Bored to death: Artificial Intelligence research reveals the role of boredom in suicide behavior.

Background: Recent advancements in Artificial Intelligence (AI) contributed significantly to suicide assessment, however, our theoretical understanding of this complex behavior is still limited. Objective: This study aimed to harness AI methodologies to uncover hidden risk factors that trigger or aggravate suicide behaviors. Methods: The primary dataset included 228,052 Facebook postings by 1,006 users who completed the gold-standard Columbia Suicide Severity Rating Scale. This dataset was analyzed using a bottom-up research pipeline without a-priory hypotheses and its findings were validated using a top-down analysis of a new dataset. This secondary dataset included responses by 1,062 participants to the same suicide scale as well as to well-validated scales measuring depression and boredom. Results: An almost fully automated, AI-guided research pipeline resulted in four Facebook topics that predicted the risk of suicide, of which the strongest predictor was boredom. A comprehensive literature review using APA PsycInfo revealed that boredom is rarely perceived as a unique risk factor of suicide. A complementing top-down path analysis of the secondary dataset uncovered an indirect relationship between boredom and suicide, which was mediated by depression. An equivalent mediated relationship was observed in the primary Facebook dataset as well. However, here, a direct relationship between boredom and suicide risk was also observed. Conclusion: Integrating AI methods allowed the discovery of an under-researched risk factor of suicide. The study signals boredom as a maladaptive 'ingredient' that might trigger suicide behaviors, regardless of depression. Further studies are recommended to direct clinicians' attention to this burdening, and sometimes existential experience.

Comparative Effectiveness of Ultra-Brief, IPT-A Based Crisis Intervention for Suicidal Children and Adolescents.

BACKGROUND: In recent years, suicidal thoughts and behaviors have become increasingly common among children and adolescents, leading to an elevation in the number of visits to emergency departments in pediatric hospitals. In Israel, the rising demand for mental health treatment due to suicidal distress is also salient, creating prolonged wait periods and low case acceptance rates. Addressing the urgent need for streamlined interventions, the present study outlines the design and results of a non-inferiority effectiveness trial of an ultra-brief suicide crisis intervention based on Interpersonal Psychotherapy for Adolescents (IPT-A-SCI). METHODS: 309 children and adolescents presenting to the Depression and Suicide Clinic at Schneider Children's Medical Center of Israel with depressive and anxiety symptoms and/or suicidal ideation/behavior were assigned to either IPT-A-SCI, Treatment as Usual (TAU), or waitlist condition. Assessments were conducted pre- and post-intervention/after five sessions/five weeks (as secondary assessments) in accordance with group assignment. RESULTS: At secondary assessment, post IPT-A-SCI, suicide ideation, and behavior as well as depression and anxiety symptoms significantly decreased, with no group differences observed between IPT-A-SCI, TAU, and control groups. CONCLUSION: IPT-A-SCI is feasible and as effective as the standard treatment in reducing suicidal, depressive, and anxiety symptoms among children and adolescents.

When a Patient Dies From Suicide: A Survey Among Mental Health Professionals in Israel.

Death of patients by suicide can have powerful impacts on mental health professionals (MHPs). The National Program for the Prevention of Suicidality and Suicide at Israel's Ministry of Health decided to invest in MHPs who have lost patients by suicide. Two hundred and two MHPs completed an online self-report survey regarding their emotional response, professional identity, and clinical practice, and the aid they felt would be supportive following a patient's suicide. Results indicated that 35% of MHP experienced at least one death of a patient by suicide. Respondents experienced difficult emotional reactions, and many felt responsible for the suicide. Nearly 50% reported that the patient's suicide affected their clinical practice. Most respondents reported the need for a support framework and information about the processes following a patient's suicide. It is important to increase awareness of the possibility of losing a patient by suicide and offer an appropriate supportive framework.

Real-Time Real-World Digital Monitoring of Adolescent Suicide Risk During the Six Months Following Emergency Department Discharge: Protocol for an Intensive Longitudinal Study.

