Background

Disability among adolescents is associated with both poorer mental health (MH) and higher levels of bullying-victimization. Bullying, therefore, conceivably mediates the association between disability and MH. Quantifying this pathway is challenging as the exposure (disability), mediator (bullying) and outcome (MH) are subjective, and subject to dependent measurement error if the same respondent reports on two or more variables.

Methods

Utilizing the counterfactual and potential outcomes approaches to causal mediation, we decomposed the total effect of disability on MH into natural indirect effects (through bullying) and natural direct effects (not through bullying) using a sample of 3409 adolescents. As the study included data from multiple informants (teacher, parent, adolescent) on the outcome (MH, as measured on the Strengths and Difficulties Questionnaire) and two informants (adolescent, parent) on the mediator (bullying), we assessed the influence of dependent measurement error.

Results

For preferred analysis (using parent-reported bullying and adolescent-reported MH), the total effect was a 2.18 [95% confidence interval (CI): 0.66–3.40] lower MH score for adolescents with a disability, compared with those with no disability (strength of association equivalent to 37% of the standard deviation for MH). Bullying explained 46% of the total effect. Use of adolescent-reported bullying with adolescent-reported MH produced similar results (37% mediation, 95% CI: 12–74%).

Conclusions

Disability exerts a detrimental effect on adolescent MH, and a large proportion of this appears to operate through bullying. This finding does not appear to be spurious due to dependent measurement error.

中文翻译：

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欺凌介导的青少年残疾与心理健康之间的关联程度如何？因果中介分析

背景

青少年中的残疾与较差的心理健康（MH）和较高的欺凌受害率有关。因此，可以想象，欺凌会调解残疾与MH之间的关联。量化该途径具有挑战性，因为暴露（残疾），介体（欺凌）和结果（MH）是主观的，并且如果相同的受访者报告两个或多个变量，则存在相关的测量误差。

方法

利用因果关系的反事实和潜在结果方法，我们使用3409名青少年样本将残疾对MH的总影响分解为自然间接影响（通过欺负）和自然直接影响（而不是通过欺凌）。由于该研究包括来自多个知情者（老师，父母，青少年）的结局数据（根据优势和困难问卷调查得出的MH）和两名知情者（青少年，父母）对调解人（欺凌）的数据，因此我们评估了取决于测量误差。

结果

对于首选分析（使用父母报告的欺凌和青少年报告的MH），与没有残疾的青少年相比，总的影响是，有残疾的青少年MH得分低2.18 [95％置信区间（CI）：0.66-3.40] （缔合强度相当于MH标准偏差的37％）。欺凌解释了总影响的46％。青春期报告的欺凌与青春期报告的MH的使用产生了相似的结果（37％的调解，95％的CI：12-74％）。

结论

残疾会对青少年MH产生有害影响，其中很大一部分似乎是通过欺负来实现的。由于相关的测量误差，该发现似乎不是虚假的。