Lardie R 2016

Journal of Child & Adolescent Mental Health
ISSN: 1728-0583 (Print) 1728-0591 (Online) Journal homepage: http://www.tandfonline.com/loi/rcmh20
Suicidal ideation among suburban adolescents:

The influence of school bullying and other
mediating risk factors
David T. Lardier Jr, Veronica R. Barrios, Pauline Garcia-Reid & Robert J. Reid
To cite this article: David T. Lardier Jr, Veronica R. Barrios, Pauline Garcia-Reid & Robert J.
Reid (2016) Suicidal ideation among suburban adolescents: The influence of school bullying and
other mediating risk factors, Journal of Child & Adolescent Mental Health, 28:3, 213-231, DOI:
10.2989/17280583.2016.1262381
To link to this article: https://doi.org/10.2989/17280583.2016.1262381
Published online: 21 Dec 2016.
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Journal of Child and Adolescent Mental Health 2016, 28(3): 213–231 Copyright © NISC Pty Ltd
JOURNAL OF
C H I L D & A D O LES C EN T M EN T A L H EA LT H
ISSN 1728-0583 EISSN 1728-0591
http://dx.doi.org/10.2989/17280583.2016.1262381
Suicidal ideation among suburban adolescents: The

influence of school bullying and other mediating risk
factors
David T. Lardier Jr,* Veronica R. Barrios, Pauline Garcia-Reid, and Robert J. Reid
Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
*Corresponding author email: lardierd1@montclair.edu
Objective: Prior research has identified multiple factors that influence suicidal ideation (SI) among
bullied youth. The effects of school bullying on SI cannot be considered in isolation. In this study,
we examined the influence of school bullying on SI, through a constellation of risks, which include
depressive and anxiety symptoms, family conflict, and alcohol, tobacco, and other drug (ATOD) use. We
also provide recommendations for therapists working with bullied youth.
Method: Our sample consisted of 488 adolescents (ages 10-18 years) from a northern New Jersey,
United States suburban community. Students were recruited through the district’s physical education
and health classes. Students responded to multiple measures, which included family cohesion/
conflict, ATOD use, mental health indicators, SI, and school bullying experiences. Following preliminary
analyses, several logistic regression models were used to assess the direct influence of bullying on SI,
as well as the unique effects of family conflict, depressive and anxiety symptoms, and substance use.
In addition, a parallel multiple mediating model with the PROCESS macro in SPSS was used to further
assess mediating effects.
Results: Logistic regression results indicated that school bullying increased the odds of SI among
males and females and that when mediating variables were added to the model, bullying no longer
had a significant influence on SI. Overall, these results display that for both males and females, school
bullying was a significant contributor to SI. Results from the parallel multiple mediating model further
illustrated the mediating effects that family conflict, depression, and ATOD use had between bullying
and SI. Some variation was noted based on gender.
Conclusion: This study draws attention to the multiple experiences associated with school bullying
on SI, and how these results may differ by gender. The results of this study are particularly important
for those working directly and indirectly with bullied youth. Therapists that engage bullied youth need
to consider the multiple spheres of influence that may increase SI among male and female clients. To
holistically and adequately assess SI among bullied youth, therapists must also consider how these
mechanisms vary between gender groups.
Introduction
The extensiveness and rates of both school bullying and suicidal thoughts and behaviours among
adolescents in the United States (U.S.) are significant public health concerns. Most mental health
professionals and researchers agree that the reported youth school bullying and suicide rates are
underestimates (Taliaferro, Oberstar, & Borowsky, 2012). The experiences of school bullying have
lifelong repercussions and can increase suicidality (Centers for Disease Control and Prevention,
2015). Unfortunately, both research (notable exceptions include Espelage et al., 2014) and practice
neglect the influence of additional controls, such as substance use, depression or anxiety, and
family conflict, when assessing and treating issues related to school bullying. Therapists, school
personnel, and other mental health practitioners are also often ill equipped to work with young
people who are bullied at school, focusing on the direct action of being bullied as opposed to the
Journal of Child & Adolescent Mental Health is co-published by NISC (Pty) Ltd and Routledge, Taylor & Francis Group
214 Lardier, Barrios, Garcia-Reid and Reid
additional psychological and contextual factors present that may increase suicidal ideations (SI).
Therefore, we cannot consider the direct effect of school bullying on SI in isolation, but instead
through the constellation of additional experiences such as family conflict, mental health indicators,
and substance use (Espelage et al., 2014). In addition, a greater awareness of gender differences
needs to be considered to provide appropriate therapeutic treatments and prevention-interventions
(Shetgiri, Espelage, & Carroll, 2015).
The present study extends research on school bullying and suicide by exploring the relationship
between school bullying and SI, and additional controls; specifically, family conflict, depression
and anxiety, and substance use. In addition, our investigation examines how these relationships
may differ between males and females. Moreover, unlike previous research conducted in this area,
we provide useful recommendations for mental health practitioners and other personnel who may
engage with bullied youth and teens experiencing SI.
Bullying and suicidal ideations

Suicide and suicidal ideations
Suicide is defined as the intentional act of ending one’s own life, while suicidal ideation (SI)
is classified as the thoughts of engaging in behaviours intended to end one’s life (Nock et al.,
2008). Within the U.S., suicide rates have decreased in recent years; however, in 2013, suicide
claimed approximately 41 149 lives (Division of Violence Prevention, 2015). In addition, suicidality
within the U.S. remains the third leading cause of death among youth 10 to 14 years of age, and
second among those 15 to 34 years of age (Division of Violence Prevention, 2015; Taliaferro et
al., 2012). Among adults within the U.S., 18 years of age and older, 9.3 million individuals (3.9%)
reported having suicidal thoughts, 2.7 million (1.1%) had a plan about how to attempt suicide,
and 1.3 million (0.6%) attempted suicide (Division of Violence Prevention, 2015). Furthermore,
among adolescents, 17% of students nationally have considered suicide, 13.5% had a plan, and
approximately 8.0% attempted suicide one or more times (Division of Violence Prevention, 2015).
Adolescent males in the U.S. were more likely to take their lives and represent, approximately,
77.9% of all suicides, whereas females are more likely to experience suicidal thoughts or ideations
(Division of Violence Prevention, 2015; Valois, Zullig, & Hunter, 2015). Numerous risk factors (e.g.,
substance use, family conflict, school bullying, community violence) have also been identified
that increase adolescents’ likelihood of dying by suicide and experiencing SI, with school bullying
victimization being one that has gained increased attention in suicide research (Cash & Bridge,
2009; Reed, Nugent, & Cooper, 2015).
School bullying
Bullying is defined as the intentional harm or wrong doing against another person or group, repeatedly
carried out over time, and often involving power differences (Shetgiri et al., 2015). School bullying
often occurs within a school or directly outside/after school and may involve physical, non-verbal,
or cyber-based harm or wrong doing against another person. Over the past decade, school
bullying victimization has become increasingly common within the U.S. For instance, in a nationally
representative sample of students in grades 9 through 12, from all 50 U.S. states and the District
of Columbia, nearly 20% of bullied students were victims on school property (Kann et al., 2016).
In addition, bullied youth tend to engage less with peer groups and in school activities (Centers
for Disease Control and Prevention, 2015). Bullied teens also experience greater loneliness and
report feelings of depression, anxiety, and suicidality (Centers for Disease Control and Prevention,
2015). For example, boys are likely to engage in suicidal behaviour when they are both bullies and
victims (Cash & Bridge, 2009). While females, who are victimized at nearly double the rate of males
(Kann et al., 2014a), tend to engage in more suicidal behaviours, due to the victimization alone –
i.e., when compared to non-victimized females and also males (Cash & Bridge, 2009; Klomek et al.,
2007). Despite the gravity of these findings, we still know very little about what brings someone to
contemplate suicide (Hinduja & Patchin, 2010), and even less about whether school bullying directly
causes suicidal behaviours and/or ideations (Centers for Disease Control and Prevention, 2015;
Espelage, Low, & De La Rue, 2012).
Journal of Child and Adolescent Mental Health 2016, 28(3): 213–231 215
The relationship between school bullying and suicide

