Currently browsing teen health posts

How to Reframe Your Child’s Negative, Anxious Self-Talk

Anxious-child-with-negative-thoughtsDo you have a child who is often emotional or moody – or prone to anxiety or depression? If so, you might be familiar with the negative self-talk that often contributes to these conditions. And, actually, any child – or adult – is subject to these thoughts on occasion.

Negative or anxious self-talk – sometimes also called “automatic negative thoughts” – is unhelpful, often skewed thinking that tends to drive negative emotions and behaviors. For example, your daughter might react to a friend who gets angry while playing and goes home, by thinking “I’m no fun to play with….nobody likes me” – and might avoid inviting any other kids to come over and play.

I learned about the concept of negative self-talk years ago through cognitive behavioral therapy while dealing with issues from my childhood. But I was surprised when I first began noticing examples of this thought pattern in my young son. When Elliott was in his first couple of years of elementary school, he would often come home at the end of the day and report that his day was “terrible”.

After digging a little I would often find out that one “bad” thing had happened each of these days – which then tainted the whole rest of the day. This overgeneralization / all-or-nothing thinking is an example of negative self-talk – and caused Elliott to have negative emotions about school and resist going in the mornings.

There are several different types of negative or anxious self-talk. A good reference book on anxiety for teens and kids – My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic (by Michael A. Tompkins, PhD and Katherine Martinez PhD) – gives an interesting classification for these unhelpful thoughts (a summary is listed at the end of this post). This book was recommended to me by a child and family psychologist and is well worth a read.

As the book title suggests, there are ways to deal with and manage such unhelpful thinking – and it’s useful to start early with kids who are prone to negative thoughts. At a minimum, it helps to start by identifying and unpacking the negative thought.

For example, with my son Elliott and his “terrible” days at school, I started asking him if anything good happened during the day. This got him to go over all the events of his time at school and put the “bad” experience into context – and I suggested that one or two bad experiences might not make a whole day terrible. Pretty soon, when I asked him how his day was, Elliott would outline how different parts of the day went (great, so-so, neutral, awful, etc) – and this pattern has persisted for more than five years! Even better, he has generally been much more positive about his school days ever since.

Additional exercises for recognizing and dealing with negative self-talk are provided in My Anxious Mind. Another practical book, with useful exercise to help teens cope with negative thoughts and other drivers of anxiety, is The Anxiety Workbook for Teens, by Lisa M. Schab, LCSW.

Types of Anxious Self-Talk  (from My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic)

Book Ends

This is anxious thinking that assumes there are only two possible outcomes of a situation – both at opposite extremes, with no possibilities in the middle. So, the child in the earlier example might be focused on how the play date with her friend needed to be perfect, and if that didn’t happen it would be a disaster.

Binocular Vision

In this unhelpful thought process, your child will “magnify” the effect of something bad – like failing a test – and assume that he won’t be able to go to college as a result. Or he might “shrink” the importance of something good, like all his excellent grades in other classes.

Fortune Telling

This type of self-talk involves your child thinking he or she can predict the future – usually thinking something bad will happen. For example, your child is engaging in fortune telling if she decides to audition for a part in the school play but spends the weeks leading up to the audition thinking “I’m not going to get the part”. Maybe she will, maybe she won’t – but she doesn’t know, and anxious self-talk won’t help the outcome either way.

Mind Reading

In the earlier example, the girl whose friend got angry and went home assumed that she could read her friend’s mind; that the friend thought she wasn’t fun and didn’t like her anymore. This is the mind reading track – and it’s important for the girl to know she isn’t a psychic and her friend will probably be back to play the next day.


With overgeneralization, similar to binocular vision, your child will focus on something small (usually bad) to make broad conclusions or sweeping statements – like, if one friend gets angry at me then no one likes me. Or if your son has one bad soccer game, assuming he’s no good and will get cut from the team.

End of the World

With this anxious track, your child is always expecting something terrible to happen. This could be at school or in relationships with friends, but it could also be thinking that every noise around the house is a burglar.

