research papers on bullying

ORIGINAL RESEARCH article

Understanding alternative bullying perspectives through research engagement with young people.

• School of Education and Social Care, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom

Bullying research has traditionally been dominated by largescale cohort studies focusing on the personality traits of bullies and victims. These studies focus on bullying prevalence, risk and protective factors, and negative outcomes. A limitation of this approach is that it does not explain why bullying happens. Qualitative research can help shed light on these factors. This paper discusses the findings from four mainly qualitative research projects including a systematic review and three empirical studies involving young people to various degrees within the research process as respondents, co-researchers and commissioners of research. Much quantitative research suggests that young people are a homogenous group and through the use of surveys and other large scale methods, generalizations can be drawn about how bullying is understood and how it can be dealt with. Findings from the studies presented in this paper, add to our understanding that young people appear particularly concerned about the role of wider contextual and relational factors in deciding if bullying has happened. These studies underscore the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Moreover, to appreciate the relational and social contexts underpinning bullying behaviors, adults and young people need to work together on bullying agendas and engage with multiple definitions, effects and forms of support. Qualitative methodologies, in particular participatory research opens up the complexities of young lives and enables these insights to come to the fore. Through this approach, effective supports can be designed based on what young people want and need rather than those interpreted as supportive through adult understanding.

Introduction

Research on school bullying has developed rapidly since the 1970s. Originating in social and psychological research in Norway, Sweden, and Finland, this body of research largely focusses on individualized personality traits of perpetrators and victims ( Olweus, 1995 ). Global interest in this phenomenon subsequently spread and bullying research began in the United Kingdom, Australia, and the United States ( Griffin and Gross, 2004 ). Usually quantitative in nature, many studies examine bullying prevalence, risk and protective factors, and negative outcomes ( Patton et al., 2017 ). Whilst quantitative research collates key demographic information to show variations in bullying behaviors and tendencies, this dominant bullying literature fails to explain why bullying happens. Nor does it attempt to understand the wider social contexts in which bullying occurs. Qualitative research on the other hand, in particular participatory research, can help shed light on these factors by highlighting the complexities of the contextual and relational aspects of bullying and the particular challenges associated with addressing it. Patton et al. (2017) in their systematic review of qualitative methods used in bullying research, found that the use of such methods can enhance academic and practitioner understanding of bullying.

In this paper, I draw on four bullying studies; one systematic review of both quantitative and qualitative research ( O’Brien, 2009 ) and three empirical qualitative studies ( O’Brien and Moules, 2010 ; O’Brien, 2016 , 2017 ) (see Table 1 below). I discuss how participatory research methodologies, to varying degrees, were used to facilitate bullying knowledge production among teams of young people and adults. Young people in these presented studies were consequently involved in the research process along a continuum of involvement ( Bragg and Fielding, 2005 ). To the far left of the continuum, young people involved in research are referred to as “active respondents” and their data informs teacher practice. To the middle of the continuum sit “students as co-researchers” who work with teachers to explore an issue which has been identified by that teacher. Finally to the right, sit “students as researchers” who conduct their own research with support from teachers. Moving from left to right of the continuum shows a shift in power dynamics between young people and adults where a partnership develops. Young people are therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspective, that of being a young person now.

Table 1. The studies.

In this paper, I advocate for the active involvement of young people in the research process in order to enhance bullying knowledge. Traditional quantitative studies have a tendency to homogenize young people by suggesting similarity in thinking about what constitutes bullying. However, qualitative studies have demonstrated that regardless of variables, young people understand bullying in different ways so there is a need for further research that starts from these perspectives and focusses on issues that young people deem important. Consequently, participatory research allows for the stories of the collective to emerge without losing the stories of the individual, a task not enabled through quantitative approaches.

What Is Bullying?