The relationship between SI and school bullying does not characterize normal developmental
trajectories or experiences; however, it undeniably demands deeper examination and
understanding. School bullying is a growing issue among teens in the U.S. (Shetgiri et al., 2015).
Extant research identifies that regardless of the type of school bullying (e.g., physical, verbal, and
cyber/virtual), the potential for suicide is significant (Klomek et al., 2007). Youth perpetrators and
victims of school bullying are at increased risk for SI and death by suicide (Centers for Disease
Control and Prevention, 2015). Evidence also suggests that experiences with peer harassment,
both as a target and perpetrator, contribute to decreased self-worth, hopelessness, and loneliness;
and serves as a forerunner to suicidal thoughts and behaviours (Espelage et al., 2014; Joiner &
Rudd, 1996; Reed et al., 2015). Interpersonal theory of suicide, a highly supported suicide etiology
theory, acknowledges and proposes that feelings of isolation or lacking belongingness increases
the potential of suicidal thoughts and behaviours (Joiner, Brown, & Wingate, 2005). For instance,
in a review of 37 studies on the association between bullying and suicide, Kim and Leventhal
(2008) found that adolescents who were involved in bullying (whether as victims or perpetrators)
were socially isolated and more likely to experience SI. Hence, the social isolation and lack of
belongingness that is associated with bullying increases SI and other negative mental health
indicators (e.g., Bauman, Toomey, & Walker, 2013; Centers for Disease Control and Prevention,
2015; Hinduja & Patchin, 2010; Shetgiri et al., 2015).
Research shows that the influence of school bullying is extensive and detrimental. However,
recent analyses suggest that school bullying only accounts for about 7% of the variance or a small
proportion of the variability in suicidality (Hinduja & Patchin, 2010; Nickerson & Torchia, 2015).
This suggests that although bullying may influence SI, other experiences (such as family conflict,
substance use, mental health symptoms) may mediate the relationship between school bullying and
SI. School bullying should therefore be considered as just one likely problem among a host of other
issues that would bring someone to experience SI (Holt, 2015). Thus, SI is an issue that moves
beyond the scope of school bullying and is associated with additional risk-factors, such as alcohol
use, aggressive behaviour, depression, and anxiety.
Research examining both school bullying and suicide has started to document additional risk
behaviours that influence SI and the experiences of school bullying victims (Espelage et al., 2014).
For example, bullied youth are likely to engage in a multitude of negative behaviours which include
substance use, violence, and risky sexual behaviours (Holt, 2015); even when controlling for
demographic factors, such as race, gender, and sexual orientation (Mueller et al., 2015). These
findings are worrisome when we begin to consider these risk behaviours together and how they
may mediate and influence one another. Although studies have started to explore the relationship
additional mediating variables, such as family conflict and substance use, hold between school
bullying and suicide, there continues to be a need for research to flesh out the presence of such
mediating controls (Tormala et al., 2015). Additional studies are also needed that examine the
experiences of school bullying and SI between males and females.
Additional risks for suicidal ideation
Adolescence is characterized as a period of heightened emotions and variations in mood (Reed et

al., 2015). Numerous internal and external events occur during this period that can either positively
impact development or cause significant distress (Bornstein, Jager, & Steinberg, 2013; Lerner et al.,
2011). School bullying is one experience that negatively affects a youth’s developmental trajectory.
Moreover, there are additional psychosocial and internal processes that influence development and
exacerbate SI among adolescents. Events such as family conflict and substance use may mediate
the effects of school bullying and account for a greater proportion of the variability found in suicide
and bring us closer to understanding why youth experience SI. For example, adolescents may use
substances as a method of coping with their school bullying victimization, which can in turn increase
their risk for SI and attempts; thereby transitioning these youth from ideation to behaviour (Gould
et al., 2003; Valois et al., 2015). However, the behavioural response to such experiences can vary
by gender. For example, Bauman et al. (2013) found among a sample of 1 491 U.S. high school
students that depression mediated the relationship between cyber bullying and suicide attempts
for females only, where previous studies (e.g., Litwiller & Brausch, 2013; Reed et al., 2015) have
identified similar experiences among males and females. As a result of such variation in findings on
gender, Reed et al. (2015) suggested that research needs to more adequately tease out how males
and females respond to school bullying. There are also additional controls, such as family conflict
and substance use that need to be considered by researchers, practitioners, and mental health
personnel to effectively understand both bullying victimization and SI.
Family conflict
The link between family dysfunction and school bullying behaviour and victimization has been
established in prior research (Bowers, Smith, & Binney, 1994; Idsoe, Dyregrov, & Idsoe, 2012;
Tormala et al., 2015). Studies have shown that individuals living in homes with conflict are more
likely to experience SI (Sigfusdottir et al., 2013; Tormala et al., 2015) and a range of psychological
and behavioural problems, when compared to those youth not living in such environments (Amato
& Sobolewski, 2001; Sigfusdottir et al., 2013; Tormala et al., 2015). For example, Sigfusdottir and
colleagues (2013) found among a sample of 9 085 high school adolescents from Iceland that youth
living in highly conflictual homes experienced more SI and attempts than those living in supportive
home environments. Family conflict or discord, as a risk factor, also intensifies the effects of school
bullying (Lau et al., 2002; Sigfusdottir et al., 2013), which further increases loneliness, lack of
belongingness, SI (Bauman et al., 2013; Storch & Masia-Warner, 2004), substance use, and other
negative externalizing behaviours, such as violence (Dube et al., 2006; Idsoe et al., 2012). There are
some studies where no significant effect was present between family conflict and suicide (Fergusson,
Woodward, & Horwood, 2000; Gould et al., 2003). However, in these studies researchers controlled
for comorbid psychological symptoms, which mediated the effect between family conflict and SI
(Fergusson et al., 2000; Gould et al., 2003). For instance, Fergusson et al. (2000) found, among a
sample of 1 265 children from New Zealand, that the influence of family conflict on SI was no longer
significant when depression, anxiety, and substance abuse disorders were added to the model.
Overall, these results indicate that although family conflict may be an indicator of SI, adverse mental
health problems may mediate these effects. Therefore, family conflict alone does not necessarily
increase the risk of a child’s exposure to school bullying, but may lead to other emotional dysfunction
due to the lack of support in these “chaotic” households (Yang & McLoyd, 2015). Thus, it is hypothesized
that family conflict would mediate the relationship between bullying and suicidal ideations (SI).
Adolescent substance use