BACKGROUND: Suicide is the second leading cause of death in adolescents, and self-harm is one of the strongest predictors of death by suicide. The rates of adolescents presenting to emergency departments (EDs) for suicidal thoughts and behaviors (STBs) have increased. Still, existing follow-up after ED discharge is inadequate, leaving a high-risk period for reattempts and suicide. There is a need for innovative evaluation of imminent suicide risk factors in these patients, focusing on continuous real-time evaluations with low assessment burden and minimal reliance on patient disclosure of suicidal intent. OBJECTIVE: This study examines prospective longitudinal associations between observed real-time mobile passive sensing, including communication and activity patterns, and clinical and self-reported assessments of STB over 6 months. METHODS: This study will include 90 adolescents recruited on their first outpatient clinic visit following their discharge from the ED due to a recent STB. Participants will complete brief weekly assessments and be monitored continuously for their mobile app usage, including mobility, activity, and communication patterns, over 6 months using the iFeel research app. Participants will complete 4 in-person visits for clinical assessment at baseline and at the 1-, 3-, and 6-month follow-ups. The digital data will be processed, involving feature extraction, scaling, selection, and dimensionality reduction. Passive monitoring data will be analyzed using both classical machine learning models and deep learning models to identify proximal associations between real-time observed communication, activity patterns, and STB. The data will be split into a training and validation data set, and predictions will be matched against the clinical evaluations and self-reported STB events (ie, labels). To use both labeled and unlabeled digital data (ie, passively collected), we will use semisupervised methods in conjunction with a novel method that is based on anomaly detection notions. RESULTS: Participant recruitment and follow-up started in February 2021 and are expected to be completed by 2024. We expect to find prospective proximal associations between mobile sensor communication, activity data, and STB outcomes. We will test predictive models for suicidal behaviors among high-risk adolescents. CONCLUSIONS: Developing digital markers of STB in a real-world sample of high-risk adolescents presenting to ED can inform different interventions and provide an objective means to assess the risk of suicidal behaviors. The results of this study will be the first step toward large-scale validation that may lead to suicide risk measures that aid psychiatric follow-up, decision-making, and targeted treatments. This novel assessment could facilitate timely identification and intervention to save young people's lives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46464.

Revisiting the intake policy at the mental child and adolescent clinics.

BACKGROUND: The psychiatric intake interview is crucial for the delivery of quality care. Currently, the interview in most public clinics varies in nature. It often consists of a clinical face-to-face interview (structured/unstructured) with or without self-report questionnaires (systematic/non-systematic). By integrating structured computerized self-report questionnaires into the intake, the assessment process could be shortened, and diagnostic accuracy increased. OBJECTIVES: The study aims to assess whether adding structured computerized questionnaires will increase the efficacy of the intake process, as indicates by shortened intakes and a higher level of diagnostic accuracy, for children and adolescents in mental health clinics in Israel. METHODOLOGY: Patients (Mage = 8.62, SDage = 1.86; 33.8% females) referred to the youth mental health clinic of Maccabi HaSharon district, were included in either the CIA group (Comprehensive Intake Assessment - with questionnaires) or IAU group (Intake as Usual - without questionnaires). RESULTS: In terms of accuracy and time measurements, the CIA group had higher diagnostic accuracy and a shorter intake duration of 6.63 min, almost 15% of an intake meeting, compared to the IAU group. No differences were found in satisfaction and therapeutic alliance between the groups. CONCLUSIONS AND IMPLICATIONS: More accurate diagnosis is essential to tailor the appropriate treatment for the child's needs. Moreover, reducing intake time by a few minutes contributes significantly to the ongoing activities of mental health clinics. With this reduction, more intakes can be scheduled at a given time, optimizing the intake process, and reducing long wait times, which are increasing due to the growing demand for psychotherapeutic and psychiatric care.

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.

Continuity of care in suicide prevention: current status and future directions.

Introduction: Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide. Methods: The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention. Results: The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations. Conclusion: CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.

Association of Cyberbullying Experiences and Perpetration With Suicidality in Early Adolescence.

Importance: Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts. Objective: To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence. Design, Setting, and Participants: This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years. Exposures: Youth reports of cyberbullying experiences or perpetration. Main Outcomes and Measures: The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression. Results: A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P < .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P < .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P < .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P < .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration. Conclusions and Relevance: In this cross-sectional study, experiencing-but not perpetrating-cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents' experience with cyberbullying.

Bullying perpetration and victimization associations to suicide behavior: a longitudinal study.

