A/HRC/43/39 37. Bullying has been linked to a variety of negative child well-being outcomes, including poorer education results and mental health problems, such as anxiety and depression symptoms, suicidal thoughts and actions, self-harm and violent behaviour, which have been found to persist into adulthood. Moreover, bullying is not only a concern for the victim’s well-being; research has shown that being the child that bullies is also associated with poorer child and later-life outcomes. In particular, bullies have been shown to exhibit higher antisocial and risk-taking behaviour, as well as later criminal offending. Importantly, being both a perpetrator of bullying and a victim further compounds the risks for psychological and conduct problems.16 38. Online exposure of children to violence and to inappropriate content (such as child abuse material, pornography, hate-speech material and material advocating unhealthy or dangerous behaviour, such as self-harm, suicide and anorexia) is consistently associated with problem behaviour, such as increases in aggression, anxiety and post-traumatic stress symptoms. Children could also end up with lower levels of empathy and compassion for others. Adolescents exposed to high levels of violence reported high levels of anger and depression. They also reported higher rates of wanting to hurt or kill themselves compared to adolescents in groups with a lower exposure to violence.17 Equally, being online brings risks related to contact and conduct, as in cases where children are induced or coerced into sharing sexual images of themselves that are then used for extortion or to humiliate them publicly. 39. More generally, experiencing sexual violence can have a range of adverse outcomes, including depression, post-traumatic stress disorder, suicide risk, substance use, teenage pregnancy, risky sexual behaviour, poorer educational outcomes and poorer self-rated health.18 The psychological and emotional impact of child sexual abuse can be particularly devastating because the surrounding secrecy, shame and stigma mean children who experience this often have to cope alone. In the context of a culture of disbelief or victim blaming, where victims are seen as responsible, shamed and shunned, it will be very difficult for a child or young person to tell anybody what has happened.19 40. The impact of institutionalization and deprivation of liberty can include severe developmental delays, disability, irreversible psychological damage and increased rates of suicide and recidivism (A/61/299, para. 54). 41. Harmful practices can have both immediate and prolonged negative psychological consequences. With regard to female genital mutilation, for example, studies have found that girls and women who have experienced it may have higher rates of mental health disorders, particularly depression, anxiety disorders, post-traumatic stress disorder and somatic (physical) complaints with no organic cause (for example, aches and pains).20 42. Emergencies create a wide range of problems experienced at the individual, family, community and society levels. Emergencies erode normally protective supports, increase the risks of diverse problems and tend to amplify pre-existing problems of social injustice and inequality. 21 Parents and other attachment figures may be killed, disabled or traumatized; schools may be damaged or become targets for military attack; and opportunities for play and friendship are often diminished as families are displaced and safe 16 17 18 19 20 21 8 See Office of the Special Representative, Ending the Torment: Tackling Bullying from Schoolyard to Cyberspace (October 2016). See Daniel J. Flannery and Mark I. Singer, “Here’s how witnessing violence harms children’s mental health”, available from http://theconversation.com/heres-how-witnessing-violence-harms-childrensmental-health-53321. Sophie Khadr and others, “Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study”, The Lancet Child and Adolescent Health, vol. 2, No. 9 (September 2018). Lorraine Radford, Debra Allnock and Patricia Hynes, Promising Programmes to Prevent and Respond to Child Sexual Abuse and Exploitation (New York, UNICEF, 2015). WHO, Care of Girls and Women Living with Female Genital Mutilation: a Clinical Handbook (Geneva, 2018). Inter-Agency Standing Committee, IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (Geneva, 2007).