Subtypes of Peer Victimization, Depressive Symptoms, and Self-harm Behaviors Among Children Affected by Parental HIV

  • Yanping JiangEmail author
  • Xiaoming Li
  • Junfeng Zhao
  • Guoxiang Zhao
Original Paper



Peer victimization is a salient stressor contributing to self-harm behaviors in children. However, the psychological mechanisms underlying this process are not well understood. The aim of this study was to examine the role of depressive symptoms in the relationships between subtypes of peer victimization and self-harm behaviors among children affected by parental HIV using a prospective design.


Participants in this study consisted of a subsample (N= 521, 6–12 years of age at baseline) of a larger research project on the psychological adjustment of children affected by parental HIV. Children self-reported subtypes of peer victimization including physical, verbal, and relational forms, depressive symptoms, and self-harm behaviors.


Structural equation models showed that verbal victimization, but not physical or relational victimization, was associated with increases in self-harm behaviors over a 24-month period (β = 0.18, p = 0.029). Moreover, the association between verbal victimization and self-harm behaviors was mediated by increases in depressive symptoms (indirect effect = 0.04, 95%CI [0.01, 0.08]), controlling for baseline self-harm behaviors, depressive symptoms, gender, AIDS orphan status, and age. In addition, such a mediation pathway was consistent across gender.


Depressive symptoms might be a psychological mechanism linking verbal victimization to self-harm behaviors among children affected by parental HIV. The findings highlight the importance of detection of depressive symptoms as a potential way to prevent self-harm behaviors among victimized children or those at high risk of experiencing peer victimization such as children affected by parental HIV.


Peer victimization Self-harm behaviors Depressive symptoms Parental HIV Children 



This work was supported by US National Institutes of Health Grants R01MH076488 and R01NR13466.

Author Contributions

YJ: analyzed the data and drafted the manuscript. XL: designed and executed the study and edited the manuscript critically. JZ: designed the study and coordinated data collection. GZ: designed the study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The approval for the study protocol was obtained from the Institutional Review Boards at Wayne State University in the United States and Beijing Normal University in China.

Informed Consent

Informed consent was obtained from all children and their caregivers included in the study.