Previous studies have reported a longitudinal association between cybervictimization and suicidal thoughts and behavior. However, the relationship between cyber-perpetration and prospective suicide risk remains unclear. The sample was composed of 2150 at-risk adolescents (mean age 15.42), enrolled in Vocational Education and Training high schools in Israel. Cyberbullying, traditional bullying, depression, hostility, serious suicidal ideations, and suicide attempts were assessed through self-report questionnaires at the beginning of the school year and one year later. All types of victimization and preparation were cross-sectionally associated with suicide ideation and attempts. Longitudinal associations were found between cyber-perpetration and suicidal ideation/attempts. Cyber-perpetrators were found to be over twice more likely to report serious suicidal ideation (OR = 2.04) or attempt suicide (OR = 2.64) in the subsequent year compared to noninvolved adolescents. These associations were significant even after adjusting for baseline depression, hostility, and traditional bullying. Traditional bullying perpetration was prospectively associated with suicide attempts. Traditional victimization was cross-sectionally associated with suicide ideation and attempts but not prospectively. Cybervictimization was prospectively associated with suicide ideation but not to suicide attempts. The findings demonstrate the prospective risk of involvement in bullying in regard to suicide ideation and behavior. Cyberbullying was found to be a somewhat differentiated phenomena from traditional bullying.

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

The moderation of attachment in the association between depressive symptoms and self-harm among a clinical sample.

BACKGROUND: Self-harm is a severe health problem worldwide and in particular in clinical settings. The association of depression and self-harm has been extensively studied alongside various variables that have been examined as moderating this association. However, no previous study has examined the moderating role of attachment in this association. AIM: We explored the role of attachment orientation in moderating the association between depressive symptoms and self-harm among a sample of patients in a community mental health clinic. METHOD: This study was a de-identified archival study of patients' medical charts, and used a convenience sample of 199 patients, which completed self-report measures following the initial intake appointment as part of clinic procedures. RESULTS: Findings showed that both attachment anxiety and avoidance moderated the association between depressive symptoms and self-harm, such that depressive symptoms were positively associated with self-harm only when attachment anxiety scores were high, and attachment avoidance scores were high or average. CONCLUSIONS: Attachment anxiety and avoidance should be assessed in the initial intake of patients as it has a contribution to understanding self-harm vulnerability among new patients. Future studies should explore this moderation longitudinally so causality could be inferred.

Impact of a New Parent Behavioral-Schema Training on Children with ADHD: A Pragmatic Control Trial.

OBJECTIVES: To examine whether adding schema therapy strategies to the conventional parent behavioral program prevents symptom relapse in children with attention deficit hyperactivity disorder (ADHD). METHOD: The intervention was designed as an adaptive pragmatic control trial. The parent behavioral training and schema-enhanced parent behavior therapy (SPBT) protocols were delivered to the control group (40 parents of 23 children) and experimental group (97 parents of 54 children), respectively. Participants were assessed at baseline, mid-treatment, and termination. Parents and teachers indicated the severity of ADHD and comorbid symptoms through their responses to standardized questionnaires designed for this purpose. RESULTS: A nested growth curve analysis demonstrated that participants in the schema-enhanced intervention group had a lower risk of symptom relapse than the control group. CONCLUSION: Participation in the SPBT program significantly reduced relapse rates by the end of the intervention. Future research may determine the long-term effects of the treatment.

Depression Symptoms as Mediator Between Adolescents' Sense of Loneliness at School and Nonsuicidal Self-Injury Behaviors.

Background: Previous studies indicated that perception of school experiences (i.e., teachers' psychological support and perceived peer climate) is associated with nonsuicidal self-injury (NSSI) behaviors among adolescents. Aims: The purpose of the current study was to explore whether depression symptoms mediate the relationship between sense of loneliness in school and NSSI behaviors among adolescents. Method: The sample included high-school students (N = 306; 51.6% girls) who completed surveys assessing their subjective sense of loneliness (feeling lonely, spending their time alone in school, and reporting a small number of friends), depression symptoms, and NSSI behaviors. Results: Multiple-group structural equation modeling, stratified by gender, supported the hypothesized model. Sense of loneliness was associated with depression symptoms, which in turn were associated with NSSI. Positive school attitudes were associated with depression symptoms only for girls. Results were robust when controlling for the relationships with parents. Limitations: The study is based on cross-sectional data, which limits the ability to make causal conclusions, and the instruments are based on self-report scales. Conclusion: Mental health professional are advised to note the significant role of subjective sense of loneliness in school as a possible risk factor for depression symptoms, which may be associated with NSSI behaviors.

