Psychological Medicine

Review Article

Childhood bullying and the association with psychosis in non-clinical and clinical samples: a review and meta-analysis

D. S. van Dama1 c1, E. van der Vena2a3, E. Velthorsta1, J. P. Seltena2a3, C. Morgana4a5 and L. de Haana1

a1 Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands

a2 Rivierduinen Institute for Mental Health Care, Oegstgeest, The Netherlands

a3 Department of Psychiatry and Psychology, Maastricht University, The Netherlands

a4 National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK

a5 Section of Social Psychiatry, Institute of Psychiatry, King's College London, UK


Approximately 11% of schoolchildren are bullied on a regular basis. It has been argued that continuous exposure to stress is related to the development of psychotic symptoms. The current study sought to investigate whether being bullied in childhood is related to the development of psychotic symptoms.

A search of PubMed, PsycINFO and EMBASE was conducted. The reference lists of included papers were searched to identify other eligible papers. A meta-analysis was performed on a subgroup of studies.

We found four clinical and 10 general population studies that met inclusion criteria. The results of the clinical studies were mixed. However, the results of the non-clinical studies provided more consistent evidence that school bullying is related to the development of non-clinical psychotic symptoms. Stronger associations were found with increased frequency and severity and longer duration of being bullied. We performed a meta-analysis on seven population-based studies, yielding unadjusted and adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI) 2.1–3.6] and 2.3 (95% CI 1.5–3.4) respectively.

Although there is some evidence of an association between bullying and psychosis in clinical samples, the research is too sparse to draw any firm conclusions. However, population-based non-clinical studies support the role of bullying in the development of psychotic symptoms later in life. These findings are consistent with findings of an increased risk of psychotic symptoms among those exposed to other types of abuse.

(Received November 30 2011)

(Revised February 03 2012)

(Accepted February 09 2012)

(Online publication March 09 2012)

Key words

  • Adolescents;
  • bullying victimization;
  • children;
  • epidemiology;
  • psychosis


c1 Address for correspondence: D. S. van Dam, M.Sc., Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, Meibergdreef 5, Room PA3-133, 1105 AZ Amsterdam, The Netherlands. (Email: