinical group.

Conclusion

Adolescents growing up with a chronic condition appear similar in their gaming intensity and peer problems compared to their healthy peers.

Patient- and caregiver-reported factors associated with school absenteeism in children with chronic kidney disease

BACKGROUND

Children with chronic kidney disease (CKD) are at risk for neurocognitive deficits while simultaneously being at risk for chronic school absenteeism (≥ 18 school days per school year). Chronic school absenteeism compounds the negative impacts of CKD on academic achievement. In this study, we examined patient- and caregiver-reported factors associated with school absenteeism in children with non-dialysis- or transplant-dependent CKD in order to help identify which factors could be modifiable and ultimately improve school attendance.

METHODS

We utilized a combination of chart review and questionnaires distributed in person to patients and caregivers at a pediatric nephrology clinic between November 2018 and August 2019 to gather data. We used descriptive statistics to illustrate clinical characteristics of the children included in the study, caregiver characteristics, and examined reported reasons for missing school.

RESULTS

Twenty-one percent of participants (10/48) missed 18 full days of school or more, categorizing them as chronically absent. The top three reasons for missing school were doctor appointments, feeling sick, and being bullied. More specific sequelae of CKD were not highly reported as reasons for missing school.

CONCLUSIONS

Chronic absenteeism is a highly reported phenomenon among children with pediatric CKD. Given that missing school for doctor appointments was a top reason for absenteeism, this data suggests alternative appointment hours and virtual appointments may reduce chronic school absenteeism in children, and by extension improve their health, behavioral, and academic outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.

Bullying in Adolescents: Differences between Gender and School Year and Relationship with Academic Performance

School bullying is a phenomenon of unjustified aggression in the school environment that is widespread throughout the world and with serious consequences for both the bully and the bullied. The objectives of this research were to analyze the differences between the different bullying categories by gender and academic year in primary and secondary education students, as well as their relationship with academic performance. To categorize students according to their bullying experiences, the European Bullying Intervention Project (EBIPQ) Questionnaire was used. The Chi-square test was used to compare the scores obtained by the students in the EBIPQ based on gender and academic year, and the one-way ANOVA test was used to analyze its relationship with academic performance. Research participants were 562 students from the 5th (n = 228) and 6th (n = 186) primary school years and the 1st (n = 134) and 2nd (n = 94) secondary school years. They were males (50.5%) and females (49.5%) ranging in ages from 10 to 15 years old (mean = 11.66, standard deviation = 1.206). The results showed statistically significant differences in gender and academic year, indicating a greater number of boys in the role of the bully/victim and girls in that of non-bully/non-victim. The most aggressive students were in the 2nd year of ESO (12–13 years old). Regarding academic performance, statistically significant differences were obtained that confirm the hypothesis that performance or average grade varies according to the category of bullying in which students find themselves. The academic performance of the non-bully/non-victim and those in the victim category was found to be higher than that of bullies and bully/victim students.

"I Gave Up Football and I Had No Intention of Ever Going Back": Retrospective Experiences of Victims of Bullying in Youth Sport

Bullying is a global issue that, beyond school, is present in different social contexts, such as sport environments. The main objective of this study was to get to know the experiences of victims of bullying in sport throughout their youth sport training. Semi-structured interviews to four Spanish women and seven Spanish men were carried out, within an age range of 17–27 (M_age = 21 years, SD = 3.69). The following main themes were established by means of a hierarchical content analysis: (a) “bullying characterization,” (b) “dealing with bullying,” and (c) “consequences of bullying.” The results show the presence of physical, verbal and social bullying in the sport context, with the changing room being the space where this type of behavior is most frequently developed. Most victims show an internal attribution (self-blame) for the bullying event, related to their motor skills and their personal physical and psychological characteristics. Double victimization can be observed, at the sport club and at the educational center. Passive strategies are used to deal with the situation, while little support is shown by sport agents (teammates and coaches). The victims, as a consequence of the bullying experience, suffer from short and long-term negative effects on a psychosocial level. The study highlights the necessity to design and implement programs focused on the prevention, detection and intervention of bullying for sport organizations, bearing in mind all the agents that make them up (coaches, management teams, families, and players). Furthermore, the importance of promoting the creation of safe sport environments, free from any kind of violence, is emphasized.