Did Bullying Victimization Decrease After Nationwide School-Based Antibullying Program? A Time-Trend Study.

OBJECTIVE: We assessed changes in traditional and cyberbullying victimization, and their associations with mental health, before and after the introduction of a nationwide antibullying program in Finnish schools in 2009. METHOD: This time-trend assessment comprised two methodologically identical cross-sectional survey studies, with 2,061 adolescents in 2008 (response rate 90.2%) and 1,936 in 2014 (91.8%). Their mean age was 14.4 years. They completed questionnaires about traditional and cyberbullying, mental health, and perceptions of school safety. Odds ratios (OR) and 95% CIs are presented with 2008 as the reference year. RESULTS: From 2008 to 2014, traditional victimization decreased from 28.9% to 19.1% (odds ratio [OR] = 0.5, 95% CI = 0.4-0.7) among boys and from 23.2% to 17.4% (OR = 0.7, 95% CI = 0.6-0.9) among girls. Cyberbullying victimization remained fairly stable at 3.3% and 3.0% (OR = 0.7, 95% CI = 0.4-1.2) for boys and at 2.7% and 4.1% (OR = 1.4, 95% CI = 0.9-2.4) for girls. Combined traditional and cyberbullying victimization decreased from 6.1% to 3.9% (OR = 0.5, 95% CI = 0.4-0.8) among boys and from 7.5% to 6.7% (OR = 0.8, 95% CI = 0.6-1.2) among girls. Those experiencing both traditional and cyberbullying reported the highest mental health problems. Perceived school safety improved among boys, but not among girls. Both boys and girls reported greater efforts by teachers and fellow students to stop bullying. CONCLUSION: Combined traditional and cyberbullying victimization was an indicator of comorbid mental health problems. Interventions that target both types of bullying, and that are integrated with mental health promotion, are needed.

Early changes in depression predict outcomes of inpatient adolescent anorexia nervosa.

PURPOSE: The aim of this study was to investigate the predictive value of early changes in depression levels during inpatient treatment of adolescent anorexia nervosa (AN). METHODS: Fifty-six adolescents (88% girls) aged 10-18 years (M = 15.35, SD = 2.23) diagnosed with AN were assessed at admission and 1 month following admission to an inpatient setting. Depression levels and eating disorder symptoms were reported at both assessments. Re-hospitalization within 12 months of discharge was documented using official national records. RESULTS: Whereas depression levels at baseline were found equivalent between subsequently re-hospitalized and non-re-hospitalized patients, at 1 month after admission patients who were later re-hospitalized had higher levels of depression compared to those who were not re-hospitalized. These differences remained significant after controlling for weight gain and anti-depressant medication intake. We additionally found that the proportion of boys in the non-re-hospitalized group was substantially larger than their proportion in the re-hospitalized group. CONCLUSIONS: Our results suggest that depression at the point of hospital admission may not be a reliable predictor of treatment outcomes, and highlight the risk of relapse in AN patients whose depression levels do not alleviate after a month of inpatient treatment. Clinicians should consider providing more adjusted and intensive attention to such patients in their efforts to facilitate remission. LEVEL OF EVIDENCE III: Well-designed cohort study.

Peer Victimization, Coping Strategies, Depression, and Suicidal Ideation Among Young Adolescents.

Background: Victimization by bullying among adolescents is a widespread phenomenon associated with depression and suicidal ideation. Coping with bullying may include aggressive responding and self-blame. Aims: The purpose of this study was to examine the role adolescent self-blame and aggression - representing coping with peer bullying - in depression and suicide ideation. Method: We recruited 97 "pure" victims (41 girls; mean age = 12.69, SD = .80) identified from a sample of 505 adolescents (242 girls; mean age = 12.73, SD = .81) from two Israeli high schools. Self-report questionnaires were used to assess victimization, aggressive responses, self-blame, depression, and suicide ideation. Results: Self-blame in the face of peer bullying was uniquely associated with both depression and suicide ideation. The effect was robust even after controlling for level of victimization. No direct effect of aggressive coping or moderating effects of self-blame or aggression on the association between victimization and depression/suicide ideation were found. Limitations: This study used a cross-sectional design and made exclusive use of self-report measures. Conclusion: Adolescents who blame themselves for being bullied might be at a heightened risk for depression and suicidality compared to adolescents who did not use self-blame.