Researching school bullying has been problematic and is partly related to the difficulty in defining it ( Espelage, 2018 ). Broadly speaking, bullying is recognized as aggressive, repeated, intentional behavior involving an imbalance of power aimed toward an individual or group of individuals who cannot easily defend themselves ( Vaillancourt et al., 2008 ). In more recent times, “traditional” bullying behaviors have been extended to include cyber-bullying, involving the use of the internet and mobile-phones ( Espelage, 2018 ). Disagreements have been noted in the literature about how bullying is defined by researchers linked to subject discipline and culture. Some researchers for example, disagree about the inclusion or not of repetition in definitions ( Griffin and Gross, 2004 ) and these disagreements have had an impact on interpreting findings and prevalence rates. However, evidence further suggests that young people also view bullying in different ways ( Guerin and Hennessy, 2002 ; Cuadrado-Gordillo, 2012 ; Eriksen, 2018 ). Vaillancourt et al. (2008) explored differences between researchers and young people’s definitions of bullying, and found that children’s definitions were usually spontaneous, and did not always encompass the elements of repetition, power imbalance and intent. They concluded, that children need to be provided with a bullying definition so similarities and comparisons can be drawn. In contrast, Huang and Cornell (2015) found no evidence that the inclusion of a definition effected prevalence rates. Their findings, they suggest, indicate that young people use their own perceptions of bullying when answering self-report questionnaires and they are not influenced by an imposed definition.

Nevertheless, differences in children and young people’s bullying definitions are evident in the research literature and have been explained by recourse to age and stage of development ( Smith et al., 2002 ) and their assumed lack of understanding about what constitutes bullying ( Boulton and Flemington, 1996 ). Naylor et al. (2001) for example, found that younger children think similarly in their definitions of bullying, while Smith et al. (2002) found that 8 year olds did not distinguish as clearly between different forms of behavioral aggression as 14 year olds. Methodological limitations associated with understanding bullying have been identified by Forsberg et al. (2018) and Maunder and Crafter (2018) . These authors postulate that quantitative approaches, although providing crucial insights in understanding bullying, are reliant on pre-defined variables, which can shield some of the complexities that qualitative designs can unravel, as individual experiences of bullying are brought to the fore. Indeed, La Fontaine (1991) suggests that unlike standard self-report questionnaires and other quantitative methods used to collect bullying data, analyzing qualitative data such as those collected from a helpline, enables the voice of young people to be heard and consequently empowers adults to understand bullying on their terms rather than relying solely on interpretations and perceptions of adults. Moore and Maclean (2012) collected survey, as well as interview and focus group data, on victimization occurring on the journey to and from school. They found that what young people determined as victimization varied and was influenced by a multifaceted array of circumstances, some of which adults were unaware of. Context for example, played an important role where certain behaviors in one situation could be regarded as victimization while in another they were not. Specific behaviors including ignoring an individual was particularly hurtful and supporting a friend who was the subject of victimization could lead to their own victimization.

Lee (2006) suggests that some bullying research does not reflect individual experiences, and are thus difficult for participants to relate to. Canty et al. (2016) reiterates this and suggests that when researchers provide young people with bullying definitions in which to position their own experiences, this can mask some of the complexities that the research intends to uncover. Such approaches result in an oversight into the socially constructed and individual experiences of bullying ( Eriksen, 2018 ). Griffin and Gross (2004) further argue that when researchers use vague or ambiguous definitions an “overclassification of children as bullies or victims” (p. 381) ensues. Consequently, quantitative research does not consider children as reliable in interpreting their own lived experiences and therefore some of the interactions they consider as bullying, that do not fit within the conventional definitions, are concealed. This approach favors the adult definition of bullying regarding it as “more reliable” than the definitions of children and young people Canty et al. (2016) . The perceived “seriousness” of bullying has also been explored. Overall, young people and adults are more likely to consider direct bullying (face-to-face actions including hitting, threatening and calling names) as “more serious” than indirect bullying (rumor spreading, social exclusion, forcing others to do something they do not want to do) ( Maunder et al., 2010 ; Skrzypiec et al., 2011 ). This perception of “seriousness,” alongside ambiguous definitions of bullying, has further implications for reporting it. Despite the advice given to young people to report incidents of school bullying ( Moore and Maclean, 2012 ), the literature suggests that many are reluctant to do so ( deLara, 2012 ; Moore and Maclean, 2012 ).

