Addressing bullying in primary care
Addressing bullying in primary care
LAS VEGAS — As young people continue to commit suicide due to bullying and cyberbullying, activist Tina Meier urged primary care clinicians to help prevent these losses by identifying mental illness in their adolescent patients.
In her presentation at the National Association of Pediatric Nurse Practitioners Annual Conference 2015 meeting, Meier told the story of her daughter, Megan Taylor Meier, who committed suicide in 2006. Megan had suffered from ADD and depression from a young age, but it was eventually cyberbullying that drove Megan to take her life at age 13.
In 2007, Meier founded the Megan Meier Foundation with the mission to “promote awareness, education, and positive change in response to the issues surrounding bullying, cyberbullying, and suicide.”
Since then, Meier has spoken to hundreds of thousands of students, educators, and medical professionals about bullying and mental illness.
“Talking to students across the country who have attempted or have suicidal ideations: They don't think about dying. That's not it. They want the pain to stop, and they don't feel that it's ever going to stop,” said Meier, “We have to find a way to be able to get to these kids before they ultimately either take that chance or complete suicide. That's my goal through all of this.”
Pediatric nurse practitioners and physician assistants are specially poised to help identify mental illness in adolescents, said Meier. By incorporating mental health screening into routine visits, primary care practitioners can help diagnose mental illnesses when their patients first start showing symptoms.
Screening for bullying
The first line of defense should be a questionnaire that patients can fill out in private, and the screening should be repeated even if the patient initially shows no warning signs.
If a patient seems to be at risk for mental illness, a full diagnostic workup should be performed. Clinicians should pay attention to any nonverbal signs the patient may display. Facial expressions and body language can offer important clues about adolescents' mental states.
If deemed necessary, the clinician should refer the patient to the appropriate community mental health services. Patients should be monitored to ensure they follow up with these recommendations.
Sometimes it isn't possible for patients to see a mental health professional, Meier noted. Many areas lack an adequate amount of psychologists and psychiatrists, and patients are either unable or unwilling to commute to a far-away doctor.
In other cases, some patients simply cannot afford the copayment associated with specialist doctors. In both of these cases, the primary care practitioner can help provide necessary mental health treatment for patients who would otherwise go untreated.
Bullying vs. cyberbullying
Bullying has become a hot-button topic fairly recently, but Meier said she believes that the word itself has become overused as a blanket term for every time a person is mean to someone else.
Bullying must contain two elements, according to Meier:
- It has to be repeated
- It has to have an imbalance of power
To put it in different terms, she likened bullying to harassment.
Cyberbullying is a more specific type of bullying that is facilitated through technology. Meier defined cyberbullying as “willful and repeated harm inflicted through the use of computers, cell phones, and other electronic devices to harass, threaten, [and] humiliate others.”
Cyberbullying has several unique features that can make it particularly harmful. Adolescents generally have access to technology all day, meaning that cyberbullying can occur constantly. Additionally, people often say or write things that they would not say in a face-to-face situation, which can result in particularly harsh insults. The ability to anonymously contact people on the internet can add to this effect, since many adolescents believe they cannot get caught.
Are certain teens more susceptible to bullying?
Certain risk factors make adolescents more likely to be victims of bullying, including learning disabilities, ADHD, autism spectrum disorder, chronic health problems, speaking another language at home, identifying as LGBTQ, and being over or underweight.
An estimated 2.2 million students were victims of cyberbullying in 2011, according to the National Crime Victimization Survey. While not all of these adolescents will react with suicidal ideation, having an undiagnosed or diagnosed mental illness greatly increases their risk for suicide.
According to several brain scan studies, adolescents react to peer exclusion the same way they react to threats to their food supply or physical safety. “There is no other time in our lives where being accepted by our peers is the most essential thing,” said Meier.
Other MRI studies have shown that adolescents and adults activate different parts of the brain when identifying emotions or motives. Adolescents use the amygdala, the region of the brain associated with fear, threat, and danger. Adults, on the other hand, use their prefrontal cortex, which is associated with reason and judgment.
When adolescents experience bullying, their brains send them into a state of panic, inhibiting their ability to think or react as they usually would. When a child is panicking, Meier stressed that adults should do what they can to calm them down.
Most importantly, adults should listen to what the child has to say and validate their emotions. Meier suggested changing the vocabulary used to address adolescents about bullying. Many adolescents do not respond well to the terms “bullying” and “cyberbullying.” Instead, frame the conversation in terms of the underlying issues, she said.
Some of the most significant problems that adolescents face are the stress and pressures of school. Focusing on these issues will create more meaningful conversations, suggested Meier.
When can bullying lead to suicide?
Most studies that have explored the link between bullying and suicide have found a positive association between the two. Suicide is the third leading cause of death among people aged 15 to 24 years. While females are more likely to attempt suicide, males are four times more likely to complete a suicide attempt.
Adolescents who are questioning their sexuality or are openly LGBTQ are two to three times more likely to be bullied and two to three times more likely to commit suicide than other adolescents.
Bullying and cyberbullying are complex issues that do not have a one-step solution. Instead, many different people need to play their respective parts to provide the victims with the support they need.
For primary care clinicians, that role is to help identify and treat mental illness in adolescent patients. Hopefully by getting patients the help they need, clinicians can help reduce the number of adolescents lost to suicide.