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Patterns of Family Adversity and Bullying Involvement in Adolescents: Association with Mental Health Problems

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Title: Patterns of Family Adversity and Bullying Involvement in Adolescents: Association with Mental Health Problems
Language: English
Authors: Mingxiao Liu (ORCID 0009-0007-4361-2962), Aiyi Liu (ORCID 0000-0002-4077-4663), Wenzhou Lin, Xiaoqing Yu (ORCID 0009-0003-1419-4221), Xinchun Wu (ORCID 0000-0002-2756-0548)
Source: Journal of Adolescence. 2025 97(3):861-870.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Family Environment, Bullying, Family Involvement, Adolescents, Family Influence, Mental Health, Mental Disorders, Adolescent Development, Family Problems, Foreign Countries, Intervention
Geographic Terms: China
DOI: 10.1002/jad.12462
ISSN: 0140-1971
1095-9254
Abstract: Introduction: Family and school environments are pivotal in adolescent development. However, the simultaneous examination of adversities in both domains remains understudied. Based on bioecological and spillover theories, this study aimed to bridge this research gap by using latent profile analysis to identify distinct patterns of family adversity and bullying involvement among Chinese adolescents. This study also explored mental health problems associated with these patterns. Methods: This study was conducted in June (T1) and December (T2) 2023, with a 6-month interval, in Henan Province, China, and involved 2,568 adolescents (50.3% girls, M[subscript age] = 13.46 ± 0.72). Participants completed questionnaires assessing family adversity and bullying involvement at T1, as well as assessments of depressive symptoms, anxiety symptoms, suicide risk, and complex posttraumatic stress disorder symptoms at both T1 and T2. Results: Six profiles were identified--low adversity and bullying (69.0%, n = 1,771), abuse only (10.9%, n = 279), neglect only (4.5%, n = 115), bullying involvement only (3.7%, n = 96), moderate adversity and bullying with severe abuse (6.9%, n = 176), and moderate adversity and bullying with severe neglect (5.1%, n = 131). Importantly, the severity of mental health problems varied significantly across these profiles. Conclusion: The study enriches our understanding of concurrent family adversity and bullying involvement and their impact on adolescent mental health, offering insights for tailored intervention strategies for affected groups.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1466437
Database: ERIC
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  Value: <anid>AN0184298302;jaa01apr.25;2025Apr09.05:04;v2.2.500</anid> <title id="AN0184298302-1">Patterns of Family Adversity and Bullying Involvement in Adolescents: Association With Mental Health Problems </title> <p>Introduction: Family and school environments are pivotal in adolescent development. However, the simultaneous examination of adversities in both domains remains understudied. Based on bioecological and spillover theories, this study aimed to bridge this research gap by using latent profile analysis to identify distinct patterns of family adversity and bullying involvement among Chinese adolescents. This study also explored mental health problems associated with these patterns. Methods: This study was conducted in June (T1) and December (T2) 2023, with a 6‐month interval, in Henan Province, China, and involved 2,568 adolescents (50.3% girls, Mage = 13.46 ± 0.72). Participants completed questionnaires assessing family adversity and bullying involvement at T1, as well as assessments of depressive symptoms, anxiety symptoms, suicide risk, and complex posttraumatic stress disorder symptoms at both T1 and T2. Results: Six profiles were identified: low adversity and bullying (69.0%, n = 1,771), abuse only (10.9%, n = 279), neglect only (4.5%, n = 115), bullying involvement only (3.7%, n = 96), moderate adversity and bullying with severe abuse (6.9%, n = 176), and moderate adversity and bullying with severe neglect (5.1%, n = 131). Importantly, the severity of mental health problems varied significantly across these profiles. Conclusion: The study enriches our understanding of concurrent family adversity and bullying involvement and their impact on adolescent mental health, offering insights for tailored intervention strategies for affected groups.</p> <p>Keywords: bullying involvement; family adversity; latent profile analysis</p> <p>Adolescence is a pivotal stage of development characterized by substantial physical, emotional, and social changes (Sawyer et al. [<reflink idref="bib36" id="ref1">36</reflink>]). During this period, adolescents transition from family‐centered interactions to peer‐focused relationships, underscoring the critical roles of both family and peer dynamics in their development (Smetana, Campione‐Barr, and Metzger [<reflink idref="bib39" id="ref2">39</reflink>]). Adolescents face numerous challenges during these transitions, including coping with family hardships and engaging in bullying, either as victims or perpetrators. These challenges are closely linked to various mental health problems, including depression, anxiety, and suicide risk, as well as trauma‐related symptoms such as complex posttraumatic stress disorder (CPTSD) (Eyuboglu et al. [<reflink idref="bib10" id="ref3">10</reflink>]; Mersky, Topitzes, and Reynolds [<reflink idref="bib31" id="ref4">31</reflink>]; Yen et al. [<reflink idref="bib50" id="ref5">50</reflink>]; Sölva, Haselgruber, and Lueger‐Schuster [<reflink idref="bib40" id="ref6">40</reflink>]). Moreover, the cumulative impact of enduring multiple adversities is more detrimental to mental health than that of single adversity (Finkelhor, Ormrod, and Turner [<reflink idref="bib12" id="ref7">12</reflink>]; Turner, Finkelhor, and Ormrod [<reflink idref="bib44" id="ref8">44</reflink>]). This underscores the necessity to elucidate complex patterns and associations influencing adolescent mental health.</p> <hd id="AN0184298302-2">Patterns of Family Adversity and Bullying Involvement</hd> <p>Family adversity is defined as a series of actions or inactions by parents or caregivers that cause harm, potential harm, or a threat of harm to children (Felitti et al. [<reflink idref="bib11" id="ref9">11</reflink>]). Initially, research on childhood adversity primarily focused on abuse and neglect (Bernstein et al. [<reflink idref="bib1" id="ref10">1</reflink>]). Over time, this definition has broadened to include additional circumstances, such as a family member's mental illness or parental divorce, particularly when these situations negatively impact the child. Given this expanded perspective, we utilized adverse childhood experience (ACE) items to comprehensively measure family adversity in this study. Approximately 60% of adults have experienced at least one form of family adversity during their childhood (Giano, Wheeler, and Hubach [<reflink idref="bib17" id="ref11">17</reflink>]). Bullying is defined as repetitive, undesired aggressive behavior among peers, characterized by an imbalance of power between the victim and perpetrator (Olweus [<reflink idref="bib32" id="ref12">32</reflink>]). Bullying mainly involves two direct roles: the perpetrator and the victim. A meta‐analysis of 68 studies revealed that the prevalence rates of bullying perpetration and victimization in the school‐aged population are 15.7% and 22.7%, respectively (Xing et al. [<reflink idref="bib49" id="ref13">49</reflink>]).</p> <p>Spillover theory posits that individuals exist within interconnected social systems, such as peer and family subsystems, where changes in one system can provoke emotional and behavioral shifts that influence interactions in other systems (Parke and Ladd [<reflink idref="bib33" id="ref14">33</reflink>]). The theory further suggests that children carry relational dynamics between peer and family subsystems (Parke and Ladd [<reflink idref="bib33" id="ref15">33</reflink>]). Family adversity and bullying involvement frequently co‐occur, exerting a combined impact on individuals. In other words, children who experience one form of victimization are more likely to experience other forms (Finkelhor, Ormrod, and Turner [<reflink idref="bib12" id="ref16">12</reflink>]). Adolescents who experience family adversity, such as abuse and neglect, during their childhood may have considerably increased risks of bullying victimization and perpetration (Merrin et al. [<reflink idref="bib30" id="ref17">30</reflink>]; Shackman and Pollak [<reflink idref="bib37" id="ref18">37</reflink>]; Hong et al. [<reflink idref="bib20" id="ref19">20</reflink>]). By contrast, both bullying perpetration and victimization can be associated with a higher risk of encountering family adversity. For example, a cross‐lagged panel study indicated that both bullying perpetration and victimization can predict subsequent emotional maltreatment (Li et al. [<reflink idref="bib25" id="ref20">25</reflink>]).</p> <p>Traditional research methods often fail to capture interactions between different types of adversities, potentially limiting our understanding of the complex situations encountered by adolescents. By contrast, person‐centered approaches, such as latent profile analysis (LPA), consider individual differences. LPA classifies individuals into latent groups based on correlations among observed continuous variables (Vermunt and Magidson [<reflink idref="bib45" id="ref21">45</reflink>]). This method demonstrates the associations between different types of adversities and identifies complex patterns of responding to these adversities. Moreover, LPA can simultaneously evaluate different subtypes of family adversity and aspects of bullying involvement. This method elucidates naturally co‐occurring patterns of family adversity and bullying involvement, further explaining the complexity of their adverse outcomes.</p> <p>To date, only one LPA study examined several subtypes of family abuse, family neglect, and bullying victimization, identifying six groups (Fu, Huebner, and Tian [<reflink idref="bib14" id="ref22">14</reflink>]): "low risk" (61.5%), "slight peer victimization" (13.0%), "high neglect" (12.1%), "severe maltreatment" (5.1%), "severe peer victimization" (4.4%), and "doubly disadvantaged" (3.7%). The "doubly disadvantaged" group exhibited the most emotional problems. However, this study did not comprehensively explore family dysfunction and bullying perpetration—factors common to both family and school settings. Thus, the present study provides a more comprehensive understanding of diverse challenges encountered by adolescents by considering neglect, abuse, family dysfunction, and both bullying perpetration and victimization.</p> <hd id="AN0184298302-3">Association With Mental Health Problems</hd> <p>According to the bioecological model (Bronfenbrenner and Morris [<reflink idref="bib2" id="ref23">2</reflink>]), family adversity and bullying involvement are part of the microsystems that directly impact an individual's development. The mesosystem, which encompasses the interplay between these experiences, plays a significant role in shaping developmental trajectories. The model suggests that positive interactions between microsystems are crucial for optimal development, whereas negative interactions may lead to adverse developmental outcomes.</p> <p>The phenomenon of poly‐victimization is particularly concerning because it is associated with more severe outcomes compared with singular forms of adversity. Consistent with the dose‐response model, the accumulation of adversities is linearly correlated with an increased risk of negative developmental outcomes (Dong et al. [<reflink idref="bib8" id="ref24">8</reflink>]; Finkelhor, Ormrod, and Turner [<reflink idref="bib12" id="ref25">12</reflink>]). Previous studies have consistently found an association between family adversity and bullying victimization with a range of mental health problems, such as anxiety (Eyuboglu et al. [<reflink idref="bib10" id="ref26">10</reflink>]; Mersky, Topitzes, and Reynolds [<reflink idref="bib31" id="ref27">31</reflink>]), depression (Eyuboglu et al. [<reflink idref="bib10" id="ref28">10</reflink>]; Mersky, Topitzes, and Reynolds [<reflink idref="bib31" id="ref29">31</reflink>]), suicidal risk (Yen et al. [<reflink idref="bib50" id="ref30">50</reflink>]; Thompson and Kingree [<reflink idref="bib43" id="ref31">43</reflink>]), and complex posttraumatic stress disorder (CPTSD) symptoms (Shevlin et al. [<reflink idref="bib38" id="ref32">38</reflink>]; Sölva, Haselgruber, and Lueger‐Schuster [<reflink idref="bib40" id="ref33">40</reflink>]). While past research has primarily focused on the victims of bullying, an increasing body of evidence reveals that the roles within bullying, encompassing both victims and perpetrators, are linked to a variety of psychological difficulties, such as internalizing and externalizing problems, as well as suicidal ideation and behaviors (Hong, Kral, and Sterzing [<reflink idref="bib21" id="ref34">21</reflink>]; Eyuboglu et al. [<reflink idref="bib10" id="ref35">10</reflink>]; Hemphill, Tollit, and Herrenkohl [<reflink idref="bib19" id="ref36">19</reflink>]; Yen et al. [<reflink idref="bib50" id="ref37">50</reflink>]).</p> <p>The specific effects of patterns of family adversity and bullying involvement on adolescents' mental health are not well understood. Although previous studies have indicated that the negative effects of bullying victimization on mental health may endure for a longer period than family abuse and neglect (Lereya et al. [<reflink idref="bib24" id="ref38">24</reflink>]; Macalli et al. [<reflink idref="bib29" id="ref39">29</reflink>]), these studies have mainly used variable‐centered approaches. Thus, the effects of naturally occurring combinations of trauma severity and subtypes remain unclear. In addition, a person‐centered study focusing only on family adversity indicated a substantially stronger association of suicidal risk with a "high adverse childhood experience (ACE)" pattern than with "high neglect" or "high abuse and neglect" patterns (Li, Huebner, et al. [<reflink idref="bib26" id="ref40">26</reflink>]). To address these gaps and limitations, this study examined the associations of patterns of family adversity and bullying involvement with adolescent mental health problems, including anxiety, depressive, suicidal risk, or CPTSD symptoms, to comprehensively understand these developmental trajectories.</p> <hd id="AN0184298302-4">The Present Study</hd> <p>Based on bioecological and spillover theories, this study examined the co‐occurrence of family adversity, including abuse, neglect, family dysfunction, and bullying involvement (both perpetration and victimization), and assessed variations in subsequent mental health problems across different patterns. Drawing from empirical evidence and theoretical frameworks reviewed in previous studies, we hypothesize that (<reflink idref="bib1" id="ref41">1</reflink>) at least four profiles would be identified, namely low adversity and bullying, high adversity and bullying, bullying involvement only, and family adversity only, and (<reflink idref="bib2" id="ref42">2</reflink>) adolescents with high levels of family adversity and bullying involvement would report the most mental health problems, while those with low levels would report the least.</p> <hd id="AN0184298302-5">Methods</hd> <p></p> <hd id="AN0184298302-6">Procedures</hd> <p>This study was approved by the research ethics committee of the institution of the first author. Before data collection, informed consent was obtained from teachers, students, and parents. This study was conducted in June (T1) and December (T2) 2023 in Henan Province, China. Adolescents collectively participated in the survey in their classrooms during class hours, with each class acting as a unit under the guidance of their psychological teachers. In this study, participants completed questionnaires assessing family adversity and bullying involvement at T1, as well as assessments of depressive symptoms, anxiety symptoms, suicide risk, and CPTSD symptoms at both T1 and T2. Participant anonymity and confidentiality of their information were strictly maintained, a measure intended to encourage honest and accurate responses. All participants were informed that they could withdraw from the study at any time.</p> <hd id="AN0184298302-7">Participants</hd> <p>Conducted over two waves with a 6‐month interval, the study investigated a total of 2,568 adolescents whose average age was 13.46 years (SD = 0.72), with 9 missing data. Among them, 1,275 (49.6%) were boys, 1290 (50.2%) were girls, and 3 (0.1%) were missing data; 512 (19.9%) were only children, 2,052 (79.9%) were non‐only children, and 4 (0.2%) were missing information. The education backgrounds of the studied participants' parents were as follows: For fathers, 767 (29.9%) received junior middle school education or below, 816 (31.8%) graduated from high schools or technical secondary schools, 958 (37.3%) attained a college degree or higher and 27 (1.1%) were missing information; for mothers, the corresponding percentages were 31.9%, 32.6%, 34.5%, and 1.0%, respectively.</p> <hd id="AN0184298302-8">Measures</hd> <p></p> <hd id="AN0184298302-9">Family Adversity</hd> <p>This study used the ACE questionnaire to assess adolescents' family adversity (Felitti et al. [<reflink idref="bib11" id="ref43">11</reflink>]; Dube et al. [<reflink idref="bib9" id="ref44">9</reflink>]). This questionnaire comprises 29 items across three domains: abuse (physical, emotional, and sexual), neglect (physical and emotional), and household dysfunction (parental divorce or separation, household violence, substance abuse, mental illness, or incarceration within the household). The participants responded to ACE items that best represented their experiences. Typically, ACE scales are analyzed by calculating total scores across all 10 types of ACEs or by assessing scores within the three specific domains (Dube et al. [<reflink idref="bib9" id="ref45">9</reflink>]). The reliability of the scale in the present study was 0.88.</p> <hd id="AN0184298302-10">Bullying Involvement</hd> <p>The Bullying Participant Behavior Questionnaire (BPBQ) (Demaray et al. [<reflink idref="bib6" id="ref46">6</reflink>]) was used to assess bullying perpetration and victimization behaviors among adolescents. The BPBQ is highly reliable and valid in Chinese populations (Qiu et al. [<reflink idref="bib35" id="ref47">35</reflink>]). This questionnaire covers five subscales corresponding to different participant roles: bully, assistant, victim, defender, and outsider. Each subscale consists of 10 items. In our study, we used only the bully and victim subscales to examine bullying perpetration and victimization behaviors. The participants were asked to rate their behaviors on a 5‐point scale ranging from 0 (<emph>never</emph>) to 4 (<emph>7 or more times</emph>), reflecting their specific experiences or actions in the last 30 days (Demaray et al. [<reflink idref="bib6" id="ref48">6</reflink>]). In this study, the reliability of the scale was 0.86 for bullying perpetration and 0.90 for bullying victimization.</p> <hd id="AN0184298302-11">Depressive Symptoms</hd> <p>The Patient Health Questionnaire‐9 was used to measure depressive symptoms during the past two weeks (Kroenke, Spitzer, and Williams [<reflink idref="bib23" id="ref49">23</reflink>]). Adolescents were asked to rate their symptoms on a 4‐point scale ranging from 0 (<emph>not at all</emph>) to 4 (<emph>nearly every day</emph>). A higher total score indicates a higher level of depressive symptoms. The internal consistencies of this scale in this study were 0.94 at T1 and T2.</p> <hd id="AN0184298302-12">Anxiety Symptoms</hd> <p>This study used the Generalized Anxiety Disorder Questionnaire‐7 to measure anxiety symptoms over the past 2 weeks (Spitzer et al. [<reflink idref="bib41" id="ref50">41</reflink>]). Adolescents rated their symptoms on a 4‐point scale ranging from 0 (<emph>not at all</emph>) to 3 (<emph>nearly every day</emph>) across seven items. A higher total score indicates a higher level of anxiety symptoms. The internal consistencies of this scale in this study were 0.94 at T1 and 0.95 at T2.</p> <hd id="AN0184298302-13">Suicide Risk</hd> <p>The questionnaire included three items rated on a 3‐point Likert‐type scale from 0 (<emph>never</emph>) to 2 (<emph>often</emph>), with higher scores indicating more severe suicidal risk over the last 6 months. This scale assessed suicide ideation ("Have you intended suicide?"), suicide planning ("Have you planned suicide?"), and suicide attempts ("Have you attempted suicide?"). The internal consistencies of this scale in this study were 0.78 at T1 and 0.80 at T2.</p> <hd id="AN0184298302-14">CPTSD Symptoms</hd> <p>The International Trauma Questionnaire was used to assess CPTSD symptoms in adolescents over the past month (Cloitre et al. [<reflink idref="bib4" id="ref51">4</reflink>]). The ITQ consists of 12 items rated on a 5‐point Likert‐type scale from 0 (<emph>not at all</emph>) to 4 (<emph>extremely</emph>), covering six dimensions: re‐experiencing, avoidance, sense of threat, affective dysregulation, negative self‐concept, and disturbances in relationships. The internal consistencies of this scale in this study were 0.93 at T1 and T2.</p> <hd id="AN0184298302-15">Statistical Analysis</hd> <p>Statistical analyses in this study were conducted in three main steps. First, the missing data was addressed using the Expectation Maximization (EM) algorithm in SPSS 26.0, except for demographic data. Second, LPA was performed in Mplus 8.3 to identify concurrent profiles of family adversity and bullying involvement. To determine the optimal number of latent profiles, solutions ranging from 2 to 7 profiles were evaluated based on goodness‐of‐fit statistics, interpretability, and theoretical considerations. The selection of the best latent profile number was informed by the lowest Akaike's Information Criterion (AIC), Bayesian Information Criterion (BIC), and adjust BIC (aBIC) the significance of the bootstrap likelihood ratio test (BLRT), the Lo–Mendell–Rubin likelihood ratio test (LMRLRT), and high entropy. Finally, this study used the Analysis of Covariance (ANCOVA) approach to examine differences among the profiles in terms of anxiety symptoms, depressive symptoms, suicide risk, and CPTSD symptoms. Gender, age, and the corresponding variable at T1 were included as covariates. Group differences were analyzed based on adjusted marginal means (adjusted means), which reflect the net effect of group differences after accounting for covariates. Pairwise comparisons were conducted using the estimated marginal means (EMMs) feature in SPSS.</p> <hd id="AN0184298302-16">Results</hd> <p></p> <hd id="AN0184298302-17">LPA Results</hd> <p>We identified six latent profiles, ranging from a 2‐profile solution to a 7‐profile solution (Table 1). Statistical analysis revealed that AIC, BIC, and aBIC values decreased as the number of specified profiles increased. Entropy values of > 0.8 indicated strong separation among different profiles, and the BLRTs were significant. In addition, AIC and BIC levels reduced gradually with an increase in the profiles. Although the 7‐profile model exhibited decreased AIC and BIC levels compared with the 6‐profile model, the percentage of the smallest group in both the profiles was < 2%. Furthermore, considering the plausibility and previous findings suggesting that adversities can manifest in various combinations and degrees, the 6‐profile solution was chosen for interpretation.</p> <p>1 Table Model fit for the various pattern solutions.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Profiles</th><th>AIC</th><th>BIC</th><th>aBIC</th><th>Entropy</th><th>BLRT P</th><th>LMRLRT</th><th>Smallest group</th></tr></thead><tbody valign="top"><tr><td>2</td><td>32900.353</td><td>32993.967</td><td>32943.130</td><td>0.988</td><td>< 0.001</td><td>< 0.001</td><td>627 (24.4%)</td></tr><tr><td>3</td><td>27785.143</td><td>27913.862</td><td>27843.962</td><td>1.000</td><td>< 0.001</td><td>0.2250</td><td>176 (6.9%)</td></tr><tr><td>4</td><td>27241.569</td><td>27405.394</td><td>27316.430</td><td>0.994</td><td>< 0.001</td><td>< 0.001</td><td>70 (2.7%)</td></tr><tr><td>5</td><td>26775.477</td><td>26974.407</td><td>26866.379</td><td>0.962</td><td>< 0.001</td><td>0.0168</td><td>70 (2.7%)</td></tr><tr><td>6</td><td>26139.076</td><td>26373.112</td><td>26246.021</td><td>0.960</td><td>< 0.001</td><td>0.0305</td><td>96 (3.7%)</td></tr><tr><td>7</td><td>25792.530</td><td>26061.671</td><td>25915.516</td><td>0.963</td><td>—</td><td>—</td><td>41 (1.6%)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> Bold type indicates final cluster solution.</p> <p>2 Abbreviations: aBIC = adjusted Bayesian Information Criterion, AIC = Akaike's Information Criterion, BIC = Bayesian Information Criterion, BLRT = Bootstrapped Likelihood Ratio Test, LMR‐LRT = Lo–Mendell–Rubin Likelihood Ration Test.</p> <p>The six‐profile model is illustrated in Figure 1. Profile 1 (69.0%) represented adolescents with low scores across family adversity and bullying involvement, labeled the "low adversity and bullying." Profile 2 (10.9%) included adolescents with medium abuse scores but low scores for neglect, family dysfunction, and bullying involvement, and was labeled "abuse only." Profile 3 (6.9%) showed slightly high abuse scores along with moderate levels of neglect, family dysfunction, and bullying involvement, and was labeled "moderate adversity and bullying with severe abuse." Profile 4 (5.1%) comprised adolescents with high neglect scores and moderate levels of abuse, family dysfunction, and bullying involvement, labeled "moderate adversity and bullying with severe neglect." Profile 5 (4.5%) included adolescents with high neglect but low scores for abuse, family dysfunction, and bullying involvement, and was termed "neglect only." Finally, Profile 6 (3.7%) featured adolescents with high bullying perpetration and victimization scores but low scores in abuse, neglect, and family dysfunction, named "bullying involvement only."</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/JAA/01apr25/jad12462-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jad12462-fig-0001.jpg" title="1 Mean Z‐scores of family adversity and bullying involvement for the six patterns." /> </p> <p></p> <hd id="AN0184298302-19">Mental Health Problems in Different Profiles</hd> <p>This study used the ANCOVA approach to analyze differences in mental health problems across six groups (Table 2). First, adolescents in the "low adversity and bullying" group reported lower levels of depressive symptoms, anxiety symptoms, suicide risk, and CPTSD symptoms compared with those in the other groups. Second, individuals in the "moderate adversity and bullying with severe neglect," "bullying involvement only," and "moderate adversity and bullying with severe abuse" groups exhibited higher levels of depressive and anxiety symptoms than those in the "neglect only" and "abuse only" groups. Furthermore, we noted no significant difference in depressive and anxiety symptoms between the "neglect only" and "abuse only" and among the "moderate adversity and bullying with severe neglect," "bullying involvement only", and "moderate adversity and bullying with severe abuse" groups. Third, no significant difference in suicide risk was observed among "neglect only," "abuse only", "moderate adversity and bullying with severe neglect," "bullying involvement only," and "moderate adversity and bullying with severe abuse" groups. Fourth, individuals in the "abuse only," "moderate adversity and bullying with severe neglect," "bullying involvement only," and "moderate adversity and bullying with severe abuse" groups demonstrated higher levels of CPTSD symptoms compared with those in the "neglect only" groups.</p> <p>2 Table Mental health problems across distinct classes.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th>Low adversity and bullying<sup>1</sup></th><th>Neglect only<sup>2</sup></th><th>Abuse only<sup>3</sup></th><th>Moderate adversity and bullying with high neglect<sup>4</sup></th><th>Bullying only<sup>5</sup></th><th>Moderate adversity and bullying with high abuse<sup>6</sup></th></tr></thead><tbody valign="top"><tr><td /><td>M(SE)</td><td>M(SE)</td><td>M(SE)</td><td>M(SE)</td><td>M(SE)</td><td>M(SE)</td></tr><tr><td>Depressive symptoms</td><td>4.80 (0.14)</td><td>6.50 (0.61)</td><td>7.29 (0.42)</td><td>9.43 (0.71)</td><td>10.24 (0.85)</td><td>10.70 (0.63)</td></tr><tr><td>Anxiety symptoms</td><td>3.37 (0.11)</td><td>4.31 (0.46)</td><td>5.23 (0.35)</td><td>6.98 (0.55)</td><td>7.53 (0.78)</td><td>7.65 (0.51)</td></tr><tr><td>Suicide risk</td><td>0.39 (0.02)</td><td>0.92 (0.14)</td><td>0.90 (0.08)</td><td>1.34 (0.16)</td><td>1.05 (0.17)</td><td>1.32 (0.13)</td></tr><tr><td>CPTSD symptoms</td><td>9.65 (0.24)</td><td>11.54 (1.04)</td><td>15.23 (0.74)</td><td>17.98 (1.13)</td><td>19.96 (1.51)</td><td>21.11 (1.00)</td></tr><tr><td /><td>1 vs. 2</td><td>1 vs. 3</td><td>1 vs. 4</td><td>1 vs. 5</td><td>1 vs. 6</td><td>2 vs. 3</td></tr><tr><td /><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td></tr><tr><td>Depressive symptoms</td><td>−0.397</td><td>−0.742<ext-link href="*" /></td><td>−2.046<ext-link href="*" /></td><td>−2.102<ext-link href="*" /></td><td>−2.186<ext-link href="*" /></td><td>−0.345</td></tr><tr><td>Anxiety symptoms</td><td>0.02</td><td>−0.488</td><td>−1.485<ext-link href="*" /></td><td>−1.571<ext-link href="*" /></td><td>−1.553<ext-link href="*" /></td><td>−0.508</td></tr><tr><td>Suicide risk</td><td>−0.253<ext-link href="*" /></td><td>−0.291<ext-link href="*" /></td><td>−0.446<ext-link href="*" /></td><td>−0.179</td><td>−0.248<ext-link href="*" /></td><td>−0.038</td></tr><tr><td>CPTSD symptoms</td><td>−0.080</td><td>−2.234<ext-link href="*" /></td><td>−3.064<ext-link href="*" /></td><td>−3.256<ext-link href="*" /></td><td>−3.714<ext-link href="*" /></td><td>−2.153<ext-link href="*" /></td></tr><tr><td /><td>2 vs. 4</td><td>2 vs. 5</td><td>2 vs. 6</td><td>3 vs. 4</td><td>3 vs. 5</td><td>3 vs. 6</td></tr><tr><td /><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td><td>EMMs</td></tr><tr><td>Depressive symptoms</td><td>−1.649<ext-link href="*" /></td><td>−1.705<ext-link href="*" /></td><td>−1.789<ext-link href="*" /></td><td>−1.304<ext-link href="*" /></td><td>−1.360<ext-link href="*" /></td><td>−1.444<ext-link href="*" /></td></tr><tr><td>Anxiety symptoms</td><td>−1.505<ext-link href="*" /></td><td>−1.591<ext-link href="*" /></td><td>−1.573<ext-link href="*" /></td><td>−0.997<ext-link href="*" /></td><td>−1.083<ext-link href="*" /></td><td>−1.065<ext-link href="*" /></td></tr><tr><td>Suicide risk</td><td>−0.193</td><td>0.074</td><td>0.005</td><td>−0.154</td><td>0.113</td><td>0.043</td></tr><tr><td>CPTSD symptoms</td><td>−2.983<ext-link href="*" /></td><td>−3.175<ext-link href="*" /></td><td>−3.633<ext-link href="*" /></td><td>−0.830</td><td>−1.022</td><td>−1.480</td></tr><tr><td /><td>4 vs. 5</td><td>4 vs. 6</td><td>5 vs. 6</td><td /><td /><td /></tr><tr><td /><td>EMMs</td><td>EMMs</td><td>EMMs</td><td /><td /><td /></tr><tr><td>Depressive symptoms</td><td>−0.056</td><td>−0.139</td><td>−0.084</td><td /><td /><td /></tr><tr><td>Anxiety symptoms</td><td>−0.086</td><td>−0.068</td><td>−0.018</td><td /><td /><td /></tr><tr><td>Suicide risk</td><td>0.267</td><td>0.198</td><td>−0.070</td><td /><td /><td /></tr><tr><td>CPTSD symptoms</td><td>−0.192</td><td>−0.650</td><td>−0.458</td><td /><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>Note:</emph> Analysis of Covariance (ANCOVA) controls for gender, age, and the corresponding variable at T1. The superscript numbers in the table represent the group labels (e.g. 1 = Low adversity and bullying).</item> <item>4 Abbreviation: EMMs = estimated marginal means.</item> <item>5 * <emph>p</emph> < 0.05.</item> </ulist> <hd id="AN0184298302-20">Discussion</hd> <p>Many adolescents have encountered various types of adversity, including those within the family and peer contexts (Turner, Finkelhor, and Ormrod [<reflink idref="bib44" id="ref52">44</reflink>]). However, the impact of combined family adversity and bullying involvement on mental health problems is not fully understood. To address this, this study used LPA to identify patterns of family adversity and bullying involvement in Chinese adolescents and examined their association with subsequent mental health problems. Six profiles of family adversity and bullying involvement were identified: low adversity and bullying (69.0%, <emph>n</emph> = 1,771), abuse only (10.9%, <emph>n</emph> = 279), neglect only (4.5%, <emph>n</emph> = 115), bullying involvement only (3.7%, <emph>n</emph> = 96), moderate adversity and bullying with severe abuse (6.9%, <emph>n</emph> = 176), and moderate adversity and bullying with severe neglect (5.1%, <emph>n</emph> = 131). Additionally, the "moderate adversity and bullying with severe abuse," "moderate adversity and bullying with severe neglect," and "bullying involvement only" groups exhibited the highest levels of depressive, anxiety, suicide risk, and CPTSD symptoms. In contrast, "low adversity and bullying" group displayed the lowest levels of depressive, anxiety, suicide risk, and CPTSD symptoms.</p> <hd id="AN0184298302-21">Patterns of Family Adversity and Bullying Involvement</hd> <p>This study used LPA to identify six profiles. A majority (69.0%) of participants fell into the "low adversity and bullying" group. This result aligns with that of a previous study indicating that most adolescents experience low levels of or are mostly not involved in victimization, whereas a smaller proportion face various patterns of victimization (Fu, Huebner, and Tian [<reflink idref="bib14" id="ref53">14</reflink>]; Burns et al. [<reflink idref="bib3" id="ref54">3</reflink>]). The contractor reviewed nine studies that used LPA to identify patterns of interpersonal adversity in a systematic manner (Contractor et al. [<reflink idref="bib5" id="ref55">5</reflink>]). The review found a distinct group of participants who reported experiencing fewer of the assessed adversities in the nine studies. In contrast, the identification of 5.1% of participants in the "moderate adversity and bullying with severe neglect" group and 6.9% in the "moderate adversity and bullying with severe abuse" group highlights the presence of multiple forms of adversity. These findings agree with spillover theory, which suggests that adversities in the family and peer systems can affect each other (Parke and Ladd [<reflink idref="bib33" id="ref56">33</reflink>]).</p> <p>Among Chinese adolescents, the "abuse only" group constituted the second largest group, comprising 10.9% of the participants. The Chinese adage "beating and scolding are signs of love" illustrates a conventional parental view. Although child abuse is defined as parents intentionally harming their child (Qiao and Xie [<reflink idref="bib34" id="ref57">34</reflink>]), many Chinese parents do not consider their minor disciplinary actions as abuse (Ma et al. [<reflink idref="bib28" id="ref58">28</reflink>]). However, as societal norms evolve, such behaviors are increasingly being considered as abusive by adolescents themselves. This shift in perception is captured in our study, which is based on self‐reports from adolescents. Furthermore, the Chinese parenting style, often characterized by control, restriction, hostility, and physical coercion (Wu et al. [<reflink idref="bib48" id="ref59">48</reflink>]), blurs the lines between physical punishment and abuse. This ambiguity (Liao et al. [<reflink idref="bib27" id="ref60">27</reflink>]) complicates the distinction between child abuse and standard parental discipline in China.</p> <p>Our study identified the "neglect only" group, comprising 4.5% of participants. Consistent with previous research, neglect is frequently reported as a common form of maltreatment by Child Protective Services (Kim et al. [<reflink idref="bib22" id="ref61">22</reflink>]), suggesting it may also be a prevalent form of childhood maltreatment in China. A global meta‐regression analysis, which reviewed 189 articles related to maltreatment subtypes (N = 44,832), found higher estimates of neglect in Asia, including China (Viola et al. [<reflink idref="bib46" id="ref62">46</reflink>]). Additionally, neglect is significantly affected by socioeconomic status variability. Studies have indicated that lower socioeconomic status is associated with higher levels of neglect (Stith et al. [<reflink idref="bib42" id="ref63">42</reflink>]; Viola et al. [<reflink idref="bib46" id="ref64">46</reflink>]). In China, the high work demands may leave many parents with insufficient time to address their children's needs, which could be perceived as neglectful.</p> <p>Our study did not identify distinct subtypes within bullying involvement, unlike the clear subtypes found in the high neglect and abuse subgroups of family adversity. We observed a "bullying involvement only" group, as reported by 3.7% of participants. This finding is consistent with that of a meta‐analysis of 22 longitudinal studies that found a robust correlation between bullying victimization and perpetration, demonstrating a bidirectional longitudinal relationship (Walters [<reflink idref="bib47" id="ref65">47</reflink>]). Such findings indicate that bullying perpetration and victimization often co‐occur, suggesting that future studies on bullying should also examine the impact of perpetration.</p> <hd id="AN0184298302-22">Association With Mental Health Problems</hd> <p>In line with our hypothesis, the analysis of the six profiles related to family adversity and bullying involvement revealed differences in subsequent mental health problems. Consistent with prior research (Fu, Huebner, and Tian [<reflink idref="bib14" id="ref66">14</reflink>]), adolescents in the "low adversity and bullying" group exhibited fewer mental health problems, such as depressive, anxiety, suicide risk, and CPTSD symptoms, than those in the other five profiles. The attenuation of neural responses within key reward processing areas of the brain, associated with experiences of adversity or bullying, has been highlighted in various studies (e.g., Dillon et al. [<reflink idref="bib7" id="ref67">7</reflink>]; Gerin et al. [<reflink idref="bib16" id="ref68">16</reflink>]; Hanson, Hariri, and Williamson [<reflink idref="bib18" id="ref69">18</reflink>]). This reduced neural activity is linked to an increased risk of mental health problems (Forbes and Dahl [<reflink idref="bib13" id="ref70">13</reflink>]; Hanson, Hariri, and Williamson [<reflink idref="bib18" id="ref71">18</reflink>]). This supports bioecological theory (Bronfenbrenner and Morris [<reflink idref="bib2" id="ref72">2</reflink>]), which emphasizes the substantial effect of various environments on children's development and the potential impact on mental health outcomes, indicating that negative interactions (e.g., family adversity and bullying involvement) may lead to unfavorable developmental consequences.</p> <p>Second, the study demonstrated that the "abuse only" and "neglect only" groups differed significantly in terms of CPTSD symptoms. Aligning with the findings of a previous study (Sölva, Haselgruber, and Lueger‐Schuster [<reflink idref="bib40" id="ref73">40</reflink>]), variations were noted in CPTSD symptoms between the "cumulative maltreatment" and "high neglect" groups. Additionally, a study examining child abuse and neglect identified emotional abuse in childhood as the primary predictor of CPTSD symptoms, outweighing the impact of other traumatic life events (Gallagher et al. [<reflink idref="bib15" id="ref74">15</reflink>]). This also indicates that the performance of distinct groups in various outcomes is not entirely the same.</p> <p>Third, our study observed that the "bullying involvement only" group exhibited higher levels of depressive and anxiety symptoms compared with the "abuse only" and "neglect only" groups. This finding aligns with that of a previous study on young adults, where the impact of peer victimization on mental health was found to be stronger than that of family abuse and neglect (Lereya et al. [<reflink idref="bib24" id="ref75">24</reflink>]; Macalli et al. [<reflink idref="bib29" id="ref76">29</reflink>]). Our findings extend the available literature, showing that the influence of peers is significant not only in young adults but also in adolescents. School‐age children often spend more time with peers than with family, increasing the importance of peer interactions (Macalli et al. [<reflink idref="bib29" id="ref77">29</reflink>]). Thus, bullying involvement may have a more substantial adverse effect than family adversity on the mental health of adolescents.</p> <p>Fourth, our study indicated that individuals in the "moderate adversity and bullying with severe neglect" and "moderate adversity and bullying with severe abuse" groups faced more severe mental health problems than those in the "abuse only" and "neglect only" groups. This result is consistent with that of a previous study on poly‐victimization, which reported that the adverse impacts of experiencing multiple traumas are greater than those of a single traumatic event (Dong et al. [<reflink idref="bib8" id="ref78">8</reflink>]; Finkelhor, Ormrod, and Turner [<reflink idref="bib12" id="ref79">12</reflink>]). However, we noted no significant differences in mental health problems among the "moderate adversity and bullying with severe neglect," "bullying involvement only" and "moderate adversity and bullying with severe abuse" groups. This finding emphasizes the detrimental effects of both severe single adversity and multiple adversities, highlighting the need for future research to consider the types and severity of trauma.</p> <hd id="AN0184298302-23">Limitation and Implications</hd> <p>This study has several limitations that should be acknowledged. First, the data were collected using self‐reported questionnaires, which may introduce response bias, particularly for sensitive topics such as suicide risk. Future research could consider incorporating more objective measures and multi‐informant data (e.g., reports from parents, teachers, or peers) to enhance the validity of the findings. Second, because participants were recruited from one province in China, the results might not be generalizable to other populations and regions. Future research should aim to include more diverse and heterogeneous samples from various parts of China to verify the generalizability of the findings.</p> <p>Despite the limitations, this study has substantial strengths with important theoretical and clinical implications. First, the use of LPA facilitates the examination of diverse patterns of family adversity and bullying involvement, providing a detailed perspective on victimization profiles among adolescents. Second, by utilizing a large and heterogeneous sample and a 2‐wave longitudinal design, the study effectively discerns significant differences among profiles regarding the indicators of mental health problems. Additionally, the findings are valuable for clinical practice, advocating for the integration of family and school settings to explore different experiences of interpersonal trauma arising from interactions with parents or peers. This comprehensive approach is crucial for devising targeted intervention strategies.</p> <hd id="AN0184298302-24">Acknowledgments</hd> <p>We thank the staff of this project for their unending contributions to this work and the students, teachers, and administrators who made this research possible. The current study was supported by The National Natural Science Foundation of China (Project No. 32071085).</p> <hd id="AN0184298302-25">Ethics Statement</hd> <p>The study was approved by the Ethics Committee of the Faculty of Psychology, Beijing Normal University (Project number: 202203280044).</p> <hd id="AN0184298302-26">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0184298302-27">Data Availability Statement</hd> <p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p> <ref id="AN0184298302-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref10" type="bt">1</bibl> <bibtext> Bernstein, D. P., Ahluvalia, T., Pogge, D., and Handelsman, L. 1997. " Validity of the Childhood Trauma Questionnaire in an Adolescent Psychiatric Population." 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Patterns of Family Adversity and Bullying Involvement in Adolescents: Association with Mental Health Problems
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Mingxiao+Liu%22">Mingxiao Liu</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0007-4361-2962">0009-0007-4361-2962</externalLink>)<br /><searchLink fieldCode="AR" term="%22Aiyi+Liu%22">Aiyi Liu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4077-4663">0000-0002-4077-4663</externalLink>)<br /><searchLink fieldCode="AR" term="%22Wenzhou+Lin%22">Wenzhou Lin</searchLink><br /><searchLink fieldCode="AR" term="%22Xiaoqing+Yu%22">Xiaoqing Yu</searchLink> (ORCID <externalLink term="http://orcid.org/0009-0003-1419-4221">0009-0003-1419-4221</externalLink>)<br /><searchLink fieldCode="AR" term="%22Xinchun+Wu%22">Xinchun Wu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2756-0548">0000-0002-2756-0548</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Adolescence%22"><i>Journal of Adolescence</i></searchLink>. 2025 97(3):861-870.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Bullying%22">Bullying</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Involvement%22">Family Involvement</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Influence%22">Family Influence</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Disorders%22">Mental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescent+Development%22">Adolescent Development</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Problems%22">Family Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22China%22">China</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/jad.12462
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0140-1971<br />1095-9254
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Family and school environments are pivotal in adolescent development. However, the simultaneous examination of adversities in both domains remains understudied. Based on bioecological and spillover theories, this study aimed to bridge this research gap by using latent profile analysis to identify distinct patterns of family adversity and bullying involvement among Chinese adolescents. This study also explored mental health problems associated with these patterns. Methods: This study was conducted in June (T1) and December (T2) 2023, with a 6-month interval, in Henan Province, China, and involved 2,568 adolescents (50.3% girls, M[subscript age] = 13.46 ± 0.72). Participants completed questionnaires assessing family adversity and bullying involvement at T1, as well as assessments of depressive symptoms, anxiety symptoms, suicide risk, and complex posttraumatic stress disorder symptoms at both T1 and T2. Results: Six profiles were identified--low adversity and bullying (69.0%, n = 1,771), abuse only (10.9%, n = 279), neglect only (4.5%, n = 115), bullying involvement only (3.7%, n = 96), moderate adversity and bullying with severe abuse (6.9%, n = 176), and moderate adversity and bullying with severe neglect (5.1%, n = 131). Importantly, the severity of mental health problems varied significantly across these profiles. Conclusion: The study enriches our understanding of concurrent family adversity and bullying involvement and their impact on adolescent mental health, offering insights for tailored intervention strategies for affected groups.
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  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1466437
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1466437
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        Value: 10.1002/jad.12462
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 861
    Subjects:
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Bullying
        Type: general
      – SubjectFull: Family Involvement
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Family Influence
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Mental Disorders
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      – SubjectFull: Adolescent Development
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      – SubjectFull: Family Problems
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      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Intervention
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      – SubjectFull: China
        Type: general
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      – TitleFull: Patterns of Family Adversity and Bullying Involvement in Adolescents: Association with Mental Health Problems
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