Attenuated psychosis and basic self-disturbance as risk factors for depression and suicidal ideation/behaviour in community-dwelling adolescents.

BACKGROUND AND AIMS: Adolescents at clinical high risk (CHR) for psychosis, as defined by the presence of attenuated psychosis symptoms (APS), exhibit increased levels of suicidal ideation and behaviour. However, no research thus far has examined the link between basic self-disturbances (SDs), an established marker for CHR, and suicidality/self-harm in this population. The goal of this pilot study was to assess the association between SD, depression and suicidal ideation and behaviour among non-help-seeking adolescents from the community. METHOD: A total of 100 community-dwelling adolescents (age range: 13-16) were assessed using the Examination of Anomalous Self-experience, Prodromal Questionnaire, Structured Interview for Prodromal Syndromes, Mood and Anxiety Symptom Questionnaire and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). The K-SADS was used to derive a binary diagnosis of unipolar depression, as well as to measure suicidal ideation and behaviour and self-harm. RESULTS: In a multiple regression analysis, SD accounted for variance in depressive symptoms and suicidality/self-harm over and above that accounted for by APS. Moreover, SD accounted for variance in suicidality/self-harm over and above that accounted for by depression symptoms. CONCLUSIONS: These pilot results suggest that SD might be a unique dimension of vulnerability to depression and suicidality/self-harm in adolescence. Also, they encourage assessment of SD as part of a suicide risk assessment, particularly in the context of risk for subsequent psychosis.

Bi-directional longitudinal associations between different types of bullying victimization, suicide ideation/attempts, and depression among a large sample of European adolescents.

BACKGROUND: The association between bullying victimization and depression, suicide ideation and suicide attempts has been studied mainly in cross-sectional studies. This study aims to test the bidirectional effect and the chronicity versus sporadic effect of physical, verbal, and relational bullying victimization on suicidal ideation/attempts and depression. METHODS: Longitudinal assessments with an interval of 3- and 12-months were performed within a sample of 2,933 adolescents (56.1% females; mean age 14.78, SD = .89) from 10 European countries, participating in the Saving and Empowering Young Lives in Europe (SEYLE) school-based multicenter control sample. Multilevel Structural Equation Models were used, controlling for sociodemographic variables. Victimization was considered chronic when a student was victimized in the first two time points and sporadic when it was reported only at one point but not in another. RESULTS: Bidirectional prospective association between all types of victimization and depression were found. Among participants, who reported victimization once (but not twice), physical victimization, but not verbal and relational, was associated with later suicidal ideation and attempts. Chronic victimization of any type increased likelihood for later depression compared with sporadic and no-victimization. Chronic relational victimization increased the likelihood of later suicidal ideation, and chronic physical victimization increased the likelihood for suicidal attempts. CONCLUSIONS: The results support the bidirectional effect of victimization and depression and indicate that there are complex longitudinal associations between victimization and suicidal ideation/attempts. Physical victimization may especially carry effect on suicidal risk over time. Interventions should focus on victimization as a cause of distress but also aim to prevent vulnerable adolescents from becoming targets of victimization.

Bullying victimization and depressive symptoms in adolescence: The moderating role of parent-child conflicts among boys and girls.

INTRODUCTION: The association between bullying victimization and depressive symptoms has been studied extensively over the years. Among the variables studied as having an impact on this association were different characteristics of the parent-child relationship. The current study was the first to specifically examine parent-child conflicts as a moderator in the association between victimization and depressive symptoms among adolescents. In addition, it was the first to examine the roles of the child and parent's gender in this moderation. METHODS: 505 7th-9th graders from two schools in two different cities across Israel (mean age = 12.736, SD = 0.8154) participated in this study. 223 (44.2%) of the participants were male. The participants filled out a battery of self-report questionnaires assessing the different study's variables. RESULTS: Significant gender differences were found: among girls, the association between bullying victimization and depressive symptoms was stronger when the level of parent-child conflicts was high, while among boys, it was stronger when the level of conflicts was low. CONCLUSIONS: Our results indicate that the psychological outcomes for victims depend on their relationship with their parents. Bullying intervention programs should include the victims' parents. Furthermore, intervention programs should be designed to fit the different needs of girls and boys.