Studies demonstrate that substance use is linked to school bullying, SI, family conflict, and
depressive and anxiety symptoms (Bauman et al., 2013; Espelage et al., 2014; Luk, Wang, &
Simons-Morton, 2010). Death by suicide and SI are associated with engaging in, or experiencing
aggressive behaviour and substance use (Gould et al., 2003; Gould et al., 1998; Litwiller &
Brausch, 2013). More specifically, school bullying victimization has been associated with higher
rates of alcohol and drug use among adolescents, when compared to non-victimized peers (Luk
et al., 2010; Mitchell, Ybarra, & Finkelhor, 2007). This situates substance use as a negative
coping mechanism for school bullying that also contributes to additional negative emotions and
experiences (Bolognini et al., 2003; Spirito et al., 2003). In addition, the relationship between
substance use, depressive symptoms, and SI tends to be more detrimental for females than males
(Fleming & Ledogar, 2008), which may be attributed to females being more prone to internalizing
negative relational experiences, when compared to males (Luk et al., 2010). For example, prior
longitudinal studies have substantiated the connection between school bullying and substance
use (Espelage et al., 2014), particularly during adulthood (Shetgiri et al., 2015). However, future
investigations are needed that investigate the effects of substance use and school bullying on SI
(Espelage et al., 2014). Based on the available literature, substance use is hypothesized to mediate
the relationship between school bullying and SI, while also demonstrating a connecting path to
depression and anxiety for females.
Depression and anxiety symptoms

