Bullying Victimization among Children with Food Allergies and Parental Mental Health

Abstract

Children with food allergies are bullied at higher rates than the general population. Little research, however, has considered how parents of children with food allergies may be affected by the bullying victimization of their children. This research examines if having a child with food allergies who is bullied relates to parental levels of stress, anxiety, and depression. Data were collected by administering surveys in several online support groups for parents of children with food allergies (N = 623). Results showed that having a food-allergic child bullied is related to higher levels of stress, anxiety, and depression among parents. Policy implications for health care and school professionals are discussed, with an emphasis on broadening treatment services to include the families of victims of bullying.

Keywords

bullying victimization food allergies mental health families

Introduction

Children are increasingly being diagnosed as having food allergies in the United States (Gupta et al., 2011; Prescott & Allen, 2011; Sicherer & Sampson, 2018). Recent studies indicate that approximately 8% of children have food allergies (Gupta et al., 2018) in the United States, resulting in estimations of about 5.6 million children living with a food allergy (Gupta et al., 2018). Not only has the prevalence of food allergies steadily increased throughout the years, but children are outgrowing food allergies at a slower pace than before (Kattan, 2016; Savage et al., 2016). Moreover, over 40% of children with food allergies have experienced severe allergic reactions or anaphylaxis, which is a life-threatening allergic reaction (Gupta et al., 2018). Thus, more parents are having cope with the risks and challenges of caring for a child with food allergies, and they are having to do so for longer periods of time than in previous years.

One of the challenges that parents of children with food allergies often face is the bullying victimization of their child. Indeed, studies have shown that children with food allergies are bullied at a much higher rate than the general population (Muraro et al., 2014; Shemesh et al., 2013). This can be a difficult experience for any parent, but may be especially detrimental to the well-being of parents of food-allergic youth who already report lower rates mental health and quality of life relative to others (Gillespie et al., 2007; Lau et al., 2014; Rouf et al., 2012; Sicherer et al., 2001). Yet, to date there has been little empirical research on the extent to which the bullying victimization of food-allergic youth may affect parents (Annunziato et al., 2014; Shemesh et al., 2013). The research that does exist, however, relies on small clinical samples and is focused on broad quality of life indicators. Using data collected from online surveys of parents of children with food allergies (N = 623), this study attempts to fill this gap in the literature by examining if bullying victimization of food-allergic youth relates to parental stress, anxiety, and depression.

Bullying Victimization among Children with Food Allergies

One of the most widely cited definitions of bullying comes from Olweus (1994), who described bullying as involving the following elements: harmful, negative actions and behaviors; repeated victimization; and a physical, social, or cognitive power imbalance between the perpetrator and the victim. While prevalence rates vary tremendously by country, measurement, and time-frame examined (Modecki et al., 2014; Thomas et al., 2015), a recent meta-analysis reported an overall prevalence rate of 35% for face-to-face bullying in schools and 15% for cyberbullying in the general population (Modecki et al., 2014). Among children with food allergies, however, studies have reported that between 45% and 60% of children with food allergies have been bullied (Muraro et al., 2014; Shemesh et al., 2013). Moreover, research by Muraro et al. (2014) used a matched-sample design to compare bullying rates among children with and without food allergies in Italy. They found that children with food allergies were twice as likely to be bullied compared to children who did not have any food allergies.

The research on bullying of children with food allergies shows that in some ways these children are bullied in a distinct way from the general population. While studies have shown that children with food allergies largely report being bullied at school and by peers (Lieberman et al., 2010; Shemesh et al., 2013), food-allergic youth frequently report acts of bullying that involve their food allergen (Annunziato et al., 2014; Lieberman et al., 2010). Children with food allergies are often targeted by bullies simply for having the food allergy condition (Lieberman et al., 2010). School accommodation policies that are intended to protect the child from harm in terms of preventing exposure to food allergens or improving treatment if exposed end up isolating children and put a spotlight on the food allergy condition, which can further lead to bullying. For example, research has found that having a 504 plan in general (law mandating disabled youth receive accommodations in elementary or secondary education institutions in the United States) or having the specific policy of the self-carry of epinephrine increases the odds that children with food allergies are bullied (Lieberman et al., 2010; Rocheleau & Rocheleau, 2020a; Rocheleau & Rocheleau, 2020b).