  1. Agnew, R. (1992). Foundation for a general strain theory of crime and delinquency. Criminology, 30(1), 47–88. Scholar
  2. Ainsworth, M., & Filmer, D. (2006). Inequalities in children’s schooling: AIDS, orphanhood, poverty, and gender. World Development, 34(6), 1099–1128. Scholar
  3. Alsaker, F. D., & Dick-Niederhauser, A. (2006). Depression and suicide. In S. Jackson & L. Goosens (Eds.), Handbook of adolescent development (pp. 308–336). Hove, England: Psychology Press.Google Scholar
  4. Arango, A., Opperman, K. J., Gipson, P. Y., & King, C. A. (2016). Suicidal ideation and suicide attempts among youth who report bully victimization, bully perpetration and/or low social connectedness. Journal of Adolescence, 51, 19–29. Scholar
  5. Asparouhov, T., & Muthen, B. (2006). Robust chi square difference testing with mean and variance adjusted test statistics. Mplus Web Notes: No. 10.
  6. Barzilay, S., Klomek, A. B., Apter, A., Carli, V., Wasserman, C., Hadlaczky, G., & Keresztény, A. (2017). Bullying victimization and suicide ideation and behavior among adolescents in Europe: A 10-country study. Journal of Adolescent Health, 61(2), 179–186. Scholar
  7. Bauman, S., Toomey, R. B., & Walker, J. L. (2013). Associations among bullying, cyberbullying, and suicide in high school students. Journal of Adolescence, 36(2), 341–350. Scholar
  8. Boyes, M. E., & Cluver, L. D. (2015). Relationships between familial HIV/AIDS and symptoms of anxiety and depression: The mediating effect of bullying victimization in a prospective sample of South African children and adolescents. Journal of Youth and Adolescence, 44(4), 847–859. Scholar
  9. Brunstein K. A., Barzilay, S., Apter, A., Carli, V., Hoven, C. W., Sarchiapone, M., Brunner, R. (2018). Bi‐directional longitudinal associations between different types of bullying victimization, suicide ideation/attempts, and depression among a large sample of European adolescents. Journal of Child Psychology and Psychiatry.
  10. Casper, D. M., & Card, N. A. (2017). Overt and relational victimization: a meta-analytic review of their overlap and associations with social-psychological adjustment. Child Development, 88(2), 466–483. Scholar
  11. Cluver, L., Bowes, L., & Gardner, F. (2010). Risk and protective factors for bullying victimization among AIDS-affected and vulnerable children in South Africa. Child Abuse and Neglect, 34(10), 793–803. Scholar
  12. Cluver, L., Operario, D., Lane, T., & Kganakga, M. (2012). “I can’t go to school and leave her in so much pain” educational shortfalls among adolescent ‘young carers’ in the South African AIDS epidemic. Journal of Adolescent Research, 27(5), 581–605. Scholar
  13. Cook, C. R., Williams, K. R., Guerra, N. G., Kim, T. E., & Sadek, S. (2010). Predictors of bullying and victimization in childhood and adolescence: a meta-analytic investigation. School Psychology Quarterly, 25(2), 65–83. Scholar
  14. Crick, N. R., Casas, J. F., & Ku, H.-C. (1999). Relational and physical forms of peer victimization in preschool. Developmental Psychology, 35(2), 376–385. Scholar
  15. Desjardins, T. L., & Leadbeater, B. J. (2011). Relational victimization and depressive symptoms in adolescence: Moderating effects of mother, father, and peer emotional support. Journal of Youth and Adolescence, 40(5), 531–544. Scholar
  16. Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health, 39(5), 662–668. Scholar
  17. Espelage, D. L., & Holt, M. K. (2013). Suicidal ideation and school bullying experiences after controlling for depression and delinquency. Journal of Adolescent Health, 53(1), S27–S31. Scholar
  18. Espelage, D. L., Low, S., & De La Rue, L. (2012). Relations between peer victimization subtypes, family violence, and psychological outcomes during early adolescence. Psychology of Violence, 2(4), 313–324. Scholar
  19. Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: Validating the center for epidemiologic studies depression scale for children. American Journal of Epidemiology, 131(3), 538–551. Scholar
  20. Fisher, H. L., Moffitt, T. E., Houts, R. M., Belsky, D. W., Arseneault, L., & Caspi, A. (2012). Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ, 344, e2683 Scholar
  21. Fox, C. L., & Boulton, M. J. (2006). Longitudinal associations between submissive/nonassertive social behavior and different types of peer victimization. Violence and Victims, 21(3), 383–400. Scholar
  22. Gershon, A., Minor, K., & Hayward, C. (2008). Gender, victimization, and psychiatric outcomes. Psychological Medicine, 38(10), 1377–1391. Scholar
  23. Gini, G., & Pozzoli, T. (2009). Association between bullying and psychosomatic problems: A meta-analysis. Pediatrics, 123(3), 1059–1065. Scholar
  24. Hawker, D. S., & Boulton, M. J. (2000). Twenty years’ research on peer victimization and psychosocial maladjustment: A meta-analytic review of cross-sectional studies. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 41(4), 441–455. Scholar
  25. Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373–2382. Scholar
  26. Hay, C., & Meldrum, R. (2010). Bullying victimization and adolescent self-harm: Testing hypotheses from general strain theory. Journal of Youth and Adolescence, 39(5), 446–459. Scholar
  27. Heilbron, N., & Prinstein, M. J. (2010). Adolescent peer victimization, peer status, suicidal ideation, and nonsuicidal self-injury: Examining concurrent and longitudinal associations. Merrill-Palmer Quarterly (1982), 56(3), 388–419. Scholar
  28. Hong, J. S., Kral, M. J., & Sterzing, P. R. (2015). Pathways from bullying perpetration, victimization, and bully victimization to suicidality among school-aged youth: a review of the potential mediators and a call for further investigation. Trauma Violence and Abuse, 16(4), 379–390. Google Scholar