Should-y/Must-y Thinking

Too many thoughts with “shoulds” and “musts” can set the bar for performance and life experience way too high – and make your child anxious and less confident.

Mind Jumps

In this type of unhelpful thinking your child will jump to conclusions (usually negative) without all the facts – like when hearing that he isn’t invited to a party at a friend’s house, your son assumes his friend doesn’t like him. Getting the facts might tell him otherwise, especially if he finds out it’s a family-only affair (for example).


How to Help Your Underweight Teen Boy Get Healthy

Are you worried about being underweight? Or perhaps your friends or parents have mentioned it.

You may have friends who are taller, heavier and more muscular than you. We all grow and develop at different rates. Lots of boys don’t reach their adult weight until they are over 18.

You can check whether you’re a healthy weight by using our healthy weight calculator. If you are underweight, your GP (*pediatrician), practice nurse or school nurse can give you help and advice.

underweight-teen-boysThere may be an underlying medical cause for your low weight that needs to be checked out. Gut problems like coeliac disease, for example, can make people lose weight.

Read about other medical problems that can cause unexplained weight loss.

Maybe you’re having mental or emotional problems that have affected your eating habits. Depression and anxiety, for example, can both make you lose weight.

Or perhaps you haven’t been eating a healthy, balanced diet.

Whatever the situation, if you’re concerned about your weight or your diet, the best thing to do is tell someone. There’s a lot that can be done to help.

Why Being a Healthy Weight Matters

Being underweight can leave you with no energy and affect your immune system, meaning you could pick up colds and other infections more easily.

If your diet is poor, you may also be missing out on vitamins and minerals you need to grow and develop.

The good news is that, with a little help, you can gradually gain weight until you get to a weight that is healthy for your height and age.

Healthy Diet for Teen Boys

It’s important that you gain weight in a healthy way. Try not to go for chocolate, cakes, fizzy drinks and other foods high in fat or sugar. Eating these types of foods too often is likely to increase your body fat, rather than building strong bones and muscles.

Instead, aim to eat three meals and three snacks a day. You should be having:

  • Plenty of starchy carbohydrates, such as bread, pasta, rice and potatoes (choose wholegrain versions or potatoes with their skins on if you can)
  • At least five portions of a variety of fruit and vegetables a day
  • Some meat, fish, eggs, beans and other non-dairy sources of protein
  • Some milk and dairy food

We all need some fat in our diet, but it’s important to keep an eye on the amount and type of fat we’re eating. Try to cut down on the amount of saturated fat you eat  that’s the fat found in sausages, salami, pies, hard cheese, cream, butter, cakes and biscuits.

Cut down on sugary foods, such as chocolate, sweets, cakes, biscuits and sugary soft drinks.

Strength training can also help to build strong muscles and bones. Find out how to increase your strength and flexibility.

Boost Your Calories

To bump up your energy intake in a healthy way, try these tips:

  • Make time for breakfast. Try porridge made with semi-skimmed (*1% or 2% milk) milk and sprinkle some chopped fruit or raisins on top. Or how about eggs on toast with some grilled tomatoes or mushrooms?
  • Crumpets, bananas or unsalted nuts all make good snacks.
  • A jacket (*baked) potato with baked beans or tuna on top makes a healthy lunch and contains both energy-rich carbohydrates and protein. Adding cheese will provide calcium.
  • Try yoghurts and milky puddings, such as rice pudding.
  • Have a healthy snack before bed. Cereal with semi-skimmed milk is a good choice (choose a cereal that is lower in sugar), or some toast.

Find out how many calories the average teenager needs.

You should also make sure you get plenty of sleep. About 8 to 10 hours a day is ideal for teenagers. Avoid smoking and alcohol.

Teen Boys and Eating Disorders

Sometimes there can be other issues that stop you from eating a healthy diet.

If you feel anxious when you think about food, or you feel you may be using control over food to help you cope with stress, low self-esteem or a difficult time at home or school, then you may have an eating disorder.

People with eating disorders often say they feel that their eating habits help them keep control of their lives. But that’s an illusion: it’s not them who are in control, but the eating disorder.

If you feel you may have an eating disorder, help is available.