Adolescent Resilience Profiles (on the Example of Adolescents with Congenital, Acquired Disabilities and Healthy Peers)

The problem of the research is important in the context of psychological assistance and interaction with adolescents with disabilities. The study aimed to carry out a comparative analysis of the resilience profiles of adolescents with congenital (cerebral palsy), acquired disabilities (oncology, rheumatic diseases) and healthy peers. The study involved 51 adolescents with cerebral palsy, 61 with oncological diseases, 51 with rheumatic diseases and 86 conditionally healthy adolescents aged 13 to 18 years old. In total it embraced 249 teenagers (mean age 14.94+1.48), of which 128 were male and 121 were female. There were used the following methods: the “Victimity” questionnaire (M.A. Odintsova, N.P. Radchikova), “Resilience Test” (E.N. Osin, E.I. Rasskazova) and “COPE” questionnaire (E.I. Rasskazova, T.O. Gordeeva, E.N. Osin). The study revealed significant differences in the resilience profiles of adolescents from different groups: healthy teenagers are mainly characterized by unstable and resilient profiles; adolescents with oncology and rheumatic diseases — by all three profiles; adolescents with cerebral palsy — by victim and unstable ones. The female part of the sample, unlike the male part, are characterized by unstable and victim profiles. The most significant differences in groups with different resilience profiles were found in coping strategies related to the dysfunctional coping style. The use of coping strategies: behavioral disengagement, mental disengagement, concentration on emotions and humor leads to a decrease in resilience in the boys of the entire sample. Concentration on emotions, behavioral disengagement, mental disengagement, and infrequent use of active coping are predictors of reduced resilience in girls.

Keeping Connected With School: Implementing Telepresence Robots to Improve the Wellbeing of Adolescent Cancer Patients

Background: Adolescent cancer patients experience considerable absence from their education, contributing to poorer academic attainment and isolation from peers, and impacting wellbeing. Telepresence robots have been used to support the educational and social needs of young people with chronic illness. This article presents the results of the development and pilot-testing of a telepresence robot service in schools for adolescent cancer patients – the TRECA (Telepresence Robots to Engage CAncer patients in education) service.

Methods: Phase I used semi-structured interviews (n = 25) to assess the views of patients, parents, schools and clinicians on the benefits, acceptability, barriers, and enablers of utilizing robots in schools for adolescent cancer patients. Results from Phase I informed the development of the TRECA service. Phase II used semi-structured interviews (n = 22) to assess the implementation experiences of adolescent cancer patients, and their families, schools, and keyworkers who pilot-tested the TRECA service.

Results: Phase I demonstrated the need for telepresence technology in connecting adolescent cancer patients to school. Given the variable support during treatment, a telepresence robot service was considered an acceptable method of facilitating a school-patient connection. The recommendations provided in Phase I, such as the need for provision of ongoing education, training, and support to the patient and school, informed the development of the TRECA service. In Phase II, the themes of The necessity of stakeholder buy-in, A facilitator of meaningful connection, and One size does not fit all were generated. The TRECA service’s flexibility in meeting the needs of its users helped facilitate meaningful connections. Participants reported that these connections provided patients an enhanced sense of agency and wellbeing. The importance of stakeholder buy-in and taking an individualized approach to service delivery were also highlighted. Stakeholder miscommunication and lack of knowledge were key aspects of implementation needing improvement as the service is rolled out on a larger scale.

Conclusion: Using telepresence robots to connect adolescents to school during cancer treatment was regarded as highly acceptable, facilitating peer and academic connection. By making stakeholder-recommended improvements to the TRECA service’s existing processes, the service will continue to grow in effectiveness and capacity.

A Meta-Analytical Review of Gender-Based School Bullying in Spain

School bullying continues to be one of the main challenges for the education community. Current research indicates that Lesbian, Gay, Bisexual, Transgender, Transsexual, and other LGBT+ people suffer the highest rates of bullying, while other studies suggest that this bullying does not occur based on the victim's actual sexual orientation or gender identity, but because they do not fit into the traditional gender roles. The aim of the present study was to carry out a meta-analytical study on the prevalence of gender-based bullying against LGBT+ schoolchildren and adolescents in Spain.

METHODS

The review was carried out following the recommendations of the PRISMA group and allowing us to identify a total of 24 studies. All of these studies were published since 2008, and most of them conducted cross-sectional survey-type research. It was also found that the instrument used to assess bullying varied greatly among studies, resulting in an enormous heterogeneity of research on this topic. Different meta-analyses were carried out according to the profile of involvement in bullying: victimisation, perpetration, and observation. In addition, three target populations were detected in the victimisation research: the general population, pre-identified bullying victims reporting the reasons behind the victimisation, and LGBT+ people.

RESULTS

The meta-analyses conducted with R have estimated the prevalence of observation of gender-based school bullying in Spain at 77.3%, perpetration at 13.3%, and victimisation at 8.6% among the general population. When the research focuses on previously identified victims, the rate was 3.6%, while if LGBT+ people are approached directly, the percentage increases to 51%.

CONCLUSIONS

These rates reveal the need to develop specific preventive strategies in schools. Greater awareness of affective-sexual diversity and respect for those who do not conform to traditional gender roles should be promoted.

Internet risky behaviours among youth with visual impairment

Background

Young individuals with visual impairment (VI), exposed to higher risky of social exclusion, might be more prone to Internet risky behaviours including electronic aggression.

Objective

Different types of Internet risky behaviours and the average time spent online were investigated among students with VI. These behaviours were analyzed for the relationship with witnessing, perpetrating and becoming a victim of electronic aggression.