Depression and anxiety are symptoms associated with a host of contextual issues that include SI
and school bullying. Targets of school bullying often experience higher levels of emotional distress
and mental illness, including withdrawal, loneliness, and sadness (Idsoe et al., 2012; Klomek et al.,
2007; Shetgiri et al., 2015). From a diagnostic perspective, these emotions are often associated
with depression and anxiety. Agnew (2006) postulated, through General Strain Theory (GST), that
an event for which an adolescent is treated wrongly affects his or her emotional and behavioural
response to the situation. Therefore, if an adolescent feels that she or he has been ill-treated or
bullied, have no or little control to change the event, and also perceive this event is unjust, then
they are likely to experience a negative emotional response, associated with depression, anxiety,
and, or substance use (Reed et al., 2015). Whether school bullying is direct or indirect, victims are,
unfortunately, isolated from peers (Idsoe et al., 2012; Nickerson & Torchia, 2015) and designated
as outcasts within their social networks, which increases their susceptibility for SI and attempts
(Mayes et al., 2014). This strain or stressor also increases the likelihood that the adolescent will
engage in negative health seeking behaviours, such as substance use and sexual risk (Espelage
et al., 2012). In addition, bullied youth suffer academically and emotionally, increasing their
susceptibility to depression, anxiety, and SI (Espelage et al., 2012; Idsoe et al., 2012). Longitudinal
studies have further documented that victims of school bullying continue to experience depression
and anxiety into adulthood, inhibiting marital quality and self-esteem (Shetgiri et al., 2015).
In summary, school bullying victimization has significant consequences that include drug use,
depression, anxiety, and suicide (Joiner & Rudd, 1996; Litwiller & Brausch, 2013). However, such
paths continue to be in need of further investigation particularly between gender groups (Reed et al.,
2015), as results between studies tend to be mixed (Bauman et al., 2013). This is of considerable
importance for practitioners and prevention specialists in that a one-size-fits-all approach is not
appropriate.
Gender differences
Prior research identifies a clear relationship between school bullying, depression, and SI. However,
there continues to be ambiguity in how males and females respond to school bullying, SI, and
associated experiences, such as substance use (Reed et al., 2015). Upon closer examination,
there are significant differences in males’ and females’ responses to school bullying. For example,
females may be likely to internalize the experiences of school bullying (Luk et al., 2010), but males
are observed to die by suicide at higher rates when compared to females, primarily due to the use
of more lethal means (Bauman et al., 2013; Gould et al., 2003). However, Klomek et al. (2009)
found in their study of 5 302 Finish children that females were more likely than males to attempt
and die by suicide following bullying victimization. In addition to this inconsistent finding, other
discrepancies concern research examining the relationship between school bullying, suicide and
SI, and drug and alcohol use. For example, some studies identify females and others males as
having a higher probability to self-medicate due to school bullying (Espelage et al., 2014; Litwiller
& Brausch, 2013). Perpetration of school bullying also differs based upon gender. Males, for
example, are often more physically aggressive perpetrators of school bullying, with females being
more covert, such as passing rumours; although less common, aggressive school bullying is also
observed among females (Espelage, Bosworth, & Simon, 2000; Underwood, Galen, & Paquette,
2001). Yet, there are some studies that have failed to illustrate gender differences in relational or
more social forms of bullying (Card et al., 2008); although, this is generally not evident within the
bullying literature (Shetgiri et al., 2015).
Despite our knowledge of gender differences, prior studies have not fully documented the
influence of gender or they have found inconsistent findings (Bauman et al., 2013; Shetgiri et
al., 2015). Awareness of gender differences has implications for the treatment and interventions
provided to teens and young adults, as well as the focus of prevention initiatives, which are often
not considered (Gould et al., 2003). Considering both the internal and external reactions to school
bullying, we expect the presence of diverging mediating paths between school bullying and SI
based on gender.
Purpose and research hypotheses
Based on extant research a couple of conclusions can be drawn: 1) family conflict, substance use,
and depression are likely to mediate the relationship between school bullying and SI; and 2) there
are likely observed differences in these effects based on gender. However, despite these results,
there is a still a lack of clarity as to how these relationships manifest among males and females
(Bauman et al., 2013; Reed et al., 2015). There is also a call for more research that examines the
effects of substance use between school bullying and SI (Espelage et al., 2014).
The purpose of this study is to examine the mediating effects of theoretically, conceptually, and
empirically related variables to school bullying and suicidal ideations (SI). First, we hypothesized that
a direct relationship will be present between school bullying and SI; however, this relationship will
account for a small proportion of the variability in SI. Second, controls (e.g., family conflict, substance
use, depression, and anxiety) will mediate the relationship between school bullying and SI. Third, we
hypothesize that paths will differ by gender. More specifically, we are likely to observe depression
and substance use as mediators among females, compared to males. As discussed, females are
more likely to experience suicidal thoughts (Division of Violence Prevention, 2015; Valois et al.,
2015) and, as a result of school bullying, identify higher rates of depression and substance use
(Luk et al., 2010). In addition, family conflict is hypothesized to mediate the experiences occurring
in school and take precedence on predicting SI for both gender groups. If supported as mediators,
family conflict, depression and anxiety, and substance use would provide three important and
interesting explanations as to how adolescents who are victims of bullying developed SI.
Methods
Sample and design
Data were collected as part of a comprehensive needs assessment within a northern New Jersey,
United States suburban community. Youth were sampled from grades 7 through 12 (N = 488), with
256 (47.7%) females and 232 (52.3%) males. These adolescents were an average age of 13.81
years (SD = 1.49) and the majority of students identified as White non-Hispanic (75%), with Asian/
Pacific Islander (11.8%) and Hispanic youth (9.7%) designating the next two largest demographic
groups. Among sampled students, 14% (N = 68) indicated that they had experienced SI during the
past 12 months, specifically 35% (24) males and 65% (44) females (see Table 1).
Data collection
A convenience sample of students were recruited through the physical education and health
classes in the district’s middle school and high school, as these are required all years from 7th
through 12th grades. Students were provided parent/guardian consent forms, which allowed
all students an equal opportunity to participate (i.e., a potential of 1 671 students). Students who
returned both parental informed consent and student assent forms were eligible to participate
in the study (N = 488 or 30%). Those students who returned these documents were given time
during these periods to complete the 120 item questionnaire, which was done through an online
survey format with computers and tablets linked to the network site. This online self-assessment
questionnaire was used to effectively and efficiently collect data, as well as disseminate results
from the survey to the school district and community. Prior research comparing online survey
formats to written formats has shown minimal differences in participants’ response to questions
(Beck, Guignard, & Legleye, 2014; Webb et al., 1999). In fact, some have reported that responses
on more sensitive questions, such as sexual risk and substance use, observed less social
desirability bias (Wang et al., 2005).
Methodological bias is, however, an inherent limitation when examining constructs such as
substance use, family conflict, depression and anxiety, and school bullying, where individuals may
respond in socially desirable ways (Williams & Nowatzki, 2005). To control for issues of response
bias several mechanisms were put in place. First, to reduce acquiescence response, positive and
negative items were balanced with higher numerical values indicating a higher score on the construct
(Podsakoff et al., 2003; Podsakoff, MacKenzie, & Podsakoff, 2012). Second, the proximal distance
Table 1: Demographics of sample (N = 488)
Full sample
n %
Gender
Female 256 47.7
Male 232 52.3
Race
White 370 75.8
Asian/Pacific Islander 58 11.8
Hispanic/Latino 47 9.7
African American/Black 13 2.7
Age (M = 13.81)
10–14 346 70.9
15–18 142 29.1
Grade (M = 8.50)
7th 156 32.0
8th 128 26.3
9th 72 14.8
10th 66 13.6
11th 34 7.0
12th 30 6.3
Suicidal Ideations
Yes (1) 68 13.9
No (0) 421 86.1
between predictors and criterion variables were considered and adjusted; meaning, substance use
measures were separate from like measures, such as depression, anxiety, and SI, which attenuates
context and question order effects (Podsakoff et al., 2012). Lastly, the survey was designed using
clear and concise language and non-complicated-ambiguous terminology (Podsakoff et al., 2012).
School counsellors were available to assist all students with processing any associated discomfort
with responding to questions. Anonymity and confidentiality was maintained for all students as per
IRB standards, and those who disclosed emotional discomfort were also protected by counsellor-
client anonymity.
Measures
The survey included multiple measures examining students’ family cohesion/conflict (Gorman-
Smith et al., 1996), alcohol tobacco and other drug use (ATOD use; Kann et al., 2014b), mental
health indicators (Achenbach, 2011; Achenbach & Edelbrock, 1983), suicidal ideations (SI), and
school bullying experiences (Gladden et al., 2014). Five variables were examined in this study.
Suicidal ideations served as the criterion variable. Main predictors of interest were: 1) school
bullying; 2) depression and anxiety symptoms; 3) family conflict; and 4) substance use. All of
the measures in the study are based on scales used in previous research. Descriptive statistics,
reliabilities, associated alpha levels (Cronbach α), ranges, and correlations are found in Table 2.
Predictor measures
School bullying
School bullying was assessed using questions from the School Relationships Questionnaire
(Hamburger, Basile, & Vivolo-Kantor, 2011) and recommendations by Gladden et al. (2014) who
articulated specific methods to measure bullying that allows for comparisons. School bullying was
measured using a three-item scale assessing the presence of bullying in the school environment
(Gladden et al., 2014; Kann et al., 2014b). The full measure was not used due to constraints,
related to the time to complete the 120 question survey. However, an adequate internal
Table 2: Correlations of main variables between subsamples
1 2 3 4 5 6
1. School bullying – 0.237** 0.190** 0.335** 0.017 0.201**
2. Depression 0.276** – 0.596** 0.443** 0.064 0.467**
3. Anxiety 0.309** 0.547** – 0.285** 0.205** 0.357**
4. Family Conflict 0.299** 0.507** 0.441** – −0.040 0.343**
5. Substance use 0.153* 0.253** 0.250** 0.172** – 0.235**
6. Suicidal Ideations 0.236** 0.482** 0.314** 0.373** 0.352** –
Mean 9.63 13.60 12.47 18.73 3.27 0.137
SD 2.76 2.19 2.84 3.22 2.49 0.344
Ranges 5 to 20 5 to 15 5 to 15 8 to 24 1 to 32 0 to 1
α 0.75 0.84 0.83 0.71 0.81 0.80
Skew 0.574 1.01 1.14 0.654 2.15 1.11
Kurtosis 0.554 1.23 0.248 0.301 14.07 1.48
Note: Males upper quadrant and females lower quadrant
*p < 0.05. **p < 0.01. ***p < 0.001
reliability-consistency (Cronbach α = 0.75) was achieved (Field, 2013). Presence of bullying in the
school environment was measured on a five-point Likert type scale from strongly disagree (1) to
strongly agree (5). (Sample items: I sometimes stay home because I do not feel safe at school?
Have you ever been bullied on school property? Sometimes I have been made to feel ostracized,
not accepted, or disliked by peers?) The majority of respondents identified moderate levels of
bullying on school property as evident by the mean of 9.63 (SD = 2.76).
It is not uncommon to use two to four-items to assess bullying if we consider previous
investigations. For instance, in a recent longitudinal study, Yang and McLoyd (2015) used a
four-item measure to assess bullying victimization and identified an overall lower reliability-internal
consistency (Cronbach α = 0.60), and continued to show significant findings. In a recent study,
Mueller et al. (2015) used only two separate questions on victimization to predict school bullying
among U.S. adolescents. Moreover, Litwiller and Brausch (2013) in their study of 4 963 public high
school students used a three-item measure to assess physical bullying and another three-item
measure to assess cyber bullying. For both measures, Litwiller and Brausch (2013) displayed
sufficient reliability-internal consistency, with Cronbach alphas ranging from 0.71 to 0.77. Although,
these studies used three to four items to assess bullying, they displayed significant and important
findings that contributed to the bullying literature.
Depressive and anxiety symptoms