Tell someone: ideally your parents, guardians or another adult you trust.

The eating disorders charity b-eat has a Youthline, where you can get advice.

Editor’s Note: *clarification provided for our US readers.

Getting Questions About Sex? How to Talk to Your Child

If your child is asking questions about sex, they’re ready for truthful answers. It’s never too early to start talking about it – find out how to go about it.

Young children are naturally curious about their bodies and other people. By answering any questions they ask, you can help them understand their bodies, their feelings and other people’s feelings. This is a good basis for open and honest communication about sex and relationships, growing up and going through puberty.

Talking to children about sex won’t make them go out and do it. Evidence shows that children whose parents talk about sex openly start having sex at a later stage and are more likely to use contraception.

How Much Should I Tell My Child About Sex?

It depends on your child. If they seem happy with your answer and don’t ask a follow-up question, you’ve probably given them enough information. If they ask another question, you can tell them more.

You don’t have to go into detail. A short, simple answer might be enough. For example, if your three-year-old asks why she hasn’t got a penis like her brother, you could tell her that boys have penises on the outside and girls have vaginas on the inside. This could be enough to satisfy her curiosity.

Work out exactly what your child wants to know. For example, if they ask a question, such as “Where do babies come from?”, identify what they’re asking. Don’t make it more complicated than it needs to be.

You could answer by saying: “Babies grow in a woman’s tummy, and when they’re ready they come out into the world”. This might be enough.

If not, your child’s follow-up question could be, “How does the baby get in there?” You could answer, “A man puts a seed in there”. Or your child may ask, “How does the baby get out?” You could answer, “It comes out through a special passage in the woman’s body called a vagina”.

What do Children Need to Know About Sex?

They need to know that it’s OK to talk about sex and relationships, and that you’re happy to talk about it. They’ll learn this through your tone and manner when you talk about sex, so try to treat sex as a normal, everyday subject.

Beyond sex, your child needs to know the following main topics:

Your child needs to know about puberty before they go through it, otherwise they could be scared or shocked by the changes. Find out more about girls and puberty and boys and puberty.

Girls need to know about periods before they’re around 10 years old, and boys need to know about the changes they can expect before they’re around 12. There’s no reason for girls and boys not to learn the same things. For example, boys can learn about periods, and girls can learn about erections.

If your child is approaching the age where they need to know about puberty or sex and relationships, but they’re not asking questions about it, use everyday situations to lead to the conversation. For example, you could talk about a story in a TV programme, or bring up periods when you see sanitary pads in a shop.

Tell your child that they’re growing up, there will be some changes that happen to everyone and you want to let them know what to expect.

Why Your Child Should Know About Sex

Children need to know about sex, pregnancy, contraception and safer sex before they start any sexual activity. This is so they will know what to think about, such as safer sex and not doing anything they don’t want to do. This way, they can make decisions that are right for them when the time comes.

Most young people in the UK don’t have sex until they’re at least 16. Those who have sex before that age will need to know how to look after themselves.

Everyone needs to know about safer sex, whether they’re straight, gay, lesbian or bisexual. Women can pass STIs on to women and men can pass STIs on to men. For more information, see sexual health for women who have sex with women and for men who have sex with men.

Have an Answer Ready For Awkward Situations

No matter how open you are about sex, there will be times when you need a quick answer to deal with awkward questions, for example, in the supermarket queue or on a bus.

Say something like, “That’s a good question. I’d like to talk about that when we get home”, or “That’s a good question, but we need to talk about it in private”. Make sure you remember to talk about it later.

Read a useful leaflet on talking to your child about sex and relationships (PDF, 1.54Mb).

To find out where to get more information on sex, relationships, contraception and STIs, see Who can I go to for advice?

Course on Talking About Sex and Relationships for Parents

Researchers from Coventry University have designed an online course to help parents talk with their children about sex and relationships.

Parents can choose three modules covering the importance of communication and skills and timing for how they talk with their child.

Advice and examples are given for children aged 5 to 10, and also for tweens and teens.

Check out the course: Besavvy About Having Difficult Conversations.

