Bullying victimization in pediatric patients with celiac disease

In this study, we aimed to investigate peer bullying and its psychosocial consequences in children with celiac disease. We examined the relationship between adherence to diet and anxiety and depressive symptoms.

The sample in this cross-sectional study consisted of 124 pediatric celiac patients on a gluten-free diet for one year or more. One hundred thirty-nine healthy children comparable in age and sex were enrolled as the control group. The Revised Olweus Bully Victim Questionnaire (OBVQ) was used to evaluate the peer victimization. The Revised Child Anxiety and Depression Scale and Strengths and Difficulties Questionnaire were used to assess children's anxiety and depressive symptoms, and emotional and behavioral symptoms, respectively. Hierarchical logistic regression analysis was performed to identify independent predictors of dietary non-adherence.

The proportion of children classified as bullying victims based on the OBVQ was significantly higher in the celiac disease group than in the healthy controls. Children who did not comply with diet therapy experienced significantly higher rates of peer bullying than those who adhered to the diet (p=0.004). However, multivariate analysis indicated that depressive symptoms appeared to account for this relationship - while bullying initially predicted dietary non-adherence (odds ratio [OR]: 3.274, p=0.004), this effect became non-significant when depression was controlled (OR: 2.177, p=0.098), whereas depression remained a significant independent predictor (OR: 1.093, p=0.044). Significant positive correlations were observed between peer bullying and anxiety and depression symptom scores. Peer bullying also exhibited positive correlations with emotional and behavioral symptoms.

The study findings show that children with celiac disease experience higher rates of peer bullying than their healthy peers. More importantly, our results suggest that the association between bullying and dietary adherence may be largely explained by co-occurring depressive symptoms. We therefore recommend that depressive symptom screening and treatment should be integrated into the management of celiac disease in children, particularly for those experiencing peer victimization.