#Bullying Thread:

It's #PinkShirtDay2021.

Let's do some teaching on bullying!

Some people who could help will wear the #pinkshirt on this day and do nothing else.

Even worse, many bullies will wear them.

To reduce bullying we actually need **to do substantial things**
1/ Bullying has 4 main components:

First, it's between peers, but an imbalance exists (socially, physically) between these peers.

**This is important.**
Teachers can't bully kids, that's ABUSE.
Bosses can't bully employees, that's ABUSE.
2/ Second, bullying is designed to cause harm or fear.

Third, bullying is repetitive, and the repetition further enforces the imbalance that already existed.

Fourth, it is an attack that can be physical, verbal, psychological, or social.
3/ Physical bullying is what most people think of when they think of bullying. The big kid that pushes the little kid for laughs. Throwing things at the kid on the bus. This is more recognizable, but also can be subtle and missed.

It is seen most often amongst boys.
4/ Psychological bullying would include intimidation without harm, creating a sense of fear through posture or threat that causes the person to act as if they were or could be harmed.
5/ Verbal bullying is repetitive derogatory, insulting, profane, or painful words designed specifically to inflict pain. This can involve name calling, labelling, or even picking on painful things (for example, someone's dead parent, or living in poverty).
6/ Relational/social bullying is the intentional exclusion, isolation, and slandering of reputation. This form of bullying is most common in girls. IT IS AS VICIOUS as physical bullying.

Racial/sexual bullying occurs in kids, and minoritized children will be victims.
7/ Let's talk Numbers and Statistics.

Bullying has not significantly changed over time. In high school, rates have been incredibly stable over 11 years. Data: @CDCgov

In High School, approximately 20% of kids report being bullied.
8/ This is true for online bullying as well.
It has not increased.

ONLINE BULLYING HAS NOT INCREASED.

Hey, media, parents, everyone.
ONLINE BULLYING HAS NOT INCREASED!!!

"These kids today" bull💩 is bull 💩.
9/ Sliiiightly more boys than girls are bullied, a finding that has been consistent for the past decade. Boys, however, are more likely to be bullies.

Bullying peaks during middle school (12-15y) and decreases to the end of high school.
10/ It doesn't stop there. Workplace bullying is certainly a thing:

Higher risk / representation:
* public sector
* health care
* women (victim)
* men (perpetrator)
* unionized employees
* authoritarian leadership
* health problems
* minorities (victim)
11/ Here's the thing though. The public has a misperception.

We commonly ID "victim" and a "bully".

The highest risk group, for all outcomes we care about, is the "bully-victim", who was or is being bullied and bullies others.

Highest rates of poor outcomes, even suicide.
12/ You may be surprised to know that the risk factors for becoming a bully or bullied are quite similar!

* chaotic upbringing, victims of abuse
* impoverishment or lower SES
* suffer from health problems
* large classrooms
* teachers' belief that bullying is "kids being kids"
13/ Typically, what separates bullies from the bullied is that bullies tend to **externalize** (lash out or suffer consequences of external behaviours), whereas the bullied tend to **internalize** (lash inward, and suffer consequences of internal distress).
14/ Bullies might have behavioural problems before they bully, but the bullied are more likely to have anxiety and depression before they are bullied.

A perfect match of victim and bully.
15/ So what can we actually do about bullying? Well, it actually requires more than buying and wearing a pink shirt for a day. Sorry.
16/ Let's:

End child abuse
Reduce classroom size
Improve family functioning
Lift kids out of poverty
Seriously fund mental health treatment
Improve neighbourhoods with material support
Combat systemic racism

These things cost more money and effort than buying a $10 t-shirt.
17/ And (sorry if this hits close to the chest) parents, fix your shit. If you have dysfunctional relationships, it will influence how kids see and treat the world. Work on your issues. Stop subjecting kids to daily dysfunction. Seriously. Parents can be part of the problem.
18/ Consider therapy, acting like grown ups, safe spaces to maturely resolve differences, not yelling in front of your kids, not subjecting your children to your problems, or a healthy divorce.
19/ Kids who die by suicide are subjected to bullying at about the same rate as all kids, "end bullying" and is totally OVERPLAYED as an "anti-suicide message," but it is a minor factor.