Teen Suicide: How to Explain Your Grief to Your Child

My son is now fourteen and a Freshman in High School. Within months of starting the new school year, his high school marching band community suffered tragedy: the suicide of one of its members. And despite the large number of kids in the band – this tragedy was close. The boy who died, Patrick, was the head of my son’s instrument section.

teen suicide - my griefI didn’t know Patrick well, but the impact of his death on me was surprising.  Both the fact and the nature of it were a profound shock when I first heard about it – via text from my son when he arrived at school one Friday morning.

The next several days were a painful procession of events and rituals: gatherings at homes of the kids, a candlelight vigil at the school stadium where the band regularly practiced, visitations and funeral mass at the local Catholic Church.

I was concerned for my son, but I was also in pain. I cried a lot. I wanted to know what happened. I wanted to know “why?”  I kept picturing Patrick at practices. He was extremely alive, outgoing and very good looking. None of this should matter, but somehow it did. When we learned he had shot himself in a moment of despair over getting in some trouble, I thought about his parents. I was sick at the thought. I was also angry. Angry that he thought this was his only option. Angry that he had access to a gun.

My son was surprised by my grief. He kept saying that I hardly knew Patrick, and he didn’t expect me to want to attend the various gatherings. I began to feel that he might think I was “muscling in” on a situation that was personal to him. Certainly he and the others in his small instrument section were closing ranks and I let him go out with them a lot, and had a couple of boys stay for a sleepover after the vigil. He was crying a lot too and talking with his peers seemed to help.

But I was pretty sure my son couldn’t see past his own confusion and grief to know that I was also genuinely in pain. I couldn’t find a lot of resources for parent grief when a child’s friend dies, but one website – the Society for the Prevention of Teen Suicide (SPTS) – gave some good advice: First deal with your own feelings.

“It is critical for you to take time to deal with your own feelings before you approach your child.  Remember the directives from air travel about the use of oxygen masks – you must put on your own mask before you can help anyone else with theirs!”   SPTS

I thought about all the reasons why I was so upset: the senseless loss, empathy for his parents, concern for the impact on my son, even worry that some incidents between my son and Patrick (which I spoke to the Band Director about)  might have contributed to the suicide decision. Bottom line, I think it was just that it felt so wrong for a boy of just 17 to die like this. Thankfully, my son is a fairly good communicator – and so, finally, I talked about how I was in pain too and I asked if he had thoughts on why I was grieving even though I wasn’t close to Patrick. He was quite perceptive since he understood that I didn’t want the same thing to happen to him. But he didn’t realize how much I was identifying with Patrick’s parents, feeling at least some of their pain. And I couldn’t let things return to “normal” right away. The police officer who led the long snaking line of cars to the cemetery gave out large stickers reading “funeral” for our windshields. I kept the sticker on my console for a few weeks afterwards. It felt right to have a visible reminder of what had happened, and not to “move on” too quickly.

In the end, talking about my grief gave us a shared experience for coping with the ordeal. It also made it possible to talk about suicide in general and how, as someone I know put it: “suicide is a terrible and permanent solution to a temporary problem” – even if it doesn’t feel that way at the time.

Resources for dealing with teen suicide:

Harmful Drug Risks: What Your Teen Needs to Know

Drug abuse can be very harmful to health. We look at some of the most commonly taken illegal drugs, what they are, and how they can affect you or your teen.

CANNABIS (hash, weed, grass, skunk, marijuana)

What is cannabis?

Cannabis is a calming drug that also alters perceptions. It is seen as “natural” because it is made from the cannabis plant, but that doesn’t mean it is safe. It can be smoked, either with tobacco in a “joint” or “spliff”, or without tobacco in a “bong”. It can also be drunk as a “tea”, or eaten when mixed into biscuits or cakes.

How does cannabis make you feel?

Cannabis can make you feel relaxed and happy, but sometimes makes people feel lethargic, very anxious and paranoid, and even psychotic.

Teens and Drug RisksHow does cannabis affect your health?