Several factors have been highlighted as to why young people are reluctant to report bullying ( Black et al., 2010 ). deLara (2012) , found apprehension in reporting bullying to teachers due to the fear that they will either not do enough or too much and inadvertently make the situation worse, or fear that teachers will not believe young people. Research also shows that young people are reluctant to tell their parents about bullying due to perceived over-reaction and fear that the bullying will be reported to their school ( deLara, 2012 ; Moore and Maclean, 2012 ). Oliver and Candappa (2007) suggest that young people are more likely to confide in their friends than adults (see also Moore and Maclean, 2012 ; Allen, 2014 ). However, if young people believe they are being bullied, but are unable to recognize their experiences within a predefined definition of bullying, this is likely to impact on their ability to report it.

Research from psychology, sociology, education and other disciplines, utilizing both quantitative and qualitative approaches, have enabled the generation of bullying knowledge to date. However, in order to understand why bullying happens and how it is influenced by wider social constructs there is a need for further qualitative studies, which hear directly from children and young people themselves. The next section of this paper discusses the theoretical underpinnings of this paper, which recognizes that young people are active agents in generating new bullying knowledge alongside adults.

Theoretical Underpinnings – Hearing From Children and Young People

The sociology of childhood ( James, 2007 ; Tisdall and Punch, 2012 ) and children’s rights agenda more broadly ( United Nations Convention on the Rights of the Child, 1989 ) have offered new understandings and methods for research which recognize children and young people as active agents and experts on their own lives. From this perspective, research is conducted with rather than on children and young people ( Kellett, 2010 ).

Participatory methodologies have proven particularly useful for involving young people in research as co-researchers (see for example O’Brien and Moules, 2007 ; Stoudt, 2009 ; Kellett, 2010 ; Spears et al., 2016 ). This process of enquiry actively involves those normally being studied in research activities. Previously, “traditional” researchers devalued the experiences of research participants arguing that due to their distance from them, they themselves are better equipped to interpret these experiences ( Beresford, 2006 ). However, Beresford (2006) suggests that the shorter the distance between direct experience and interpretation, the less distorted and inaccurate the resulting knowledge is likely to be. Jones (2004) further advocates that when young people’s voices are absent from research about them the research is incomplete. Certainly Spears et al. (2016) , adopted this approach in their study with the Young and Well Cooperative Research Centre (CRC) in Australia. Young people played an active role within a multidisciplinary team alongside researchers, practitioners and policymakers to co-create and co-evaluate the learning from four marketing campaigns for youth wellbeing through participatory research. Through this methodological approach, findings show that young people were able to reconceptualize mental health and wellbeing from their own perspectives as well as share their lived experiences with others ( Spears et al., 2016 ). Bland and Atweh (2007) , Ozer and Wright (2012) , highlight the benefits afforded to young people through this process, including participating in dialog with decision-makers and bringing aspects of teaching and learning to their attention.

Against this background, data presented for this paper represents findings from four studies underpinned by the ethos that bullying is socially constructed and is best understood by exploring the context to which it occurs ( Schott and Sondergaard, 2014 ; Eriksen, 2018 ). This socially constructed view focusses on the evolving positions within young people’s groups, and argues that within a bullying situation sometimes a young person is the bully, sometimes the victim and sometimes the bystander/witness, which contrasts the traditional view of bullying ( Schott and Sondergaard, 2014 ). The focus therefore is on group relationships and dynamics. For that reason, Horton (2011) proposes that if bullying is an extensive problem including many young people, then focusing entirely on personality traits will not generate new bullying knowledge and will be problematic in terms of interventions. It is important to acknowledge that this change in focus and view of bullying and how it is manifested in groups, does not negate the individual experiences of bullying rather the focus shifts to the process of being accepted, or not, by the group ( Schott and Sondergaard, 2014 ).

The Studies

This section provides a broad overview of the four included studies underpinned by participatory methodologies. Table 1 presents the details of each study. Young people were involved in the research process as respondents, co-researchers and commissioners of research, along a continuum as identified by Bragg and Fielding (2005) . This ranged from “active respondents” to the left of the continuum, “students as co-researchers” in the middle and “students as researchers” to the right of the continuum. Young people were therefore recognized as equal to adults in terms of what they can bring to the project from their own unique perspectives ( Bradbury-Jones et al., 2018 ).