Depressive (Cronbach α = 0.84; sample item: I often feel unwanted at home?) and anxiety
symptoms (Cronbach α = 0.83; sample item: Do you fear or have you feared thinking of doing
something bad?) were both measured using five item scales that assessed the extent adolescents
problems related to these diagnoses. Questions were derived from the Child Behaviour Checklist
and used a three-point Likert scale from (1) not true to (3) very true (Achenbach, 2011; Achenbach
& Edelbrock, 1983). Responses for each were totalled to reflect a greater likelihood of experiencing
depressive and anxiety symptoms. Youth identified a moderate to high level of depression
(M = 13.60, SD = 2.19) and anxiety (M = 12.47, SD = 2.84) as evident in Table 1.
Family conflict
The Family Conflict construct consists of four items from the Student Survey of Risk and Protective
Factors/Family Conflict Scale that determines role and magnitude of arguments in the family
(Gorman-Smith et al., 1996). The second measure used for this construct was a six-item scale from
the Family Relations Scale/Cohesion Scale that examined level of family cohesion, closeness, and
connectedness among members (Gorman-Smith et al., 1996). Responses for both scales ranged
from not true to always true or almost always. Family Conflict was coded to represent greater levels
of conflict in the home, not true (1) to always true or almost always (4); and Family Cohesion was
reverse coded, from the original positive direction, to represent lower levels of family cohesion, not
true (4) to always true or almost always (1). Measures were combined (Cronbach α = 0.71), with
youth identifying moderate levels of family conflict in the home, as evident by the mean of 18.73
(SD = 3.22).
Substance use
Substance use was measured using 14-items from the alcohol, tobacco, and other drug (ATOD)
use scale of the Youth Risk Behaviour Surveillance Survey (sample items: During the past 30
days did you smoke part or all of a cigarette? During the past 30 days, on how many days did
you have at least one drink of alcohol; Kann et al., 2014b). Responses ranged from 0 days (0) to
all 30 days (6). Variables were totalled to represent greater levels of substance use among youth
(Cronbach α = 0.81). Youth identified lower levels of substance use as evident by the mean of 3.27
(SD = 2.49).
Although students responded with lower rates of 30-day substance using behaviour, this is not
atypical when examining sensitive topics, such as drug and alcohol use (Beck et al., 2014; Wang
et al., 2005; Watson et al., 2001). Importantly, previous research has observed similarly lower
mean substance use scores among adolescents and drawn important conclusions (Christens &
Peterson, 2012; Christens et al., 2012). For the purposes of the current study, evidence suggests
that self-reported substance using behaviours among adolescents has a degree of validity, although
it could never be perfect (Williams & Nowatzki, 2005).
Criterion measure
Suicidal ideation
Suicidal Ideation (SI) is derived from two questions from the Youth Risk Behavioural Surveillance
Survey (Kann et al., 2014b), measuring thoughts and intent of attempting suicide (sample item:
During the past 12 months did you ever seriously consider harming yourself; During the past 12
months did you make a plan about how you would harm yourself?). Two measures were used due
to previously discussed survey constraints. Items were measured dichotomously, (1) yes and (0)
no (Cronbach α = 0.80). Responses were summed reflecting a greater likelihood of SI (M = 2.19,
SD = 0.51). To better identify those youth experiencing SI, responses were dichotomized for OLS
(Ordinary Least Squares) regression, following Multiple Imputation (MI) across data, with all youth
1-standard deviation (SD) at and above the mean identified as yes (1), experiencing SI; and those
below the mean as no (0), not experiencing SI. Following DeCoster, Iselin, and Gallucci’s (2009)
recommendations, the dichotomous variable matched the proportions of the continuous distribution
and was highly correlated (r = 0.94), showing a strong collinear relationship to the original
distribution.
It is not uncommon within the bullying literature to measure suicidal ideation using one or two
items. For example, Mueller et al. (2015) used a single suicide item as a criterion measure among
a diverse cohort of adolescents. Elsewhere, Mayes et al. (2014) examined bullying and SI using the
Paediatric Behaviour Scale. These authors not only identified significant findings, but did so utilizing
a single SI item (Mayes et al., 2014). Therefore, utilizing two items to assess SI is an effective
means of measuring suicidal ideations.
Analysis
Multiple Imputation (MI) techniques were used in SPSS 21 to examine patterns of missing data
to assess type and level of missingness (Graham, 2009), with the most missing at 11 percent. To
impute data, ten MI iterations were run, with complete blocks resulting (Graham, 2009). Following
imputation, bivariate correlations, means, and standard deviations were examined for main study
variables (see Table 2). In addition, normality and issues of collinearity were assessed among all
variables (see Table 2). All variables, with the exception of 30-day substance use, were within
appropriate parameters of normality. Substance use was observed as non-normal, with a skewness
of 2.15 and kurtosis of 14.07. However, because a bootstrapping technique was employed during
t-test analysis, logistic regression, and PROCESS macro multiple mediation analyses, additional
transformations were not used (Field, 2013; Wright, London, & Field, 2011). No issues of
collinearity were evident, with variance inflation factor (VIF) within the appropriate parameter range
– i.e., less than 10.00 (Field, 2013).
Following the analysis of data and MI, an independent samples t-test was used to examine
preliminary differences by gender on main study variables, as theoretical and empirical evidence
suggests gender differences. Following these analyses, logistic regression analysis (see Table 3)
was used to assess the direct influence school bullying had on SI between males and females
(Model 1). Next, controlling for school bullying, the effects of family conflict, depressive symptoms,
anxiety symptoms, and substance use on SI were analysed as covariates between these same
groups (Model 2). Findings led to further examining mediation using a parallel multiple mediating
model with the PROCESS macro in SPSS (Hayes, 2009, 2012). All variables were included with
the exception of anxiety symptoms, as this variable was not a significant predictor in either group.
The Direct Effect (DE), Total Indirect Effect (IE), and individual paths were examined for variation
between groups (Table 4).
Results
Preliminary analysis
Correlations were run among main study variables between subsamples (i.e., males and females).
Correlations were generally as expected, although for males, substance use was only correlated
with anxiety symptoms. Among females, substance use was correlated with all main study
variables, showing potential variation based on gender and providing justification for examining
mediation effects (Field, 2013). The outcome variable, SI, was significantly correlated (p < 0.01)
to all predictors (see Table 2). Preliminary differences among gender groups were tested using
an independent samples t-test and 5 000 bootstrap resamples among the main predictor and
outcome variable. Bootstrapping was used as a robust method to reduce potential bias (Field,
2013). As expected, a significant difference was present between gender groups for both bullying,
t (486) = –2.48, p < 0.05, with a mean difference, –0.618, BCa 95% CI [–1.12, –0.142] and SI,
t (486) = –2.09, p < 0.05, with a mean difference, –0.065, BCa 95% CI [–0.127, –0.002]. Based on
the absolute value of these results, females experienced higher levels of school bullying and SI.
Analytic results
Main analytic results were derived from a multivariate logistic regression analysis to better assess the
unique effect of bullying on SI, as well as those variables predicting SI when bullying is held constant.
Odds Ratios (OR) for logistic regressions on SI are presented in Table 3. Analyses were performed
on males and females separately to assess differences in predictors of SI. Model 1 establishes the
direct relationship between school bullying and SI among males and females. To more adequately
Table 3: Logistic regression results on determinants of suicidal ideations between males and females (N = 488)
Males (N = 232) Females (N = 256)