Cannabis has been linked to mental health problems such as schizophrenia, and, when smoked, to lung diseases including asthma. Cannabis affects how your brain works, so regular use can make concentration and learning very difficult. Frequent use can have a negative effect on your fertility. It is also dangerous to drive after taking cannabis. Mixing it with tobacco is likely to increase the risk of heart disease and lung cancer.

Can cannabis be addictive?

Yes, it is possible to become psychologically dependent on cannabis. And some people do experience withdrawal symptoms when they stop taking it. For information about coming off drugs, go to Drugs: getting help. You can also get help cutting down from the FRANK website.

COCAINE (powder cocaine, coke, crack)

What is cocaine?

Powder cocaine (coke), freebase and crack are all types of cocaine, and all are powerful stimulants. Freebase and crack can be smoked, and powder cocaine can be snorted in lines. Both cocaine powder and crack can also be prepared for injecting.

How does cocaine make you feel?

Cocaine gives the user energy, a feeling of happiness and being wide awake, and an over-confidence that can lead to taking risks. The effects are short-lived, so more drug is taken, which is often followed by a nasty “comedown” that makes you feel depressed and unwell, sometimes for several days.

How does cocaine affect your health?

If you take cocaine, it is possible to die of an overdose from overstimulating the heart and nervous system, which can lead to a heart attack. Taking cocaine is particularly risky if you have high blood pressure or already have a heart condition. If you’re pregnant, cocaine can harm your baby and even cause miscarriage. If you’ve had previous mental health problems, it can increase the chance of these returning. If you snort cocaine, it can damage the cartilage of your nose over time. If you inject it, you are at higher risk of dying due to an overdose, and your veins and body tissues can be seriously damaged. If you share needles, you put yourself at risk of catching HIV or viral hepatitis.

Can cocaine be addictive?

Yes, cocaine is highly addictive and can cause a very strong psychological dependence. For advice on getting help for a cocaine addiction, go to Cocaine: get help. The Cocaine Anonymous website also offers further advice.

MEPHEDRONE (meow meow, miaow miaow, meph)

What is mephedrone?

Mephedrone is a strong amphetamine-like stimulant with some effects that are similar to ecstasy. It was once available to buy on the internet as a “legal” alternative to drugs such as speed or ecstasy. Mephedrone, and other cathinones like it, are now Class B drugs that are illegal to possess or supply to others. Mephedrone is a fine white or off-white powder that is usually snorted or swallowed wrapped in paper. It is also sometimes injected.

How does mephedrone make you feel?

It can make you feel awake, confident and happy. But it can also make you feel paranoid and anxious. It causes vomiting and headaches in some users.

How does mephedrone affect your health?

Mephedrone can overstimulate your heart and nervous system. It can cause periods of insomnia, and its use can lead to fits and to agitated and hallucinatory states. It has been identified as the cause of a number of deaths.

ECSTASY (MDMA, pills, crystal, E)

What is ecstasy?

Ecstasy is a “psychedelic” stimulant drug usually sold in tablet form, but is sometimes dabbed on to gums or snorted in its powder form. It is also known as MDMA or “crystal”.

How does ecstasy make you feel?

Ecstasy can make you feel alert, affectionate and chatty, and it can make music and colours seem more intense. Taking ecstasy can also cause anxiety, confusion, paranoia and even psychosis.

How does ecstasy affect your health?

Long-term use has been linked with memory problems, depression and anxiety. Ecstasy use affects the body’s temperature control and can lead to dangerous overheating and dehydration. But a balance is important as drinking too much fluid can also be very dangerous for the brain, particularly because ecstasy tends to stop your body producing enough urine, so your body retains the fluid. For more information see the FRANK website.

Is ecstasy addictive?

Ecstasy can be addictive, as users can develop a psychological dependence on this drug. It is also possible to build up a tolerance to the drug and a need to take more and more in order to get the same effect.

SPEED (amphetamine, billy, whizz)

What is speed?

Speed is the street name for drugs based on amphetamine, and is a stimulant drug. It is usually an off-white or pink powder that is dabbed onto gums, snorted or swallowed in paper.

How does speed make you feel?