Of course, I'm not complaining about reducing bullying.
20/ But if you want to have a bit of a preview on how to substantially reduce suicide in kids, i bet we might do a bit more if we address tweets 16-18.
21/ And most of all, the solution to bullying is not to "attack the bullies." These are often kids who are suffering. Revenge is NOT going to fix this problem.
22/ My presentation on bullying:

drive.google.com/file/d/1E-z8Ex…

The importance of *helping bullies*, most of whom are kids who are suffering: (on the radio 7 #pinkshirtday's ago!!)

cbc.ca/player/play/24…

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More from @tylerblack32

22 Feb
Suicidology 2020:
Subgroup analysis (youth, sex, race)

I was able to access a data set from a Cook County, Illinois. Cook County is home to 5.2M people and includes Chicago.

It's the 2nd largest county in the US
/cont
1/ In total, there were 438 suicides in 2020 in Cook County, compared to an average of about 480 in the past 3 years. During the pandemic spikes, suicides decreased.

All in all, it was a below-average year for suicide deaths.
2/ Black residents died by suicide at a much higher rate (42% increase). This increase was occurring before the pandemic as well. During the first wave of the pandemic, it worsened, second wave it lessened.

A much higher year for Black suicides: 97 vs. an average of 68 in 5y.
Read 11 tweets
20 Feb
Friday Update for Suicidology Data/News regarding 2020:

We have new data on Oregon has layers of detail. Suicides overall in 2020 were down 10.6%, from 910 in 2019 to 820.

(recommend you assume Nov goes up a slight amount, dec a little bit more, and Jan significantly)

/1
Importantly, more evidence to the pile that the reporting on suicide presentations to the ER are MISQUOTED and MISATTRIBUTED. It is generally not true that presentations are up (both nationally and at state level data).

/2
Here, suicide presentations to the ER dropped off and overall were lower than 2019, but not as severely as visits for other reasons, making the *proportion of visits higher*. So it is not true in Oregon that "presentations for suicide were up".

/3
Read 16 tweets
19 Feb
I am glad so many are seriously considering suicides in school-aged children as more than just about "mental health."

Recognizing that school may be a factor in youth suicide is very important.

Here's 1999-2019 in America, prior to COVID.

Source: @CDCgov
Let's make sure we don't pretend that we will solve the problem of youth suicide by "getting back to normal."

We will all need to continue to focus, on a national level, to our children's wellbeing and work to remove stresses, barriers, stigmas, and structural inequalities.
As any person who works with kids in an emergency department, mental health centre, crisis call centre, or psychology/psychiatry department will tell you, school and its surrounding stressors are a MAJOR CAUSE of youth distress.
Read 4 tweets
17 Feb
Update: USA Suicidology 2020

3 new jurisdictions are in:
* NJ (decreased 16.5%)
* HI (decreased 26.8% April-Dec)
* Franklin County, OH (decreased 6.1% Jan-Sep)

/1
Due to lag, the "-11%" number is probably more like -4%. Interesting to note, this matches very well with the @CDCgov Jan-July report, which shows that suicides are about 4.6% fewer in 2020.

/2
What these data are not:
NOT A PREDICTION:
* other states or counties
* 2021
* other parts of the world

What these data are:
A REPORT:
* the counties and states reported
* everything that has been reported
* for the time ranges reported!

/3
Read 13 tweets
17 Feb
Using a quick example of how sensational numbers in headlines can paint an incomplete picture. In Franklin County, Ohio, Suicides are overall down in 2020, but the article portrays something different for youth:

dispatch.com/story/news/loc…

/1
Of course, the headline is not incorrect, but there is a larger context to provide. Using the data provided, I'm plotting the youth (8y-25y) suicide rate next to the adult+ suicide rate.

/2
As the headline states, there is an increase in 2020 vs 2019. However, 2019 also saw a substantial decrease, and just 4 years prior, 2017 saw an even greater increase from the previous year.

/3
Read 8 tweets
17 Feb
"Frequently Asked Questions" about the data I post regarding suicides in 2020 not changing overall from 2019. Due to the number of requests/questions I get, I will stop answering them personally if they are listed here. ImageImageImageImage
FAQ 1:

What about "attempts?"

* numbers of attempts are not necessarily related to deaths numbers of death suicide (by far, most who attempt do not end up dying by suicide); overall, attempts are down in emergency departments (But the proportion of presentations is up)
FAQ 2:
What about "Deaths of Despair"

I hate the term.

"Despair" (what this ugly lumping calls "worsening socioeconomics") affects ALL DEATHS. It's honestly NOT OK and IGNORANT about social effects on health to use this term to separate suicide, overdose, and alcoholism.
Read 9 tweets

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