Methods

A total of 490 special needs school students with VI answered a self-administered questionnaire. The average time spent online, different types of risky Internet activities and electronic aggression were recorded, as well as sociodemographic characteristics.

Results

Male students downloaded software illegally, hacked, published and viewed sites with sexual content, and gambled online statistically more often than female counterparts. Concerning electronic aggression, more than half of participants were engaged as witnesses, every fifth student as a victim and 11.6% as perpetrators. Two sets of ordinal logistic regression analyses have shown that communication with a person promoting violence and an excessive amount of time spent online during weekends predicted significantly the risk of witnessing and being a victim of electronic aggression. Additionally, communicating with a person promoting violence and an excessive amount of time spent online during schooldays were associated with increased odds for engagement in electronic aggression as a perpetrator.

Conclusions

Population with VI is prone to risky Internet use and likely to be engaged in electronic aggression. New instruments and preventive strategies need to be developed, as well as diagnostic tools tailored specifically to the needs of young people with VI.

Bullying in the Russian Secondary School: Predictive Analysis of Victimization

Background: Bullying has been recognized as an important risk factor for personal development in adolescence. Although numerous studies report high prevalence of bullying in Russian schools, limited research was based on the large-scale, nationally representative analysis, which highlights the lack of findings applicable to the national context.

Objective: This study aims to address the following research questions: (1) What is the bullying victimization prevalence in Russian secondary schools? (2) What is the socio-demographic profile of the bullying victims? (3) To what extent do learning outcomes in core subject domains predict bullying? (4) How does psychological climate at school affect the occurrence of bullying? (5) Which emotional states do bullying victims typically display? (6) Which psychosocial traits are the most common for bullying victims?

Data and Methods: The study adopts the statistical analysis of the Programme for International Student Assessment (PISA) data in Russia. The final sample consists of 6,249 children aged 15 years who answered the bullying questions. K-means clustering approach was adopted to identify schoolchildren who should be classified as bullying victims amongst those who have reported bullying. Logistic regression was used to estimate the probability change of bullying under different psychosocial factors and examine the effect of bullying on the emotional states of the victims.

Results: The results of the study reveal that 16% of children are victims of bullying in the Russian secondary school. Bullying is strongly associated with learning outcomes in reading, thus outlining that low performers are at risk of severe victimization. Bullying is also contingent on the psychological climate and tends to develop more frequently in a competitive environment. The findings outline that bullying increases negative feelings such as misery, sadness, and life dissatisfaction amongst its victims, making a substantial footprint on their lives. Logically, bullying victims are less likely to feel happy and joyful. Finally, it was revealed that bullying victims do not tend to share negative attitudes to the per se, which identifies directions for future research in this domain.

Implications: Instead of dealing with the consequences of bullying, prevention strategies should aim at facilitating a positive environment at school, thus addressing the problem.

A. B, J. M. VDB, A. H. M. B, C. C. B, C. J. F, J. W. G, C. M. VDH, B. J, A. K, H. K, B. J. P. K, L. A. M, M. A. MH, M. P, M. A. J. VR, N. W. P. R, H. J. S, A. Y. N. S, F. S, M. M. T, A. S. P. T, F. A. W. Paediatric patients report lower health-related quality of life in daily clinical practice compared to new normative PedsQLTM data

Aim

To compare Health‐Related Quality of Life (HRQOL) of paediatric patients with newly collected HRQOL data of the general Dutch population, explore responses to individual items and investigate variables associated with HRQOL.

Methods

Children (8–12y) and adolescents (13–17y) from the general population (N = 966) and from a paediatric population (N = 1209) completed the Pediatric Quality of Life Inventory (PedsQL^TM) online via the KLIK Patient‐Reported Outcome Measures portal. PedsQL^TM scale scores were compared between groups with independent t tests, by age group and gender. Responses to PedsQL^TM items were explored using descriptive analyses. Linear regression analyses were performed to determine which variables were associated with HRQOL.

Results

Paediatric patients reported worse HRQOL than the general population on all PedsQL^TM scales (p ≤ .001, d = 0.20–1.03), except social functioning, and a high proportion reported problems on PedsQL^TM items, for example, ‘I have trouble sleeping’. Younger age, female gender and school absence were negatively associated with HRQOL (β = −0.37–0.10, p ≤ .008).

Conclusion

Paediatric patients reported lower HRQOL than the general population, and school absence, female gender and younger age were associated with lower HRQOL. The results underline the importance to structurally monitor paediatric patients’ HRQOL in clinical practice to detect problems and offer the right help on time.