A plethora of studies have demonstrated numerous harms that bullying can have on children (refer to Moore et al., 2017 for review). For example, youth who are bullied are at increased risk for depression, suicide ideation, eating disorders, anxiety, psychiatric problems, loneliness, low self-esteem, and low academic performance (Dake et al., 2003; Wilkins-Shurmer et al., 2003). Considering children with food allergies, some research has likewise found a variety of harms that victims of bullying experience (Annunziato et al., 2014; Lieberman et al., 2010; Shemesh et al., 2013). For example, one study has found that 64% of children with food allergies have reported embarrassment from bullying and over 65% have reported depression from being bullied (Lieberman et al., 2010). Given that youth with food allergies are often bullied with the food allergen, another harm that can occur is that the experience can intensify fears children have about having physical reactions to their allergen (Dean et al., 2016).

Bullying Victimization of Food-allergic Youth and Parental Mental Health

The responsibility of caring for a child with food allergies is immense and can affect the mental health of the parent, as it is a constant concern that can have lethal consequences for some children. For example, research has found that parents of children with food allergies report high levels of fear regarding allergen exposure or their child’s mortality (Gillespie et al., 2007; Rouf et al., 2012; Warren et al., 2015). Not surprisingly, parents of children with food allergies report worse quality of life than parents of children without food allergies (Howe et al., 2014; Sicherer et al., 2001; Springston et al., 2010; Valentine & Knibb, 2011; Ward & Greenhawt, 2015). In particular, several studies have found that parents of children with food allergies report high levels of stress, anxiety, and depression (Gillespie et al., 2007; Lau et al., 2014; Rouf et al., 2012; Sicherer et al., 2001). Moreover, poor mental health is particularly stark for mothers and for those parenting children with multiple and more severe food allergies (Bollinger et al., 2006; Howe et al., 2014; King et al., 2009; Sicherer et al., 2001; Springston et al., 2010; Warren et al., 2015). Given the increased risk for poor mental health that parents of children with food allergies have to begin with, the experience of also having to cope with the bullying victimization of a food-allergic child has the potential to have devastating consequences to the already vulnerable mental health of parents.

There is a limited body of research examining how bullying victimization of children pertains to parents. While much of the existing body of research examines parenting styles or relies on parents as informers for their children (Baldry & Farrington, 2000; Kaufmann et al., 2000; Ladd & Ladd, 1998; Nordhagen et al., 2005), some evidence demonstrates that having a child who is bullied can have a detrimental impact on parental mental health. For instance, research on parents of bullied youth has found that parents experience a range of negative emotions such as worry, anger, frustration, feeling helpless, mad, and guilt about the inability to stop the bullying and help their child (Humphrey & Crisp, 2008; Sawyer et al., 2011). The worry about how to stop the bullying is often paramount for parents, with parents of youth who are bullied reporting feeling isolated, unsure of how to advocate effectively for their children at school, and concerned about how to engage with teachers and school staff about bullying without being labeled as an overprotective parent (Humphrey & Crisp, 2008).

Fewer studies still have considered how the bullying victimization of children with food allergies may affect parents. The only studies that we are aware of have shown that having food-allergic children bullied related to lower levels of quality of life and increased levels of distress for parents (Annunziato et al., 2014; Shemesh et al., 2013). Both of these studies, however, were based on small samples from caregivers of patients out of New York clinics and focused on broad quality of life indicators and distress. More research is needed to further examine how the bullying victimization of food-allergic children relates to parental mental health.

Current Study

This study seeks to build on the limited body of research that has found that bullying victimization of food-allergic children can affect quality of life among parents (Annunziato et al., 2014; Shemesh et al., 2013). In particular, this study advances this area of scholarship by using a larger sample than previous research and by considering specific aspects of mental health (i.e., stress, anxiety, and depression). The scarcity of empirical studies in this area is of particular concern given the steady increase in the number of children diagnosed with food allergies (Gupta et al., 2018) and the poor quality of life that parents of children with food allergies already have (Bollinger et al., 2006; Herbert et al., 2016). Since parents of children with food allergies already report high levels of stress, anxiety, and depression, they may be particularly susceptible to poor mental health if their food-allergic child is bullied. Therefore, our first hypothesis is that having a food-allergic child bullied will be related to higher levels of stress. Our second hypothesis is that having a food-allergic child bullied will be related to higher levels of anxiety. Our third hypothesis is that having a food-allergic child bullied will be related to higher levels of depression. Hypotheses are tested using linear regression in Stata/SE 15.