Model 1 Model 2 Model 1 Model 2
OR (B coeff) OR (B coeff) OR (B coeff) OR (B coeff)
Intercept 0.014 (−4.29) 0.001 (−7.43) 0.019 (−3.95) 0.001 (−6.82)
On Premises School Bullying 1.24** (0.215) 1.11 (0.105) 1.25*** (0.225) 1.14 (0.128)
Family Conflict 1.25** (0.226) 1.16* (0.148)
Depressive Symptoms 1.52** (0.417) 1.37*** (0.318)
Anxiety Symptoms 1.09 (0.095) 0.973 (−0.003)
ATOD (Alcohol Tobacco & Other Drug Use) 1.40** (0.338) 1.64*** (0.496)
χ2 (df) 8.5 (1) 53.57 (5) 13.97 (1) 77.42 (5)
R2 0.07 (7%) 0.42 (42%) 0.09 (9%) 0.44 (44%)
*p < 0.05. **p < 0.01. ***p < 0.001
understand the relationship between school bullying and SI, family conflict, depressive symptoms,
anxiety symptoms, and substance use were incorporated in Model 2 (see Table 3).
Model 1 results indicate that school bullying increased the odds of SI among males and females,
showing that in isolation, school bullying is a significant predictor of SI and detrimental to adolescent
well-being. Model 1, however, accounted for a small percentage of the variability in SI among males
(7%) and females (9%), which is consistent with our hypothesis and prior research (e.g., Hinduja &
Patchin, 2010; Nickerson & Torchia, 2015). Adding variables (e.g., family conflict, depressive and
anxiety symptoms, and substance use) that were predictive of SI increased the variability among
males and females. Our main purpose here was to assess if school bullying was still a significant
indicator of SI in the presence of these additional variables, as well as the unique effects of family
conflict, depressive and anxiety symptoms, and substance use on SI.
In Model 2, bullying was no longer a significant indicator of SI among males and females,
suggesting that the introduction of these additional variables mediated the path between bullying
and SI. In this model, for every one-point increase in substance use, the odds of SI increased 40%
for males and nearly 64% for females. In the presence of depressive symptoms, the odds of SI
increased 52% among males and 37% among females. Family conflict also increased the odds
of SI by 25% for males and 16% for females (see Table 3). Anxiety symptoms were not found to
predict SI. Overall, results display that for both males and females, school bullying was a significant
contributor to SI. However, when additional controls for SI were present, school bullying was no
longer significant, indicating potential mediation (Baron & Kenny, 1986; Field, 2013; Hayes, 2012;
Hayes & Preacher, 2014). Next, mediation analysis was conducted to flesh out the potential
mediating paths.
Mediation analysis
A parallel multiple mediating model using the PROCESS macro in SPSS examined the direct and
indirect effect of school bullying (X) on SI (Y), as well as individual path coefficients between groups
(Figure 1). A bootstrapping technique was employed with the PROCESS macro, which sidesteps
issues regarding sampling distribution shape, and makes assumptions based on the indirect effect,
proving useful for multiple mediators (Hayes, 2009). Bootstrapping entails repeatedly resampling
data and estimating the most accurate indirect effect; therefore, for these data, 5 000 Bootstrap
resamples were used, which is considered robust (Hayes, 2009). PROCESS also allows multiple
mediators to be tested simultaneously, which is in contrast to the Baron and Kenny (1986)
approach that tests them individually, often resulting in estimation bias (Hayes, 2009). Results are
presented in Table 4 and Figure 1.
Table 4: Path coefficients and indirect effects for mediation model on suicidal ideations
Males Females
Indirect effects
Effect (SE) 95% Boot ULCI, LLCI Effect (SE) 95% Boot ULCI, LLCI
Total Indirect 0.161 (0.06)* 0.063, 0.300 0.182 (0.06)* 0.08, 0.34
Path 1 0.087 (0.05)* 0.017, 0.194 0.053 (0.03)* 0.004, 0.116
Path 2 0.041 (0.017)* 0.016, 0.081 0.04 (0.02)* 0.017, 0.078
Path 3 −0.010 (0.009) −0.04, 0.0005 0.004 (0.008) −0.01, 0.025
Path 4 0.004 (0.004) 0.0003, 0.0171 0.009 (0.006) 0.002, 0.03
Path 5 0.029 (0.025) −0.009, 0.0086 0.04 (0.02)* 0.005, 0.090
Path 6 0.003 (0.004) −0.0003, 0.017 0.011 (0.007)* 0.001, 0.04
Path 7 0.008 (0.003) −0.03, 0.082 0.027 (0.04) −0.03, 0.122
BY = Bully; DP = Depression; FC = Family Conflict; ATOD = Alcohol, Tobacco & Other Drug Use; SI = Suicidal
Ideation
Path1: BY→FC→SI; Path 2: BY→FCDP SI; Path 3: BY→FC→AT→SI; Path 4: BY→FC→DP→ATOD→SI;
Path5: BY→DP→SI; Path 6: BY→DP→ATOD→SI; Path 7: BY→ATOD→SI
*Path ignificant if Boot LLCI and ULCI does not contain zero
Depressive
symptoms
Experiences Substance
0.075 (0.023)
of family use
conflict
0.355*** (0.495***)
0.382*** (0.356***)
On premises
Suicidal
school
ideation
bullying c10.215** (0.224**) R2= 0.07 (0.08)
c ′ 0.106 (0.127) R2= 0.42 (0.44)
*p < 0.05; **p < 0.01; ***p < 0.001