Bibliometric mapping of psychological well-being among children with a visual impairment

Children with a visual impairment experience lower psychological well-being than normative populations. While research on this subject is abundant, an overview is lacking of the methods used and topics commonly studied, to guide future research. The aim was to provide a visual overview of common topics included in psychological well-being research from 2000 to 2018 among children with a visual impairment. We created a bibliometric map with the VOSviewer programme using the text mining functionality to construct and visualise co-occurrences of relevant terms from the titles and abstracts in the included literature. The results show that common subjective terms are behaviour, relationships, attachment and parenting, cerebral visual impairment, cerebral palsy, autism spectrum disorder, and intellectual disability. The common methodological terms include literature and randomized control trials, with the latter restricted to specific terms such as parenting. The conclusions and implications are that the results give insight into the subject terms studied in past years and provide a roadmap for future research in the fields of visual impairment and psychological well-being of children. The topics needing more research are rare disorders, siblings, assistive technology, romantic relationships, bullying, and the frequent cooccurrences of visual impairment with autism spectrum disorders and intellectual disability.

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder

Background

Attention problems and decreased quality of life are frequently accompanied in Cerebral Palsy (CP), which can negatively affect rehabilitation of physical disability. However, the majority of affected children remain untreated in the aspects of attention or psychosocial factors. Equine-Assisted Activities and Therapies (EAAT) use horse as a therapeutic modality including grooming as well as mounted riding activities in which patients exercise and experience mounted stimulation. It is known to help improve attention in children with ADHD, so that it can be an exercise therapy that is expected to improvement of attention as well as rehabilitating effects in CP patients. EAA may be a promising strategy to address the unmet need for CP patients. This study aims to investigate the efficacy of EAA for children with CP, those with both CP and ADHD and confirm the comorbidity between CP and ADHD.

Methods

Forty-six children with cerebral palsy participated in this study. For the exercise group, they participated in a 40-min session twice a week for a 16-week period, while the control group engaged in daily life without any special treatments. Each children individually were assessed on attention and psychological wellbeing at baseline and post-treatment. Comorbidity were identified based on the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5) and confirmed by Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL).

Results

Perseveration rated using the Conner’s Performance Test (CPT) showed a significant decrease only in the exercise group (p < .024). However, no significant improvement in children’s quality of life was observed after EAA program compared with control group. Among the total participants, fifteen children (31.91%) were diagnosed with ADHD. When conducting an additional analysis with the subsample of CP patients diagnosed with ADHD, the d’, commission error and perseveration showed a significant decrease only in the exercise group. Children with CP and ADHD reported an improvement in quality of life both in exercise and control group, but only in the exercise group social functioning exhibited a significant difference.

Conclusion

The positive effects of the EAA on attention and quality of life were confirmed. Children with CP in the exercise group were more capable to sustain their attention longer. Those with CP and ADHD showed an increase in attention and perceived to have better social skills after receiving 16 weeks of EAA compared to those in the control group. Considering high comorbidity of CP and ADHD, it seems that the EAA program could be the better alternative treatment for CP with attentional problem. The results of this study will contribute to growing evidence for the efficacy of EAA in children especially with CP and ADHD.

Trial registration

This trial was registered on ClinicalTrials.gov (NCT03870893). Registered 26 July 2017.

Knowledge About Bullying by Young Adults With Special Educational Needs With or Without Disabilities (SEN/D)

Bullying of people with Special Educational Needs with or without disabilities (SEN/D) is a reality, being one of the most affected groups. This study presents the data obtained in a European Erasmus+ project in which 96 young people and adults with SEN/D from four countries participated: Ireland, Spain, Italy, and Portugal. Firstly, a questionnaire was passed to see the general knowledge of these people in relation to bullying. Then a training program was carried out and finally the questionnaire was passed again to see if the data improved. From the data it appears that people with SEN/D lack skills, knowledge, and resources to deal with bullying. After the completion of the training program the data obtained from the questionnaire improved in many respects. Sometimes people with SEN/D are not aware that they are suffering from this type of situation due to lack of knowledge, so it is necessary to continue implementing training programs to help improve this situation.

What Do We Know about Bullying in Schoolchildren with Disabilities? A Systematic Review of Recent Work

Bullying is a serious problem that particularly affects schoolchildren with disabilities. However, studies in this group have been carried out on smaller cohorts and the results obtained are, therefore, less representative and sometimes inconclusive. The purpose of this paper is to perform a systematic review of the work carried out in recent years, including the analysis of several variables related to the sample, the methodology applied and the type of bullying. The guidelines set down by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement were followed in three phases. The total sample consisted of 55 children who fulfilled the inclusion criteria. The results reveal that half the studies were conducted in cohorts of less than 250 schoolchildren and drew no distinctions between the different types of disabilities. Furthermore, there is no consensus regarding the methodology used, and no specialized instruments were used. Hardly any specific interventions have been performed into the type of bullying investigated, in which victimization is the predominant mode. We concluded that there is an urgent need to increase the number of studies, including a larger number of individuals and using specialized instruments, in order to obtain more solid results. Such studies will allow us to create specific prevention and intervention programs to address the bullying of schoolchildren with disabilities.