Method

Data and Sample

The data were collected by administering an online survey to parents of children with food allergies over a four-month window in 2016 (July, August, September, and October). Being a challenging population to reach, respondents were recruited from several online support groups for parents of children with food allergies. The administrators of each support group were first contacted and asked permission to post a link to the survey in the forum. The administrators were also asked to follow up or “bump up” the survey link on a weekly basis for approximately the first month. Administrators granted permission to post the survey in eight different support groups. The support groups varied by type of allergy (i.e., milk, nuts, egg, soy, sesame or general), number of daily and weekly posts by members, and membership size (ranging from 851 to 13,809 members). A university-affiliated Institutional Review Board (IRB) approved the study’s procedures prior to data collection.

There were a total of 1,019 initial respondents to an online survey. Respondents were parents of children with food allergies in online support groups. Parents answered a variety of survey questions about their own general well-being, but the bulk of the questions pertained to their children with food allergies. Most notably, questions were asked about the nature of the food allergy, medical experiences, and bullying experiences of the child. Parents were permitted to report on up to three children with food allergies (if they had more than three, they reported on behalf of their oldest). Questions about bullying of children, however, were only asked to those parents who had school-aged children (between 4 and 18) with food allergies. Thus, the sample for this study is restricted to the 623 parents who indicated that they had at least one school-aged child with food allergies.

Measures

Dependent variables

There are three dependent variables used to measure levels of stress, anxiety, and depression in parents of children with food allergies. The variables are largely based on items from the DASS-21 scale which has been shown to have strong internal consistency and concurrent validity (Antony et al., 1998). The variable parent stress is based on the following questions asking about how often in the past week the parent: became upset by trivial things; tended to overreact to situations; found it difficult to relax; got upset rather easily; was using a lot of nervous energy; was getting impatient when delayed in any way; and felt rather touchy (Cronbach’s alpha = 0.91). Similarly, the variable parent anxiety is based on several questions about how often in the past week the parent: felt dryness of mouth; experienced difficulty breathing; felt shaky; felt very anxious in situations; felt faint; perspired noticeable in the absence of high temperatures or physical exertion; and felt scared without any good reason (Cronbach’s alpha = 0.83). Last, the variable parent depression is based on the following questions asking parents about how often in the past week they: could not experience any positive feeling; could not seem to get going; felt that there was nothing to look forward to; felt sad and depressed; lost interest in just about everything; felt little worth as a person; and felt that life was not worthwhile (Cronbach’s alpha = 0.92). For each of the three respective dependent variables, mean scales are created that range from 1 = never to 5 = always.

Independent variable

The independent variable, food allergy child bullied, is based on a question asking parents if their child with food allergies has ever been bullied. As stated previously, parents were permitted to report on up to three children with food allergies. The variable is coded such that 1 = the parent responded that any of their children with food allergies were bullied and 0 = none of their food-allergic children were bullied.

Control variables

Several control variables are included in this study. The variable parent age is employed from a question asking about the age of the parent in years. Due to disproportionate distributions in responses, the variables parent White (1 = White, non-Hispanic and 0 = other) and parent married (1 = parent married and 0 = other) are created to account for race and family structure. This study also controls for parent education, measured by taking the highest level of the responding parent’s education ranging from 1 = less than high school to 8 = doctorate degree; and parent income, measured as the annual family household income and ranging from 1 = $10,000 or less to 8 = over $250,000. Finally, the variable total food-allergic children is based on the total number of children with food allergies the parent has.

