Adolescents with chronic medical conditions such as asthma are at particularly high risk for being bullied.

Bullying victimization has been tied to a broad range of psychological and social conditions among adolescents, such as social isolation, depression and anxiety, psychosomatic symptoms, sleep disturbance, and poor school performance and attendance. In addition, adolescents with chronic medical conditions such as asthma are at particularly high risk for being bullied, according to previous research.

“Bullying is a significant problem among adolescents, and it is associated with numerous negative outcomes that can last a lifetime,” explains April Ancheta, PhD. “It can be particularly problematic during adolescence, a key time for the development of identity and self-esteem. We know having a chronic illness puts adolescents at greater risk for being bullied, but there are few studies on the intersection of having asthma and bullying victimization, and these studies rarely focus on youth from rural schools. Given that asthma rates and morbidity are high among rural youth, this is an important research gap that we set out to fill.”

‘Bullying Is Stressful, and Asthma is Triggered by Stress’

There are several potential ways that bullying impacts how well an adolescent can manage their asthma, says Jean-Marie Bruzzese, PhD. “Bullying is known to be associated with increased anxiety and depressive symptoms, and these symptoms may impede an adolescent’s ability to care for their asthma,” she notes. “Also, bullying negatively impacts one’s self-esteem, and it is plausible that this lack of confidence translates into confidence managing their asthma. Finally, bullying is stressful, and asthma is triggered by stress.”

For a study published in the Journal of Asthma, Drs. Ancheta and Bruzzese and colleagues examined the association between asthma and bullying victimization using a large rural cohort (N=1,905; 44.5% Black) of high school students. In a survey, students were asked about demographic characteristics, asthma symptoms and diagnosis, and bullying victimization.

The study team used logistic regression analyses with school as a fixed effect to assess the extent to which demographic factors, asthma diagnosis, and asthma status (ie, no asthma, current asthma, and possible undiagnosed asthma), as well as asthma severity among those with current asthma, were associated with bullying victimization. They also conducted sensitivity analyses using bullying frequency as the outcome.

Clinicians Should Be Aware of the Risk of Bullying Among Young Patients

They observed that more than a quarter (26.0%) of students reported bully victimization. Increased risk for bullying victimization was correlated with younger age and self-identifying as White. Students with current asthma or possible undiagnosed asthma were a greater risk for bullying victimization compared with those with no asthma (aORs, 2.42 and 2.46, respectively). Persistent symptoms increased the risk for bullying victimization among those with current asthma (aOR=2.59).

These findings suggest that rural students with asthma could benefit from schools creating inclusive environments that reduce victimization based on their medical condition, according to the study authors. In addition, “it is critical that allergist and primary care physicians who treat adolescents with asthma be aware of the increased risk for bullying victimization in their patients and the impact it has on asthma control,” Dr. Bruzzese says, suggesting that they can incorporate a brief screening scale into their practice.