Assessment of School Anti-Bullying Interventions: A Meta-analysis of Randomized Clinical Trials

IMPORTANCE

Bullying is a prevalent and modifiable risk factor for mental health disorders. Although previous studies have supported the effectiveness of anti-bullying programs; their population impact and the association of specific moderators with outcomes are still unclear.

OBJECTIVE

To assess the effectiveness of school anti-bullying interventions, their population impact, and the association between moderator variables and outcomes.

DATA SOURCES

A search of Ovid MEDLINE, ERIC, and PsycInfo databases was conducted using 3 sets of search terms to identify randomized clinical trials (RCTs) assessing anti-bullying interventions published from database inception through February 2020. A manual search of reference lists of articles included in previous systematic reviews and meta-analyses was also performed.

STUDY SELECTION

The initial literature search yielded 34 798 studies. Included in the study were articles that (1) assessed bullying at school; (2) assessed the effectiveness of an anti-bullying program; (3) had an RCT design; (4) reported results; and (5) were published in English. Of 16 707 studies identified, 371 met the criteria for review of full-text articles; 77 RCTs were identified that reported data allowing calculation of effect sizes (ESs). Of these, 69 independent trials were included in the final meta-analysis database.

DATA EXTRACTION AND SYNTHESIS

Random-effects and meta-regression models were used to derive Cohen d values with pooled 95% CIs as estimates of ES and to test associations between moderator variables and ES estimates. Population impact number (PIN), defined as the number of children in the total population for whom 1 event may be prevented by an intervention, was used as an estimate of the population impact of universal interventions targeting all students, regardless of individual risk.

MAIN OUTCOMES AND MEASURES

The main outcomes are the effectiveness (measured by ES) and the population impact (measured by the PIN) of anti-bullying interventions on the following 8 variable categories: overall bullying, bullying perpetration, bullying exposure, cyberbullying, attitudes that discourage bullying, attitudes that encourage bullying, mental health problems (eg, anxiety and depression), and school climate as well as the assessment of potential assocations between trial or intervention characteristics and outcomes.

RESULTS

This study included 77 samples from 69 RCTs (111 659 participants [56 511 in the intervention group and 55 148 in the control group]). The weighted mean (range) age of participants in the intervention group was 11.1 (4-17) years and 10.8 (4-17) years in the control group. The weighted mean (range) proportion of female participants in the intervention group was 49.9% (0%-100%) and 50.5% (0%-100%) in the control group. Anti-bullying interventions were efficacious in reducing bullying (ES, -0.150; 95% CI, -0.191 to -0.109) and improving mental health problems (ES, -0.205; 95% CI, -0.277 to -0.133) at study end point, with PINs for universal interventions that target the total student population of 147 (95% CI, 113-213) and 107 (95% CI, 73-173), respectively. Duration of intervention was not statistically significantly associated with intervention effectiveness (mean [range] duration of interventions, 29.4 [1 to 144] weeks). The effectiveness of anti-bullying programs did not diminish over time during follow-up (mean [range] follow-up, 30.9 [2-104] weeks).

CONCLUSIONS AND RELEVANCE

Despite the small ESs and some regional differences in effectiveness, the population impact of school anti-bullying interventions appeared to be substantial. Better designed trials that assess optimal intervention timing and duration are warranted.

Efficacy of a Web-Enabled, School-Based, Preventative Intervention to Reduce Bullying and Improve Mental Health in Children and Adolescents: Study Protocol for a Cluster Randomized Controlled Trial

Introduction: Bullying is a major preventable risk factor for mental disorders. Available evidence suggests school-based interventions reduce bullying prevalence rates. This study aims to test the efficacy of a web-enabled, school-based, multicomponent anti-bullying intervention to prevent school bullying and to assess its effects on mental health and quality of life. Methods and analysis: Cluster randomized controlled trial conducted in 20 publicly funded primary and secondary schools in Madrid, Spain. Schools are randomly allocated to either the intervention arm (n = 10) or conventional practices arm (n = 10). The web-enabled intervention (LINKlusive) lasts ~12 weeks and consists of three main components: (i) an online training program for teachers and parents, (ii) a web-guided educational program for students, focusing on promoting respect for diversity, empathy, and social skill development, and (iii) a web-guided, teacher-delivered, targeted intervention program for bullying situations identified based on peer-support strategies and individual intervention for those involved (i.e., bullying victims and perpetrators). The primary objective is to compare differences between peer-reported bullying victimization in the intervention and control arms at the end of the intervention. Secondary outcome measures are additional measures of bullying victimization and perpetration, mental health symptoms, self-esteem, and quality of life. A follow-up assessment is conducted 1 year after the end of the intervention. Treatment effects will be tested using multilevel mixed models, adjusting for school-, classroom-, and student-related covariates. Considering the increased bullying rates in children with special educational needs, a specific subgroup analysis will test the efficacy of the intervention on bullying prevalence, mental health, and quality of life in this particularly vulnerable population. Ethics and Dissemination: The Deontology Commission of the School of Psychology, Universidad Complutense in Madrid, Spain reviewed the study protocol and granted ethical approval on 21st January 2019. The results of the trial will be disseminated in relevant peer-reviewed journals and at conferences in the field. Trial Registration Number: ISRCTN15719015.

