School bullying in children and adolescents with neurodevelopmental and psychiatric conditions: a systematic review and meta-analysis

Background Bullying is a common form of violence among children and adolescents. Young people with neurodevelopmental or psychiatric conditions might have an increased risk of bullying victimisation and perpetration. We aimed to assess the odds of bullying involvement and its association with mental health measures in these populations. Methods In this systematic review and meta -analysis, we searched PubMed, ERIC, Psychology and Behavioural Sciences Collection, Web of Science Core Collection, PsycArticles, and PsycInfo databases from inception up to Aug 8, 2023, and included articles reporting data on bullying outcomes of current bullying (within the past year) among children and adolescents (aged 4-17 years) with a diagnosis of a neurodevelopmental or psychiatric condtion provided by a health professional. Bullying type was classified as traditional (physical, verbal, or relational) or as cyberbullying (intentional and repeated harm inflicted through electronic devices and social media), and bullying involvement was classified as victimisation, perpetration, and perpetration-victimisation. Mental health measures were collected and the associations with bullying involvement assessed. We used random-effects meta-analyses to estimate prevalence and odds ratios (ORs) for bullying involvement. Heterogeneity was assessed using the I2 statistic, and publication bias was tested with Egger's regression. This study is registered with PROSPERO, CRD42021235043. Findings We included 212 studies in the meta -analysis. The total sample comprised 126 717 cases (mean age 12 center dot 34 years [SD 1 center dot 82], 37 center dot 6% girls) and 504 806 controls (12 center dot 5 years [SD 1 center dot 86], 47 center dot 6% girls). For traditional bullying, the pooled prevalence was 42 center dot 2% (95% CI 39 center dot 6-44 center dot 9) for victimisation, 24 center dot 4% (22 center dot 6-26 center dot 3) for perpetration, and 14 center dot 0% (11 center dot 4-17 center dot 1) for perpetration-victimisation. For cyberbullying, the prevalence was 21 center dot 8% (16 center dot 0-28 center dot 9) for victimisation, 19 center dot 6% (13 center dot 4-27 center dot 7) for perpetration, and 20 center dot 7% (8 center dot 4-42 center dot 6) for perpetration-victimisation. Compared with controls, young people with neurodevelopmental or psychiatric conditions were more likely to be involved in traditional and cyberbullying as a victim (OR 2 center dot 85 [95% CI 2 center dot 62-3 center dot 09] and 2 center dot 07 [1 center dot 63-2 center dot 61]), perpetrator (2 center dot 42 [2 center dot 20-2 center dot 66] and 1 center dot 91 [1 center dot 60-2 center dot 28]), and perpetrator-victim (3 center dot 66 [2 center dot 83-4 center dot 74] and 1 center dot 85 [1 center dot 05-3 center dot 28]). Bullying involvement was associated with higher scores in mental health measures in young people with neurodevelopmental or psychiatric conditions, particularly internalising symptoms and externalising symptoms. Interpretation Our study underscores bullying involvement as a prevalent risk factor in young people with neurodevelopmental or psychiatric conditions that might add to their disease burden through its negative effects on mental health. Interventions targeting these vulnerable populations are warranted to improve their mental health and their future social integration. Funding Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Consorcio Centro de Investigacion Biomedica en Red. Copyright (c) 2023 Elsevier Ltd. All rights reserved.