A key finding from study one ( O’Brien, 2009 ) was the lack of voice afforded to young people through the research process and can be seen to reflect the far left of Bragg and Fielding (2005) continuum, as young people were not directly involved as “active respondents” but their views were included in secondary data analysis and informed the studies that followed. For example, the quantitative studies used an agreed academic definition of bullying which may or may not have influenced how young participants defined bullying within the studies. On the other hand, the qualitative study involved a group of students in deciding which questions to ask of the research participants and in interpreting the findings.

In contrast, study two ( O’Brien and Moules, 2010 ) was commissioned and led by a group of young people called PEAR (Public health, Education, Awareness, Researchers), who were established to advise on public health research in England. PEAR members were based in two large English cities and comprised 20 young people aged between 13 and 20 years. The premise of the study was that PEAR members wanted to commission research into cyber bullying and the effects this has on mental health from the perspectives of young people rather than adult perspectives. This project was innovative as young people commissioned the research and participated as researchers ( Davey, 2011 ) and can be seen to reflect the middle “students as co-researchers” as well as moving toward to right “students as researchers” of Bragg and Fielding (2005) continuum. Although the young people did not carry out the day-to-day work on the project, they were responsible for leading and shaping it. More importantly, the research topic and focus were decided with young people and adults together.

Study three ( O’Brien, 2016 ) involved five self-selecting students from an independent day and boarding school who worked with me to answer this question: What do young people in this independent day and boarding school view as the core issue of bullying in the school and how do they want to address this? These students called themselves R4U (Research for You) with the slogan researching for life without fear . Three cycles of Participatory Action Research (PAR) ensued, where decision making about direction of the research, including methods, analysis and dissemination of findings were made by the research team. As current students of the school, R4U had a unique “insider knowledge” that complemented my position as the “academic researcher.” By working together to generate understanding about bullying at the school, the findings thus reflected this diversity in knowledge. As the project evolved so too did the involvement of the young researchers and my knowledge as the “outsider” (see O’Brien et al., 2018a for further details). Similar to study two, this project is situated between the middle: “students as co-researchers” and the right: “students as researchers” of Bragg and Fielding (2005) continuum.

Study four ( O’Brien, 2017 ) was small-scale and involved interviewing four young people who were receiving support from a charity providing therapeutic and educational support to young people who self-exclude from school due to anxiety, as a result of bullying. Self-exclusion, for the purposes of this study, means that a young person has made a decision not to go to school. It is different from “being excluded” or “truanting” because these young people do not feel safe at school and are therefore too anxious to attend. Little is known about the experiences of young people who self-exclude due to bullying and this study helped to unravel some of these issues. This study reflects the left of Bragg and Fielding (2005) continuum where the young people were involved as “active respondents” in informing adult understanding of the issue.

A variety of research methods were used across the four studies including questionnaires, interviews and focus groups (see Table 1 for more details). In studies two and three, young researchers were fundamental in deciding the types of questions to be asked, where they were asked and who we asked. In study three the young researchers conducted their own peer-led interviews. The diversity of methods used across the studies are a strength for this paper. An over-reliance on one method is not portrayed and the methods used reflected the requirements of the individual studies.

Informed Consent

Voluntary positive agreement to participate in research is referred to as “consent” while “assent,” refers to a person’s compliance to participate ( Coyne, 2010 ). The difference in these terms are normally used to distinguish the “legal competency of children over and under 16 years in relation to research.” ( Coyne, 2010 , 228). In England, children have a legal right to consent so therefore assent is non-applicable ( Coyne, 2010 ). However, there are still tensions surrounding the ability of children and young people under the age of 18 years to consent in research which are related to their vulnerability, age and stage of development ( Lambert and Glacken, 2011 ). The research in the three empirical studies (two, three and four) started from the premise that all young participants were competent to consent to participate and took the approach of Coyne (2010) who argues that parental/carer consent is not always necessary in social research. University Research Ethics Committees (RECs) are nonetheless usually unfamiliar with the theoretical underpinnings that children are viewed as social actors and generally able to consent for themselves ( Lambert and Glacken, 2011 ; Fox, 2013 ; Parsons et al., 2015 ).