Fatigue among children with a chronic disease: a cross-sectional study

OBJECTIVE

To determine: (1) which biological/lifestyle, psychological and/or social factors are associated with fatigue among children with a chronic disease and (2) how much each of these factors contributes to explaining variance in fatigue.

DESIGN AND SETTING

This was a cross-sectional study across two children's hospitals.

PATIENTS

We included children aged 8-18 years who visited the outpatient clinic with cystic fibrosis, an autoimmune disease or postcancer treatment.

MAIN OUTCOME MEASURES

Fatigue was assessed using the PedsQL Multidimensional Fatigue Scale. Generic biological/lifestyle, psychological and social factors were assessed using clinical assessment tools and questionnaires. Multiple linear regression analyses were used to test the associations between these factors and fatigue. Finally, a multivariable regression model was used to determine which factor(s) have the strongest effect on fatigue.

RESULTS

A total of 434 out of 902 children were included (48% participation rate), with a median age of 14.5 years; 42% were male. Among these 434 children, 21.8% were severely fatigued. Together, all biopsychosocial factors explained 74.6% of the variance in fatigue. More fatigue was uniquely associated with poorer physical functioning, more depressive symptoms, more pressure at school, poorer social functioning and older age.

CONCLUSIONS

Fatigue among children with a chronic disease is multidimensional. Multiple generic biological/lifestyle, psychological and social factors were strongly associated with fatigue, explaining 58.4%; 65.8% and 50.0% of the variance in fatigue, respectively. Altogether, almost three-quarters of the variance in fatigue was explained by this biopsychosocial model. Thus, when assessing and treating fatigue, a transdiagnostic approach is preferred, taking into account biological, psychological and social factors.

The Scarcity of Literature on the Psychological, Social, and Emotional Effects of Gastroparesis in Children

Gastroparesis (GP) is a chronic, gastric dysmotility disorder with significant morbidity and mortality. The hallmark of GP is the delayed emptying of the contents of the stomach in the absence of any mechanical obstruction. Patients most commonly report chronic symptoms of nausea, vomiting, feeling full quickly when eating, bloating, and abdominal pain. Treatments are limited with relatively poor efficacy. As such, children with GP are at significant risk for the development of psychological co-morbidities. In this paper, we provide a topical review of the scientific literature on the psychological, social, and emotional impacts of gastroparesis in pediatric patients. We aim to document the current state of research, identify gaps in our knowledge with appropriate recommendations for future research directions, and highlight the unique challenges pediatric patients with GP and their families may face as they manage this disease. Based on the current review, research into the psychosocial impacts in children with GP is essentially non-existent. However, when considering research in children with other chronic digestive diseases, children with GP are likely to face multiple psychosocial challenges, including increased risk for anxiety and depression, stigma, and reduced quality of life. These significant gaps in the current understanding of effects of GP across domains of childhood functioning allow for ample opportunities for future studies to address psychosocial outcomes.

Peer-Victimization of Young Children With Developmental and Behavioral Difficulties-A Population-Based Study

OBJECTIVE

The aim is to investigate if young children with developmental and behavioral difficulties (DBDs) have greater risk of peer-victimization compared with typically developing (TD) children.

METHOD

The sample was drawn from the Norwegian Mother and Child Cohort Study (MoBa). MoBa has collected population-based data on children's health and development for 114,500 children. We included children that were 5 years of age (n = 41,609). Multivariate logistic regression was used to estimate the effect of different DBDs and of co-occurring DBDs on peer-victimization compared with TD children. Categories of DBDs included autistic traits, emotional difficulties, behavioral difficulties, general learning difficulties, attention difficulties/impulsive behavior, motor development difficulties, language difficulties, and hearing and vision difficulties. Results were adjusted for socioeconomic status and the child's sex.

RESULTS

Peer-victimization was 2.8% (933) among TD children, and 8.0% (615) among children with DBD. The highest risk of peer-victimization was found among children with autistic traits and children with five or more co-occurring DBDs (adjusted odds ratios [ORs] = 12.76; 95% confidence interval [CI] 8.64-18.84; p ≤ .001) and 17.37 (95% CI 12.15-24.82; p ≤ .001)], respectively. The lowest risk was found among children with hearing and vision difficulties and children with only one DBD [adjusted ORs = 1.98 (95% CI 1.71-2.29; p ≤ .001) and 1.95 (95% CI 1.70-2.22; p ≤ .001)].

CONCLUSION

Children with DBD have a substantially higher risk of peer-victimization compared with TD children. Peer-victimization varies with type of DBD and increases cumulatively by number of DBDs.