Data Analysis

There were a large number of missing data, about 27%, on questions pertaining to parental income and the key psychological items gauging parental stress, anxiety, and depression. While this represents a relatively large number of missing data, Little’s MCAR tests indicated that the data are missing completely at random. Hence, missing data are multiply imputed with ICE software in Stata/SE 15 that uses chained equations for imputation. Linear regression is employed to test all three hypotheses, that having children with food allergies who are bullied will be related to higher levels of stress, anxiety, and depression.

Results

Table 1 reports the descriptive statistics. As reported in the table, parents of children with food allergies report moderate levels of stress at 2.56. Notably lower are levels of parent anxiety and depression, with means of 1.77 (parent anxiety) and 1.79 (parent depression). Regarding bullying, Table 1 indicates that 41.55% of parents had at least one child with food allergies who has ever been bullied. As for the demographic controls, the mean age of parents is nearly 40 (39.80), about 90% of parents were White, non-Hispanic, 92.90% of parents were married, the mean level of education and income were moderately high at 5.06 and 5.84, respectively. Finally, parents reported a mean of 1.28 number of children with food allergies.

Table 1.

Descriptive Statistics (N = 623).

Variable	Mean or %	SE	Minimum	Maximum
Parent stress	2.56	0.04	1.00	5.00
Parent anxiety	1.77	0.03	1.00	5.00
Parent depression	1.79	0.04	1.00	5.00
Food allergy child bullied	41.55%	−	0.00	1.00
Parent age	39.80	0.25	13.00	66.00
Parent White	90.32%	−	0.00	1.00
Parent married	92.90%	−	0.00	1.00
Parent education	5.06	0.06	1.00	8.00
Parent income	5.84	0.08	1.00	8.00
Total food-allergic children	1.28	0.02	1.00	4.00

Note. SE = Standard error.

The three main hypotheses, that having a child with food allergies who is bullied will be related to higher levels of stress, anxiety, and depression in parents, are tested in Table 2 using linear regression in Stata/SE 15. According to the first model predicting parent stress, parents who had a child with food allergies bullied report higher levels of stress than parents who did not have a child with food allergies bullied (b = 0.23, p < 0.01). Interestingly, those who were married also report higher levels of stress compared to those who were not (b = 0.41, p < 0.05). The second model predicts parent anxiety. Like the previous model, parents with a food-allergic child who was bullied report higher levels of anxiety compared to those with a food-allergic child who was not bullied (b = 0.23, p < 0.001). Here, higher levels of parent income are associated with lower levels of anxiety (b = −0.06, p < 0.01), and married parents report higher levels of anxiety (b = 0.32, p < 0.05). The last model reported in Table 2 reveals that parents who had a child with food allergies bullied also experience higher levels of depression (b = 0.23, p < 0.01). Also significant in this model is parent income (b = −0.06, p < 0.05), where higher levels of parent income are related to lower levels of depression.

Table 2.

Linear Regression of Food Allergy Child Bullied on Parent Stress, Parent Anxiety, and Parent Depression (N = 623).

	Parent Stress		Parent Anxiety		Parent Depression
Variable	b	SE	b	SE	b	SE
Food allergy child bullied	0.23**	0.08	0.23***	0.06	0.23**	0.07
Parent age	−0.01	0.01	−0.01	0.01	−0.01	0.01
Parent White	0.26	0.13	0.04	0.10	0.07	0.11
Parent married	0.41*	0.18	0.32*	0.14	0.08	0.16
Parent education	0.01	0.03	−0.01	0.02	−0.01	0.03
Parent income	−0.04	0.03	−0.06**	0.02	−0.06*	0.03
Total food-allergic children	0.06	0.08	−0.00	0.06	0.05	0.07
Intercept	2.42***	0.41	2.12***	0.30	2.08***	0.36
F _{(7, 1000)}	2.73**		4.33***		2.65*

Notes. SE = Standard error.

p < .05, **p < .01, ***p < .001.

Supplemental analyses are conducted that examine if having a child bullied due to their food allergy status is also related to stress, anxiety, and depression among parents. As seen in Table 3, the results are nearly identical to those in Table 2. The overwhelmingly similar findings are likely reflective of the fact that nearly 75% of all children bullied in this sample reported being bullied specifically because of their food allergy status, as reported by parents.

Table 3.