Speed can make you feel alert, confident and full of energy, and can reduce appetite. But it can make you agitated and aggressive, and can cause confusion, paranoia and even psychosis. You can also become very depressed and lethargic for hours or days after a period of heavy use.

How does speed affect your health?

Taking speed can be dangerous for the heart, as it can can cause high blood pressure and heart attacks. It can be more risky if mixed with alcohol, or if used by people with blood pressure or heart problems. Injecting speed is particularly dangerous, as death can occur from overdose. Speed is usually very impure and injecting it can cause damage to veins and tissues, which can also lead to serious infections in the body and bloodstream. Any sharing of injecting equipment adds the risk of catching hepatitis C and HIV.

Is speed addictive?

Regular use of amphetamines can become highly addictive.


The following articles provide help and advice if you’re concerned about your own or someone else’s drug misuse:

Study: Sibling Bullying Linked to Depression as Adult

“Being bullied regularly by a sibling could put children at risk of depression when they are older,” BBC News reports.

A new UK study followed children from birth to early adulthood. Analysis of more than 3,000 children found those who reported frequent sibling bullying at age 12 were about twice as likely to report high levels of depressive symptoms at age 18.

sibling bullying linked to depressionThe children who reported sibling bullying were also more likely to be experiencing a range of challenging situations, such as being bullied by peers, maltreated by an adult, and exposed to domestic violence. While the researchers did take these factors into account, they and other factors could still be having an impact. This means it is not possible to say for certain that frequent sibling bullying is directly causing later mental health problems. However, the results do suggest that it could be a contributor.

As the authors suggest, interventions to target sibling bullying, potentially as part of a programme targeting the whole family, should be assessed to see if they can reduce the likelihood of later psychological problems.

Where did the story come from?

The study was carried out by researchers from the University of Oxford and other universities in the UK. The ongoing cohort study was funded by the UK Medical Research Council, the Wellcome Trust and the University of Bristol, and the researchers also received support from the Jacobs Foundation and the Economic and Social Research Council.

The study was published in the peer-reviewed medical journal Pediatrics. The article has been published on an open-access basis so it is available for free online.

This study was well reported by BBC News, which reported the percentage of children in each group (those who had been bullied and those who had not) who developed high levels of depression or anxiety. This helps people to get an idea of how common these things actually were, rather than just saying by how many times the risk is increased.

What kind of research was this?

This was a prospective cohort study that assessed whether children who experienced bullying by their siblings were more likely to develop mental health problems in their early adulthood. The researchers say that other studies have found bullying by peers to be associated with increased risk of mental health problems, but the effect of sibling bullying has not been assessed.

A cohort study is the best way to look at this type of question, as it would clearly not be ethical for children to be exposed to bullying in a randomised way. A cohort study allows researchers to measure the exposure (sibling bullying) before the outcome (mental health problems) has occurred. If the exposure and outcome are measured at the same time (as in a cross sectional study) then researchers can’t tell if the exposure could be contributing to the outcome or vice versa.

What did the research involve?

The researchers were analysing data from children taking part in the ongoing Avon Longitudinal Study of Parents and Children. The children reported on sibling bullying at age 12, and were then assessed for mental health problems when they were 18 years old. The researchers then analysed whether those who experienced sibling bullying were more at risk of mental health problems.

The cohort study recruited 14,541 women living in Avon who were due to give birth between 1991 and 1992. The researchers collected information from the women, and followed them and their children over time, assessing them at intervals.

When the children were aged 12 years they were sent a questionnaire including questions on sibling bullying, which was described as “when a brother or sister tries to upset you by saying nasty and hurtful things, or completely ignores you from their group of friends, hits, kicks, pushes or shoves you around, tells lies or makes up false rumours about you”. The children were asked whether they had been bullied by their sibling at home in the last six months, how often, what type of bullying and at what age it started.

When the children reached 18 they completed a standardised computerised questionnaire asking about symptoms of depression and anxiety. They were then categorised as having depression or not and any form of anxiety or not, based on the criteria in the International Classification of Diseases (ICD 10). The teenagers were also asked whether they had self-harmed in the past year, and how often.