Risk Behaviors in Teens with Chronic Kidney Disease: A Study from the Midwest Pediatric Nephrology Consortium

Introduction

There is a paucity of information about risk behaviors in adolescents with chronic kidney disease (CKD). We designed this study to assess the prevalence of risk behaviors among teens with CKD in the United States and to investigate any associations between risk behavior and patient or disease characteristics.

Methods

After informed consent, adolescents with CKD completed an anonymous, confidential, electronic web-based questionnaire to measure risk behaviors within five domains: sex, teen driving, alcohol and tobacco consumption, illicit drug use, and depression-related risk behavior. The reference group was composed of age-, gender-, and race-matched US high school students.

Results

When compared with controls, teens with CKD showed significantly lower prevalence of risk behaviors, except for similar use of alcohol or illicit substances during sex (22.5% vs. 20.8%, p=0.71), feeling depressed for ≥2 weeks (24.3% vs. 29.1%, p=0.07), and suicide attempt resulting in injury needing medical attention (36.4% vs. 32.5%, p=0.78). Furthermore, the CKD group had low risk perception of cigarettes (28%), alcohol (34%), marijuana (50%), and illicit prescription drug (28%). Use of two or more substances was significantly associated with depression and suicidal attempts (p < 0.05) among teens with CKD.

Conclusions

Teens with CKD showed significantly lower prevalence of risk behaviors than controls. Certain patient characteristics were associated with increased risk behaviors among the CKD group. These data are somewhat reassuring, but children with CKD still need routine assessment of and counselling about risk behaviors.

GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care

BACKGROUND

Bullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help from a GP. However, there is currently little research on GPs' views on and perceptions of their role in dealing with disclosures of bullying in primary care.

AIM

To explore GPs' views about their role in dealing with CYPs' disclosures of being bullied, especially factors that have an impact on GPs' roles.

DESIGN AND SETTING

In this cross-sectional qualitative study, semi-structured interviews were conducted with GPs in primary care in England from October to December 2017.

METHOD

Purposive sampling was used to achieve variation in GP age, professional status in practice, profile of the patients served by the practice, practice size and location, and whether the GPs considered themselves to be actively in research or teaching.

RESULTS

Data from 14 semi-structured interviews revealed three main themes: remaining clinically vigilant; impact of bullying in schools; and training and guidance on dealing with bullying and cyberbullying. GPs felt that dealing with disclosures of bullying and cyberbullying came down to their clinical experience rather than guideline recommendations, which do not currently exist, and that bullying was a precipitating factor in presentations of CYPs' mental health issues.

CONCLUSION

GPs feel they have a role to play in managing and supporting the health of CYP who disclose being bullied during consultations. However, they feel ill-equipped to deal with these disclosures because of lack of professional development opportunities, and guidance on treating and managing the health consequences of being bullied.

Mental health disorders, participation, and bullying in children with cerebral palsy

AIM

To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP).

METHOD

This cross-sectional study included 6- to 17-year-olds with (n=111; 40.4% 6-11y, 59.6% 12-17y) and without (n=29 909; 50.2% 6-11y, 49.8% 12-17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention-deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships.

RESULTS

After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9-8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4-11.3), and multimorbidity (OR 2.8; 95% CI 1.1-7.0), but not depression (OR 1.4; 95% CI 0.6-3.8) or attention-deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6-4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased.

INTERPRETATION

The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors.

WHAT THIS PAPER ADDS

Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population.

Marfan syndrome in childhood: parents' perspectives of the impact on daily functioning of children, parents and family; a qualitative study

Background

Marfan syndrome (MFS) is a heritable connective tissue disease caused by a defect in FBN1. The diagnosis is based on the revised Ghent criteria. The main features involve the cardiovascular, musculoskeletal, ophthalmic, pulmonary systems and facial features. Although the clinical manifestations of MFS in children are thoroughly addressed in several studies, literature on the impact of MFS on daily functioning is restricted to pediatric advice on sports and leisure participation. Therefore, the full impact of MFS on daily functioning remains unclear. The aim of this qualitative study was to explore parents’ perspectives on the impact of MFS on daily functioning of children with MFS aged 4–12 years, themselves and family regarding functional performance, activities, participation, personal and environmental factors, and disease burden.

Methods

In this qualitative study parents participated in individual semi-structured interviews (n = 10) and 3 focus groups (n = 5, n = 5 and n = 6). Meetings were transcribed, and data were analyzed using thematic analysis. Meaningful concepts were coded, and concepts concerning children with MFS were linked to the International Classification of Functioning, Disability and Health for Children and Youth. Thereafter themes were identified and interpreted.

Results

Parents reported their children could not keep up with peers because of fatigue, pain and physical impairments. Children experienced participation restrictions in school, sports, play and other leisure activities. Parents reported their child as being different due to physical appearance, which provoked unsupportive attitudes. Parental burden was caused by high care needs, lack of support, a limited social life, and concerns about the child’s development. Family burden was caused by adjusted and complex family schedules, other family members with MFS, and reproductive planning decision-making, whereas family cohesiveness and caring were positively perceived factors.

Conclusions

Parents perceived a large impact of MFS on daily functioning of their children with MFS, themselves and their family. More awareness among all professionals involved in the care of children with MFS and their families is needed so that professionals can address their support needs and provide tailored interventions, rehabilitation and/or educational programs to empower and improve daily functioning of the children, parents and family.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1612-6) contains supplementary material, which is available to authorized users.

Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study

AIM

To examine the prevalence of mental health disorders among children with and without cerebral palsy (CP), and to examine how physical risk factors in children with CP might mitigate any elevated risk of mental health disorders in this population.

METHOD

Children from 6 years to 17 years of age with (n=111) and without (n=29 909) CP from the 2016 National Survey of Children's Health were included in this cross-sectional study. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention deficit disorder/attention-deficit/hyperactivity disorder (ADHD). Physical risk factors included physical activity (number of active days ≥60min), sleep duration, and pain.

RESULTS

Adjusting for sociodemographics, children with CP had higher odds of mental health disorders (odds ratio [OR]=2.7-7.1, p<0.05) except for attention deficit disorder/ADHD (OR=2.5; 95% confidence interval [CI]=0.9-7.1). Further adjusting for physical factors, the odds of depression were no longer increased (i.e. attenuated) in children with CP (OR=1.0; 95% CI=0.3-3.3); however, the odds of anxiety (OR=3.8; 95% CI=1.9-7.8) and behavior/conduct problems (OR=3.8; 95% CI=1.3-11.1) remained elevated. Assessed individually, low physical activity and pain attenuated the odds of depression in children with CP (OR=1.9; 95% CI=0.7-5.3; OR=1.4; 95% CI=0.6-3.8 respectively).

INTERPRETATION

Children with CP have an elevated prevalence of mental health disorders even after accounting for physical risk factors. Low physical activity and pain partially accounts for the association between CP and depression.

WHAT THIS PAPER ADDS

Children with cerebral palsy (CP) have an elevated risk of developing mental health disorders. Physical factors do not fully account for higher mental health disorder prevalence. Physical activity partially accounts for the relationship between CP and depression. Pain partially accounts for the relationship between CP and depression.

A Systematic Review Summarizing the State of Evidence on Bullying in Childhood Cancer Patients/Survivors

BACKGROUND

One in four school-aged children is bullied. However, the risk may be greater for childhood cancer patients/survivors (diagnosed <18 years), because of symptoms of the disease and treatment that may prejudice peers. While the serious consequences of bullying are well documented in the general population, bullying may have even greater impact in children with cancer due to the myriad of challenges associated with treatment and prolonged school absence.

OBJECTIVE

To summarize the state of evidence on bullying in childhood cancer patients/survivors; specifically, the rate and types of bullying experienced and the associated factors.

METHOD

We searched five electronic databases from inception to February 2018 for original research articles reporting on bullying in childhood cancer patients/survivors.

RESULTS

We identified 29 eligible articles, representing 1,078 patients/survivors ( M = 14.35 years). Self-reports from patients/survivors revealed a considerably higher rate of bullying (32.2%) compared with the general population (25%). Our review identified little information on the factors associated with bullying in patients/survivors. However, the bullying described tended to be verbal and was often related to the physical side effects of treatment, indicating that differences in appearance may prejudice peers. It was further suggested that educating the child's classmates about cancer may prevent bullying.

CONCLUSIONS

Our findings confirm that bullying is a significant challenge for many childhood cancer patients/survivors. Additional studies are needed to identify factors that may influence the risk of bullying, which will inform the development of evidence-based interventions and guidelines to prevent bullying in childhood cancer patients/survivors.

Bullying among people with visual impairment: Prevalence, associated factors and relationship to self-efficacy and life satisfaction

AIM

To examine associated factors of bullying and to determine associations between bullying and psychosocial outcomes among individuals with visual impairments (VI).

METHODS

We conducted an age-stratified cross-sectional survey of adults with VI who were recruited from the Norwegian Association of the Blind and Partially Sighted. Data were collected through structural telephone interviews in the period between February and May, 2017. Linear regression models were used to examine factors related to bullying and associations of bullying with self-efficacy and life satisfaction.

RESULTS

A total of 736 individuals were interviewed. The lifetime and 6-mo prevalence of bullying was 41.7% and 8.2%, respectively. The majority of bullied participants reported VI-specific bullying (65.1%). Victimization of bullying was associated with young age, early onset-age of VI, and having other impairments. Participants who reported bullying had lower levels of self-efficacy [Adjusted relative risk (ARR): 0.40, 95% confidence interval (CI): 0.19-0.85] and life satisfaction (ARR: 0.68, 95%CI: 0.51-0.91).

CONCLUSION

Bullying is highly prevalent among individuals with VI. Our findings suggest that interventions to reduce bullying may be beneficial for improving the well-being and life quality of people with VI.