Linear Regression of Bullied Due to Food Allergy on Parent Stress, Parent Anxiety, and Parent Depression (N = 623).

Variable	Parent Stress		Parent Anxiety		Parent Depression
Variable	b	SE	b	SE	b	SE
Bullied due to food allergy	0.22*	0.09	0.27***	0.07	0.23**	0.08
Parent age	−0.01	0.01	−0.01	0.01	−0.01	0.01
Parent White	0.23	0.13	0.01	0.10	0.05	0.11
Parent married	0.42*	0.18	0.33*	0.14	0.08	0.16
Parent education	0.01	0.03	−0.02	0.02	−0.01	0.03
Parent income	−0.04	0.03	−0.06**	0.02	−0.06*	0.03
Total food-allergic children	0.06	0.08	0.00	0.06	0.05	0.07
Intercept	2.47***	0.42	2.19***	0.30	2.15***	0.36
F _{(7, 1000)}	2.56*		4.73***		2.55*

Notes. SE = Standard error.

p < .05, **p < .01, ***p < .001.

Discussion

Some research has examined how bullying affects children with food allergies (Annunziato et al., 2014; Lieberman et al., 2010; Shemesh et al., 2013), yet little research has considered how such bullying may affect parents and has been limited in scope (Annunziato et al., 2014; Shemesh et al., 2013). We fill this gap in the literature by examining if having a child with food allergies who is bullied is related to higher levels of stress, anxiety, and depression in parents using data collected from parents of children with food allergies in various online support groups. Support for all three hypotheses were found, as bullying victimization among food-allergic children was found to be related to higher levels of stress, anxiety, and depression among parents.

Thus, the key findings show that, among parents of children with food allergies, having a child with food allergies who is bulled has deleterious effects on their mental health. Parents of children with food allergies already suffer from poorer mental health compared to others (Gillespie et al., 2007; Lau et al., 2014; Rouf et al., 2012; Sicherer et al., 2001). The burden of raising a child with a disability is great, and parents of children with food allergies face daily challenges navigating their child’s health and safety as they interact with others in society. This is apparent as previous research has reported the substantial difficulties families of children with food allergies have in terms of social and family activities outside of the home (Bollinger et al., 2006; Primeau et al., 2000; Sicherer et al., 2001; Springston et al., 2010; Valentine & Knibb, 2011). One reason having a food-allergic child bullied may affect the mental health of parents is because the bullying may function to further isolate their child socially. Being bullied can carry with it a social stigma, whereby other children will distance themselves or disassociate altogether from the victim as a result of the stigma or to avoid becoming the next target of the bully (Hamarus & Kaikkonen, 2008; Thornberg, 2015). This social loss could be especially devastating to the families of food-allergic children who have more limited social opportunities to begin with.

Another reason the bullying victimization of children with food allergies could affect parents has to do with specific emotions parents of children with food allergies commonly experience. For example, one of the more common emotions parents of children with food allergies experience is fear (Gillespie et al., 2007; Rouf et al., 2012; Warren et al., 2015). Parents of children with food allergies frequently have reported fear from the fact that their child can at any moment be exposed to a food that, for some, has the potential to kill the child if consumed and not treated properly. Other research has indicated that when children with food allergies are bullied, they are often done so with the very food the child is allergic to (Annunziato et al., 2014; Lieberman et al., 2010). The taunting, teasing, touching, or forced ingestion of an allergy has the potential to produce substantial consequences in food-allergic children, and such a traumatic experience that can serve to reaffirm the fears that parents of children with food allergies have, manifesting in heightened stress, anxiety, and depression.

Another interesting finding regarding family structure warrants some discussion as well. With respect to marriage, parents who are married reported higher levels of stress and anxiety. Considering all but 10 respondents were female, this finding is not surprising given that married women generally take on disproportionate amounts of responsibility managing the household in the United States, particularly those who also work (Bianchi et al., 2000; Coltrane, 2010; Hochschild & Machung, 2012; Kawamura & Brown, 2010). Pile on to the already heightened household workload of married women, women with children who have food allergies have even greater responsibilities to manage. The burdens of this management are evident in prior research, as mothers of food-allergic children report suffering more in terms of mental health than fathers of food-allergic children (King et al., 2009; Warren et al., 2015). Parents of children with food allergies also can face stress on their marriage (Gupta et al., 2010), particularly if the parents are not on the same page as far as how to manage the food allergy or if one parent is taking on all of the work managing the allergy.