  29. Kawabata, Y., Tseng, W.-L., & Crick, N. R. (2014). Mechanisms and processes of relational and physical victimization, depressive symptoms, and children’s relational-interdependent self-construals: Implications for peer relationships and psychopathology. Development and Psychopathology, 26(3), 619–634. Scholar
  30. Leadbeater, B. J., Thompson, K., & Sukhawathanakul, P. (2014). It gets better or does it? Peer victimization and internalizing problems in the transition to young adulthood. Development and Psychopathology, 26(3), 675–688. Scholar
  31. Lereya, S. T., Winsper, C., Heron, J., Lewis, G., Gunnell, D., Fisher, H. L., & Wolke, D. (2013). Being bullied during childhood and the prospective pathways to self-harm in late adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 608–618. Scholar
  32. Liu, X., Tein, J. Y., Zhao, Z., & Sandler, I. N. (2005). Suicidality and correlates among rural adolescents of China. Journal of Adolescent Health, 37(6), 443–451. Scholar
  33. Muthén, L. K., & Muthén, B. O. (2012). Mplus Version7 User’s Guide. Los Angeles, CA: Muthén & Muthén.Google Scholar
  34. Olsson, G., & von Knotting, A. L. (1997). Depression among Swedish adolescents measured by the self rating scale Center for Epidemiology Studies-Depression Child (CES-DC). European Child & Adolescent Psychiatry, 6(2), 81–87. Scholar
  35. Papafratzeskakou, E., Kim, J., Longo, G. S., & Riser, D. K. (2011). Peer victimization and depressive symptoms: Role of peers and parent–child relationship. Journal of Aggression, Maltreatment & Trauma, 20(7), 784–799. Scholar
  36. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. Scholar
  37. Prinstein, M. J., Boergers, J., & Vernberg, E. M. (2001). Overt and relational aggression in adolescents: Social-psychological adjustment of aggressors and victims. Journal of Clinical Child Psychology, 30(4), 479–491. Scholar
  38. Putallaz, M., Grimes, C. L., Foster, K. J., Kupersmidt, J. B., Coie, J. D., & Dearing, K. (2007). Overt and relational aggression and victimization: Multiple perspectives within the school setting. Journal of School Psychology, 45(5), 523–547. Scholar
  39. Reed, K. P., Nugent, W., & Cooper, R. L. (2015). Testing a path model of relationships between gender, age, and bullying victimization and violent behavior, substance abuse, depression, suicidal ideation, and suicide attempts in adolescents. Children and Youth Services Review, 55, 128–137. Scholar
  40. Reijntjes, A., Kamphuis, J. H., Prinzie, P., & Telch, M. J. (2010). Peer victimization and internalizing problems in children: A meta-analysis of longitudinal studies. Child Abuse and Neglect, 34(4), 244–252. Scholar
  41. Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132(1), 98–131. Scholar
  42. Sampasa-Kanyinga, H., Roumeliotis, P., & Xu, H. (2014). Associations between cyberbullying and school bullying victimization and suicidal ideation, plans and attempts among Canadian schoolchildren. PLoS ONE, 9(7), e102145 Scholar
  43. Saunders, K. E., & Smith, K. A. (2016). Interventions to prevent self-harm: what does the evidence say? Evidence-based Mental Health, 19(3), 69–72. Scholar
  44. Storch, E. A., & Ledley, D. R. (2005). Peer victimization and psychosocial adjustment in children: Current knowledge and future directions. Clinical Pediatrics, 44(1), 29–38. Scholar
  45. Storch, E. A., Nock, M. K., Masia-Warner, C., & Barlas, M. E. (2003). Peer victimization and social-psychological adjustment in Hispanic and African-American children. Journal of Child and Family Studies, 12(4), 439–452. Scholar
  46. Taylor, K. A., Sullivan, T. N., & Kliewer, W. (2013). A longitudinal path analysis of peer victimization, threat appraisals to the self, and aggression, anxiety, and depression among urban African American adolescents. Journal of Youth and Adolescence, 42(2), 178–189. Scholar
  47. Tishler, C. L., Reiss, N. S., & Rhodes, A. R. (2007). Suicidal behavior in children younger than twelve: a diagnostic challenge for emergency department personnel. Academic Emergency Medicine, 14(9), 810–818. Scholar
  48. UNICEF. (2016). Statistics by Area/HIV/AIDS UNICEF, 2016.
  49. Vuijk, P., van Lier, P. A., Crijnen, A. A., & Huizink, A. C. (2007). Testing sex-specific pathways from peer victimization to anxiety and depression in early adolescents through a randomized intervention trial. Journal of Affective Disorders, 100(1), 221–226. Scholar
  50. Wang, B., Li, X., Barnett, D., Zhao, G., Zhao, J., & Stanton, B. (2012). Risk and protective factors for depression symptoms among children affected by HIV/AIDS in rural China: A structural equation modeling analysis. Social Science & Medicine, 74(9), 1435–1443. Scholar
  51. Williams, S. G., Langhinrichsen-Rohling, J., Wornell, C., & Finnegan, H. (2017). Adolescents transitioning to high school: Sex differences in bullying victimization associated with depressive symptoms, suicide ideation, and suicide attempts. The Journal of School Nursing, 33(6), 467–479. Scholar
  52. Winsper, C., Lereya, T., Zanarini, M., & Wolke, D. (2012). Involvement in bullying and suicide-related behavior at 11 years: a prospective birth cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(3), 271–282. Scholar
  53. Yu, C. Y., & Muthen, B. (2002). Evaluation of model fit indices for latent variable models with categorical and continuous outcomes (Technical Report). Los Angeles: University of California at Los Angeles, Graduate School of Education & Information Studies.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaUSA
  2. 2.International Research Center for Psychological Health of Vulnerable PopulationsHenan UniversityKaifengChina
  3. 3.Department of PsychologyHenan Normal UniversityXinxiangChina

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