Bullying in clinical high risk for psychosis participants from the NAPLS-3 cohort

Soc Psychiatry Psychiatr Epidemiol. 2022 Jul;57(7):1379-1388. doi: 10.1007/s00127-022-02239-5. Epub 2022 Feb 3.


Purpose: Bullying is associated with a heightened risk for poor outcomes, including psychosis. This study aimed to replicate previous findings on bullying prevalence in clinical high-risk (CHR) individuals, to assess the longitudinal course of clinical and functional variables between bullied and non-bullied CHR and the association of bullying with premorbid functioning, clinical outcome, transition to psychosis and risk of violence.

Methods: The sample consisted of 691 CHR participants and 96 healthy controls. Participants reported whether they had experienced bullying and how long it had lasted. Assessments included DSM-5 diagnoses, attenuated psychotic symptoms, negative symptoms, social and role functioning, depression, stress, premorbid functioning, and risk of violence. The bullied and non-bullied CHR groups were compared at baseline and further longitudinally on clinical and functioning variables and transition to psychosis.

Results: Bullying was more prevalent among CHR individuals than healthy controls. Bullied CHR had a higher prevalence of PTSD and more severe depression and stress at baseline than non-bullied CHR. There was no impact of bullying on clinical and functional variables over time. Bullying was not related to final clinical status or transition to psychosis. However, bullied participants had poorer premorbid functioning and a greater risk of violence.

Conclusion: While bullying may not impact the likelihood of CHR individuals to transition to psychosis, it may be a risk factor for development of the at-risk state and may be related to a greater risk of violence. Future studies should consider bullying perpetration among CHR individuals.

Keywords: Bullying; Clinical high risk; Psychosis; Psychotic symptoms; Violence risk.

MeSH terms

  • Bullying*
  • Cohort Studies
  • Humans
  • Prodromal Symptoms
  • Psychotic Disorders* / complications
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / epidemiology
  • Risk Factors