We also found that parent income was negatively related to anxiety and depression, with lower levels of parent income associating with higher levels of anxiety and depression. One reason that, among parents of children with food allergies, those from poorer families have worse mental health could be because of social class differences in access to quality mental health care (Newacheck et al., 2003; Wang et al., 2005). Parents of children with food allergies suffer from poor mental health (Gillespie et al., 2007; Lau et al., 2014; Rouf et al., 2012; Sicherer et al., 2001), and those with fewer resources lack the means to seek out care and treatment needed. Another reason could be that those from poorer families may suffer from greater levels of anxiety and depression because they are less able to obtain additional support by having fewer resources. Being able to have a parent stay home, to hire help to manage the household, and to simply have important personal and couple time are often not realistic options for those from poorer families. Thus, parents of food-allergic children from poorer families do not get as much relief from the daily grind, and consequently their mental health suffers.

There are limitations with this study. The first is that we use parental reports for indicators of bullying victimization in children. Parents are not always aware of everything that goes on with their children, and it is likely some parents are simply unaware of the bullying. Indeed, prior research has found that rates of bullying among children with food allergies are lower when parental reports are used instead of self-reports by the children (Shemesh et al., 2013). That being said, one would expect that the direct ramifications of children being bullied on the mental health of parents would only affect those parents who are actually aware of the bullying. A second limitation with this study concerns the representativeness of the sample. By drawing the sample from online support groups, this study is not representative of all parents with food allergies. For example, it is likely that joining the support groups in the first place is a way for parents of children with food allergies to cope with mental health strains from parenting. Thus, there may be parents with disproportionately high levels of stress, anxiety, and depression in this sample compared to the target population. In addition, the sample is more affluent than the target population, and only 1.6% of respondents were male. For these reasons, it is difficult to generalize these findings to the larger target population of food allergy parents. Finally, while our measures for mental health were based on the DASS-21, this study uses a slightly different 5-point Likert scale for the responses which may somewhat hamper direct comparisons with other studies. Our measures do, however, demonstrate fairly high reliability reporting Chronbach’s alpha of 0.92, 0.91, and 0.83 for the respective measures.

In spite of these limitations, we make a significant contribution to the literature by considering how the bullying victimization experience of food-allergic children relates to parental mental health. This is an important and timely topic given the steady increase of food allergies in the general population (Gupta et al., 2018) and the high rate at which children with food allergies are bullied (Muraro et al., 2014; Shemesh et al., 2013). Our findings show that parents who have children with food allergies who are bullied experience higher levels of stress, anxiety, and depression compared to those who do not. These findings have important policy ramifications. Namely, our study highlights the need to provide ample support to parents of children with food allergies, particularly with regard to access to mental health services. Health care practitioners should discuss the mental health risks with food-allergic children and their families, as well as provide information for support services. In addition, as much of the bullying of food-allergic children occurs by peers at schools (Lieberman et al., 2010; Shemesh et al., 2013), support services at schools should not only focus on the children involved with the bullying, but support should also be extended to the families of children. Moreover, our findings suggest that support services should especially target families from lower social class backgrounds who may otherwise lack the means to receive the care they need. Families with food allergies face many obstacles with respect to maintaining a healthy quality of life. Greater awareness and treatment of the mental health of parents can go a long way to mitigate some of the difficulties these families face.

Given the main findings of this study, future research should further examine specific mechanisms through which having a child bullied relates to parental mental health among those with food-allergic children. For example, future research could consider if parental fear and social exclusion mediate relationships between bullying victimization in food-allergic children and mental health in parents. Furthermore, additional queries of research are also gleaned from our findings with respect to family structure and social class. Much more research needs to be undertaken to examine how having children with food allergies affects the relationships of parents and caretakers, as well as to identify additional ways in which social class affects families of children with food allergies, such as with the care and treatment of the allergy.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Gregory C. Rocheleau

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