Note: Estimates outside parenthesis are for males and those within parentheses are for females.
Figure 1: Multiple Mediation Model predicting suicidal ideation among male and female suburban adolescents
Results from this mediator model confirm that a significant direct effect between school bullying
and SI is present among males (b = 0.215, p < 0.01) and females (b = 0.224, p < 0.001). When
mediators (e.g., family conflict, depressive symptoms, and substance use) were added, the
relationship between school bullying (X) and SI (Y) was no longer significant between gender groups
(Table 4 and Figure. 1), accounting for 42% (males) and 44% (females) of the variance. From the
analysis, seven mediating paths resulted, with three significant paths identified for males and five
paths for females – i.e., when 95% CI is positive or negative and does not contain zero (Field 2013;
Hayes 2009, 2012). These individual paths (see Table 4) were specified as having a significant
indirect influence on SI. Results ranged from large (greater than 0.10) to moderate (0.05–0.09) and
small indirect effect (0.01 or less; Field 2013).
Results indicate that a strong total model indirect effect was found for both males (b = 0.161,
p < 0.05) and females (b = 0.182, p < 0.05), illustrating that the impact of school bullying on SI was
mediated by family conflict, depressive symptoms, and substance use (see Table 4). Individual paths
showed some variation as a result of gender – for example, path 5 identifies that school bullying
significantly affected depressive symptoms, which in turn increased SI. This path was not present
for males (CI95 = -0.009, 0.086), suggesting that females (CI95 = 0.005, 0.09) may be more likely
to internalize the experiences of school bullying. A small indirect effect was also present among
females only (b = 0.011, p < 0.05, CI95 [0.001, 0.04]), between bullying, depression, substance use,
and SI. Based on a Test of Joint Significance (TSJ), which requires significant paths from main
predictor to mediator and from mediator to outcome (Leth-Steensen & Gallitto, 2015), this previously
discussed result is identified as having a small indirect effect and partially mediating the relationship
between school bullying and SI. Beyond these results, there were additional paths that showed
significant mediating relationships between school bullying and SI, among both males and females.
Path 1 and path 2 significantly mediated the relationship between school bullying and SI. Path 1
identified the strongest effect between both groups (see Table 4), illustrating that school bullying in
the presence of family conflict mediated the relationship on SI. This result signifies the dire impact
that living in a conflictual home has on both school bullying and SI. Path 2 furthered findings from
path 1 and identified that not only does family conflict predict SI, but it also predicts depression,
explicating that both family conflict and depressive symptoms mediate the relationship between
school bullying and SI. These results increase our knowledge of the effect school bullying has on SI
and also the mediating relationship family conflict, depression, and substance use hold; as these are
often overlooked controls in both research and practice.
Discussion
Further examining the influence of school bullying on SI is an important and needed area of inquiry.
Previous studies have identified the relationship between school bullying and SI, while more
recent analyses (e.g., Bauman et al., 2013; Cash & Bridge, 2009; Espelage et al., 2014; Mueller
et al., 2015; Nock et al., 2008; Reed et al., 2015; Valois et al., 2015) have explored the relationship
additional internal and external experiences have between school bullying and SI. In addition,
recent research has explored how males and females experience school bullying and SI (Espelage
et al., 2014; Litwiller & Brausch, 2013; Shetgiri et al., 2015) and more important, how additional
controls such as family conflict (Sigfusdottir et al., 2013; Tormala et al., 2015), depression and
anxiety (Idsoe et al., 2012; Shetgiri et al., 2015), and substance use (Espelage et al., 2014)
influence the relationship between school bullying and SI. However, future studies need to expand
upon and test the influence of gender on school bullying, SI, and our main control variables.
This study examined the direct and indirect effects of school bullying, family conflict, depressive
and anxiety symptoms, and substance use on SI among a cohort of middle and high school aged
suburban adolescents. All hypotheses were confirmed, with the exception of how anxiety influenced
SI in the presence of bullying. Results indicated that school bullying had a significant impact on SI
among males and females in isolation; however, as other variables (e.g., family conflict, depressive
and anxiety symptoms, and substance use) were added to the regression model, school bullying
was no longer a significant predictor of SI, demonstrating the potential mediation between bullying
and SI. The results of logistic regression analysis further identified that predictors of SI were stronger
for males, except with the substance use construct, showing the strong relationship females had with
using substances and experiencing SI.
Mediation analysis, using a parallel multiple mediating model, further established the mediating
effect of these additional variables among males and females, along with the specific and diverging
paths by gender. Family conflict mediated the relationship between school bullying and suicidal
ideations for both gender groups. One explication that can be drawn from this is that the presence of
family conflict significantly increased the potential for SI among bullied youth, which may be a result
of further social isolation and lack of support (Bowers et al., 1994; Espelage et al., 2014; Idsoe et al.,
2012). Males were equally likely to internalize the emotions of school bullying, but only as a result
of family conflict. This relationship was also present for females, identifying that the presence of
additional stressors may increase the potential for negative emotions. The direct relationship family
conflict holds with depressive symptoms further illustrates that youth who experience increased
loneliness and isolation are at risk for depression and in turn SI (Espelage et al., 2012; Idsoe et al.,
2012; Storch & Masia-Warner, 2004; Yang & McLoyd, 2015). Two indirect effects were observed to
occur among females only.
Depression was identified as a mediator for females only. This result is consistent with previous
research that has shown bullied females internalize more of their emotions, increasing their
susceptibility to SI and attempts (Fleming & Ledogar, 2008; Luk et al., 2010). In addition, we
identified a small and significant indirect relationship between school bullying, depressive symptoms,
substance use, and SI. School bullying increased the likelihood of females to experience depression,
which in turn had a direct effect on substance use and in turn SI. The relationship between school
bullying and depression, and depression and substance use, is consistent with previous research
(e.g., Espelage et al., 2014; Fleming & Ledogar, 2008; Reed et al., 2015). We can theorize that
females who were bullied at school and experienced symptoms of depression used substances
as a method of coping, which increased their propensity to experience SI. Of note, no paths were
present that identified substance use as a significant mediator for either gender group, a finding that
is generally consistent in previous studies (e.g., Luk et al., 2010; Mitchell et al., 2007). However,
as prior research has indicated (e.g., Reed et al., 2015), depressive symptoms tend to be present
in conjunction with substance use. This comorbid association, in turn, mediates the relationship
between bullying and SI.
Our findings provide insight into the experiences of school bullying and SI among males and
females. This study draws attention to the additional experiences associated with school bullying,
and how these results may differ by gender. In addition, this exploratory study illustrates the
importance of considering additional mediating or control variables when attempting to understand
school bullying and the relationship it holds with SI. Future research is encouraged to examine family
experiences, such as sibling violence, which may provide a similar mediating response. The results
of this investigation are particularly noteworthy for those working directly and indirectly with bullied
youth, whether in the school, private practice, or in prevention.
Recommendations for mental health practitioners and prevention
Whether working in schools, community-based agencies, or hospitals, therapists and mental