The researchers also used data on other factors that could affect risk of mental health problems, collected when the children were eight years of age or younger (potential confounders), including any emotional or behaviour problems at age seven, the children’s self-reported depressive symptoms at age 10, and a range of family characteristics. They took these factors into account in their analyses.

What were the basic results?

A total of 3,452 children completed both the questionnaires about sibling bullying and mental health problems. Just over half of the children (52.4%) reported never being bullied by a sibling, just over a tenth (11.4%) reported being bullied several times a week, and the remainder (36.1%) reported being bullied but less frequently. The bullying was mainly name calling (23.1%), being made fun of (15.4%), or physical bullying such as shoving (12.7%).

Children reporting bullying by a sibling were more likely to:

  • Be girls
  • To report frequent bullying by peers
  • To have an older brother
  • To have three or more siblings
  • To have parents from a lower social class
  • To have a mother who experienced depression during pregnancy
  • To be exposed to domestic violence or mistreatment by an adult
  • To have more emotional and behavioural problems at age seven

At 18 years of age, those who reported frequent bullying (several times a week) by a sibling at age 12 were more likely to experience mental health problems than those reporting no bullying:

  • 12.3% of the bullied children had clinically significant depression symptoms compared with 6.4% of those who were not bullied
  • 16.0% experienced anxiety compared with 9.3%
  • 14.1% had self-harmed in the past year compared with 7.6%

After taking into account potential confounders, frequent sibling bullying was associated with increased risk of clinically significant depression symptoms (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.11 to 3.09) and increased risk of self-harm (OR 2.26, 95% CI 1.40 to 3.66). The link with anxiety did not reach statistical significance after adjusting for potential confounders.

How did the researchers interpret the results?

The researchers concluded that “being bullied by a sibling is a potential risk factor for depression and self-harm in early adulthood”. They suggest that interventions to address this should be designed and tested.


The current study suggests that frequent sibling bullying at age 12 is associated with depressive symptoms and self-harm at age 18. The study’s strengths include the fact that it collected data prospectively using standard questionnaires, and followed children up over a long period. It was also a large study, although a lot of children did not complete all of the questionnaires.

The study does have limitations, which include:

  • As with all studies of this type, the main limitation is that although the study did take into account some other factors that could affect the risk of mental health problems, they and other factors could still be having an effect.
  • The study included only one assessment of bullying, at age 12. Patterns of bullying may have changed over time, and a single assessment might miss some children exposed to bullying.
  • Bullying was only assessed by the children themselves. Also collecting parental reports, or those of other siblings, might offer some confirmation of reports of bullying. However, bullying may not always take place when others are present.
  • The depression assessments were by computerised questionnaire, this is not equivalent to a formal diagnosis of having depression or anxiety after a full assessment by a mental health professional, but does indicate the level of symptoms a person is experiencing.
  • A large number of the original recruited children did not end up completing the questionnaires assessed in the current study (more than 10,000 of the 14,000+ babies starting the study). This could affect the results if certain types of children were more likely to drop out of the study (e.g. those with more sibling bullying). However, the children who dropped out after age 12 did not differ in their sibling bullying levels to those who stayed in the study, and analyses using estimates of their data did not have a large effect on results. Therefore the researchers considered that this loss to follow-up did not appear to be affecting their analyses.

While it is not possible to say for certain that frequent sibling bullying is directly causing later mental health problems, the study does suggest that it could be a contributor. It is also clear that the children experiencing such sibling bullying are also more likely to be experiencing a range of challenging situations, such as being bullied by peers, maltreated by an adult, and exposed to domestic violence.

As the authors say, the findings suggest that interventions to target sibling bullying, potentially as part of a programme targeting the whole family, should be assessed to see if they can reduce the likelihood of later psychological problems.

Read more about bullying, how to spot the signs and what to do if you suspect your child is being bullied (or is a bully themselves).

Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.


“Being bullied regularly by a sibling could put children at risk of depression when they are older,” BBC News reports. A new UK study followed children from birth to early adulthood. Analysis of more than 3,000 children found.

Links to Headlines

Links to Science

NHS Choices logo


Next Page »