How well young people negotiate their social world is a powerful determinant to their health during adolescence. This lecture is on Peer influences during adolescence. Time spent with peers increases across childhood and especially through adolescence. The influence of peers also increases significantly over the same period. The social environment of peers provides the context of school life for children and adolescents, especially in high income countries. So it should be no surprise that the quality of peer relationships can have profound implications for adolescent health. Despite these happy photos here, the influence of peers is not always positive. One particular challenge with important policy implications for schools is that of bullying. Bullying occurs in all schools. On the one hand, it can therefore be considered an almost normal developmental experience. And in some studies, around half of all students report some bullying. Alternatively, it can be considered an important cause of stress, and or physical and emotional problems, which is more likely in the 10% of adolescents who report bullying at least weekly. For most students, frequent bullying is a considerable source of stress. A range of physical or somatic symptoms are more common in those who are bullied frequently, including bed wetting, difficulty sleeping, headaches, and abdominal pain. Bullying can also result clearly in young people feeling unhappy and unsafe at school and, indeed, being fearful about even attending school. These are very common experiences and symptoms in response to any form of worrying in the young. Certainly it is symptoms like these that are presented to health professionals commonly these some, somatic symptoms rather than complaints of bullying itself given how highly stigmatising it is for young people to, if you like, confess to being bullied. Bullying is also associated with common mental health concerns including low self esteem, depression and anxiety, self harm. And a number of highly publicised deaths from suicide have occurred in the context of severe bullying. Both in schools and in the workplace. So what is the directionality of the association of bullying and common mental disorder? Depression among those who are frequently bullied might be expected. However, adolescents who are depressed or anxious may also attract negative attention from their peers. Research suggests that students who are bullied have less positive social relationships than their non-bullied peers. Depression and anxiety could therefore be appreciated as both a result of and a reason for being bullied. A longitudinal design is necessary to address the question of causality, of what comes first - poor peer relationships, or depression. In a longitudinal study from our group in Australia, the effect on bullying on mental health status was clearest for girls, who had a two-point-sixfold increased risk of depression than those who did not report bullying. Being victimised had a significant impact on the future emotional well being of young adolescent girls, independent of their social relations. And, interestingly, the same finding did not hold for boys. We showed that a history of victimisation and poor social relationships predicts the onset of emotional problems in adolescence with previous recurrent emotional problems not significantly related to future victimisation. It is results like these that highlight the importance of victimisation and bullying in relation to mental health. But especially reinforce the importance of managing bullying at schools, given that around one in ten adolescents is significantly bullied while at school. So as we've heard, bullying is common which means that bullies are common. Indeed, while about 10% of adults are frequently bullied, around five to 10% of adolescents are themselves bullies. You may be surprised to appreciate that bullies are often as depressed as those who are bullied. And, suicidal ideation is even more common among bullies especially in boys. For example, the young Finn study we talked about in a previous lecture, that time on physical inactivity, showed that among boys, severe suicidal ideation was associated with being a bully. Bullies therefore, also need support. Bullying interventions should recognise the role of depressive disorders in the background of bullies as much as we recognise the importance of bullying as a cause of depression particularly in girls. And to take it a step even further, an adolescent can be both a bully and be bullied. And while depression occurs equally frequently among those who are bullied and from those are bullies. Data from the young Finn study suggests that depression is most common among those who were both bullied by others and were also bullies themselves. They also showed that bullied victims were the most troubled group. Displaying the highest level of conduct, school, and peer relationship problems. You've previously heard from George in earlier lectures about the importance of school environments for health. We can see in this schema, the complexity of interrelationships between one's individual characteristics on the far left. The ability that schools have to provide opportunities for students to learn new skills, including non academic skills. And the importance of schools in recognising pro-social behaviours, as shown in the yellow box. The impact on these health related beliefs and behaviours on the far right is thought to be mediated through social connections within the school environment. Social connections both with other students, and with teachers. The intent of bullying behaviour is positive social outcomes for the bully such as dominance or status among peers. By joining in with the bullying or being an audience for the bully, the bully's behaviour is reinforced by peers. In this way without negative consequences from teachers, parents, or peers bullying behaviour will increase. Effective responses to bullying can therefore be seen as requiring a whole of school intervention. Rather than simply sanctions against an individual bully, or responses to the individual who has been bullied. The Norwegian academic Dr. Olweus, who developed the well known bullying prevention program in schools in Bergen in Norway, suggested that anti bullying intervention programs should restructure the social environment of schools. He argues that this could be developed by developing and implementing clear rules against bullying behaviour. In order to reduce the positive consequences of bullying. Whole of school programs like this reinforce the interrelationships between bullies, victims, and their social environment. Such approaches require engagement of the entire school leadership group, together with teachers, parents, and students. Other elements include teacher training, adult supervision during breaks in order to support supervision of students. Within whole of school programs, attention is also given to serious talks with bullies, victims, and parents of all children involved. Linkage to health professionals for those who are most severely effected, for those who are either bullied or the bullies is also a necessary part of the school response. Other aspects of a whole of school policy include the importance of using peer engagement such as small groups for learning as these promote greater social inclusivity. And classroom based approaches such as skill building around conflict resolution, embedding relevant themes within the curriculum of certain subjects is also a valuable strategy, which might, for example, influence the choice of books studied in English. The policy focus here is on policy that relates to whole school interventions against bullying. But, bullying policy is equally relevant to consider within the work place. It is only in the past few decades that the potential consequences of severe bullying have become appreciated. Much can be done to change the culture of individual schools and workplaces, so that bullying is no longer acceptable within young people's formal, social environments.