health professionals engage with bullied youth. School-based mental health personnel have
been identified as being situated in a unique setting, spending multiple hours and days with these
adolescents, thus making schools a particularly important venue for intervention and receiving
mental health services. Schools have also been identified as providing more mental health and
prevention services to youth than in any other sector (Singer & Slovak, 2011). However, findings
from this study have significant implications for mental health practitioners and clinicians beyond
the school setting, which is important when providing holistic therapeutic and prevention services.
These findings identify the personal (e.g., depression, substance use, and SI) and interpersonal
(e.g., family) spheres of influence that increase SI. Therapists need to consider all of these factors to
holistically and adequately assess SI among bullied youth. First, as this study and others have found,
family conflict does not only mediate the relationship between school bullying and SI for males and
females, it may also be a significant indicator of SI, as found in our logistic regression results. Our
results also indicated that family conflict increased depressive symptoms and in turn SI for both
males and females. For clinicians, these findings are important as they identify the significance of
understanding the home life of bullied youth, and also the need to engage families in therapeutic
interventions and treatment (Israel et al., 2011). For example, family-based therapeutic techniques
that increase parental availability and reduce family conflict, as well as help youth navigate family
terrain could be beneficial in building family support and rapport between youth and their families,
while simultaneously decreasing the impact of school bullying (Israel et al., 2011). If we can redefine
the processes present in the family as more supportive, bullied youth may be less likely to experience
SI, considering research on bullying and SI has recognized family cohesion as a compensatory
mechanism (Hertz, Donato, & Wright, 2013; Sapouna & Wolke, 2013). Among victimized females
in particular, mental health practitioners should consider the effect of family conflict on depression,
substance use, and SI, and also the effect of depressive symptoms on substance use and SI.
As has been identified, victimized females in this study tend to internalize emotions and
use substances at higher rates when compared to their male counterparts. Therapists, school
counsellors, and social workers should acknowledge this difference, particularly in how they
approach future treatment and planning. Specifically, it is important to identify additional factors
that would increase depression and substance use, beyond school bullying (Espelage et al.
2012). For example, practitioners may need to build in substance use treatment protocols to work
through negative coping mechanisms. Findings also have implications for prevention programming.
For instance, school bullying prevention programs often focus on within-school culture, without
addressing the contextual factors outside of school. School bullying prevention programs should
consider the family in their prevention efforts, since family processes can have a significant effect
on bullying and SI. Involving families in prevention can reduce the potential for further isolation
among bullied youth. Overall, considering that negative family processes increase the potential for
depression and SI, the need to add family-based therapeutic treatment and prevention efforts while
working with victimized youth, is imperative.
Limitations and future research
Recommendations and findings should be considered in light of several limitations. First, the
directionality of these paths are guided by previous studies; however, it is possible that depressed
youth may be more likely to be bullied. Therefore, a reciprocal path may be present, but not
included in the model. Future studies should consider this by utilizing longitudinal designs, as
well as more advanced statistical processes. Second, this study is cross-sectional, thus causal
associations cannot be made. Prospective investigations should consider using longitudinal data
to adequately explore causal associations. Third, although we utilized a sample of U.S. middle and
high school students, the majority of these youth were White non-Hispanic (75.8%) and living within
a northeastern suburban community. Findings from this study need to be replicated and explored
in other communities to increase external validity of results. Fourth, issues regarding response
bias and social desirability may have been present, despite methodological checks to reduce such
issues. Although findings in the present study were significant, future research should consider
multiple options to reduce methodological biases, particularly response bias, which is inherent
when examining social issues, such as substance use and suicide (Podsakoff et al., 2012). Lastly,
complete school bullying and suicide measures were not incorporated into the needs assessment
due to the time constraints needed to complete survey; although reliabilities were acceptable.
However, utilizing three items for bullying (Litwiller & Brausch, 2013; Yang & McLoyd, 2015) and
two items for suicide (Mayes et al., 2014; Mueller et al., 2015) is not uncommon in the bullying
and suicide literature. Despite these limitations, this study advanced this area of inquiry in several
ways: 1) we have a better understanding of the relationship that family conflict, substance use,
depression, and anxiety has on bullied youth and in turn SI; 2) we identified variation in our findings
based on gender, contributing the limited, yet growing discussion on gender differences in the
school bullying and suicide literature; and 3) we provided a discussion and recommendations that
focus on implications for practitioners and prevention programmers, thus interpreting our findings
for practical and immediate use.
Taken together, findings support and extend research on bullying and suicide. This study explored
the relationship between school bullying and SI, as well as the mediating influence of additional
variables, such as family conflict, depression, and substance use. This study extended our
understanding by examining these relationships between males and females. Unlike other studies
in this area, we provided recommendations for mental health practitioners and other personnel who
may come in contact or work with bullied youth. Future research should continue to examine the
influence of school bullying on SI, in addition to the multitude of other factors present that both
moderate and mediate this relationship. Moving forward, researchers should consider additional
populations of U.S. adolescents; particularly those youth living in urban communities where factors
not experienced by suburban youth are present (e.g., violent crime, gang activity). Considerations
should also be given to the effects of school bullying on SI among LGBTQ (Lesbian, Gay, Bisexual,
Transgender, and Questioning) and MSM (Men having Sex with Men) adolescents, as these young
people may be identified as particularly vulnerable populations (Poteat & Rivers, 2015). Lastly,
longitudinal studies could help tease out causal associations for a better understanding of the
relationship among school bullying, SI, and suicidality.
Acknowledgements — We thank the gracious reviewers for their time in reviewing our manuscript. Doing so has
made it a stronger addition to the literature.
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Journal of Child & Adolescent Mental Health

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Suicidal ideation among suburban adolescents:

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Suicidal ideation among suburban adolescents: The

Bullying and suicidal ideations

The relationship between school bullying and suicide

Additional risks for suicidal ideation

Adolescence is characterized as a period of heightened emotions and variations in mood (Reed et

Adolescent substance use

Depression and anxiety symptoms

Purpose and research hypotheses

Table 1: Demographics of sample (N = 488)

Table 2: Correlations of main variables between subsamples

Depressive and anxiety symptoms

Males (N = 232) Females (N = 256)

*p < 0.05; **p < 0.01; ***p < 0.001

Recommendations for mental health practitioners and prevention

Whether working in schools, community-based agencies, or hospitals, therapists and mental

Limitations and future research

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p < 0.05; p < 0.01; p < 0.001