In order to ensure the young people in these reported studies were fully informed of the intentions of each project and to adhere to ethical principles, age appropriate participant information sheets were provided to all participants detailing each study’s requirements. Young people were then asked to provide their own consent by signing a consent form, any questions they had about the studies were discussed. Information sheets were made available to parents in studies three and four. In study two, the parents of young people participating in the focus groups were informed of the study through the organizations used to recruit the young people. My full contact details were provided on these sheets so parents/carers could address any queries they had about the project if they wished. When young people participated in the online questionnaire (study two) we did not know who they were so could not provide separate information to parents. Consequently, all participants were given the opportunity to participate in the research without the consent of their parents/carers unless they were deemed incompetent to consent. In this case the onus was on the adult (parent or carer for example) to prove incompetency ( Alderson, 2007 ). Favorable ethical approval, including approval for the above consent procedures, was granted by the Faculty Research Ethics Committee at Anglia Ruskin University.

In the next section I provide a synthesis of the findings across the four studies before discussing how participatory research with young people can offer new understandings of bullying and its impacts on young people.

Although each study was designed to answer specific bullying research questions, the following key themes cut across all four studies 1 :

• Bullying definitions

◦ Behaviors

• Impact of bullying on victim

• Reporting bullying

Bullying Definitions

Young people had various understandings about what they considered bullying to be. Overall, participants agreed that aggressive direct behaviors, mainly focusing on physical aggression, constituted bullying:

“…if someone is physically hurt then that is bullying straight away.” (Female, study 3).

“I think [cyber-bullying is] not as bad because with verbal or physical, you are more likely to come in contact with your attacker regularly, and that can be disturbing. However, with cyber-bullying it is virtual so you can find ways to avoid the person.” (Female, study 2).

Name-calling was an ambiguous concept, young people generally believed that in isolation name-calling might not be bullying behavior or it could be interpreted as “joking” or “banter”:

“I never really see any, a bit of name calling and taking the mick but nothing ever serious.” (Male, study 3).

The concept of “banter” or “joking” was explored in study three as a result of the participatory design. Young people suggested “banter” involves:

“…a personal joke or group banter has no intention to harm another, it is merely playful jokes.” (Female, study 3).

However, underpinning this understanding of “banter” was the importance of intentionality:

“Banter saying things bad as a joke and everyone knows it is a joke.” (Male, study 3).

“Banter” was thus contentious when perception and reception were ambiguous. In some cases, “banter” was considered “normal behavior”:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke…” (Male, study 3).

The same view was evident in relation to cyber-bullying. Some participants were rather dismissive of this approach suggesting that it did not exist:

“I don’t really think it exists. If you’re being cyber-“bullied” then there is something wrong with you- it is insanely easy to avoid, by blocking people and so on. Perhaps it consists of people insulting you online?” (Male, study 2).

When young people considered additional factors added to name calling such as the type of name-calling, or aspects of repetition or intention, then a different view was apparent.

“…but it has to be constant it can’t be a single time because that always happens.” (Male, study 3).

Likewise with words used on social media, young people considered intentionality in their consideration of whether particular behaviors were bullying, highlighting important nuances in how bullying is conceptualized:

“Some people they don’t want to sound cruel but because maybe if you don’t put a smiley face on it, it might seem cruel when sometimes you don’t mean it.” (Female, study 2).

Study one also found that young people were more likely to discuss sexist or racist bullying in interviews or focus groups but this information was scarce in the questionnaire data. This is possibly as a result of how the questions were framed and the researchers’ perspectives informing the questions.

Evident across the four studies was the understanding young people had about the effects of continuous name-calling on victims:

“…you can take one comment, you can just like almost brush it off, but if you keep on being bullied and bullied and bullied then you might kind of think, hang on a minute, they’ve taken it a step too far, like it’s actually become more personal, whereas just like a cheeky comment between friends it’s become something that’s more serious and more personal and more annoying or hurtful to someone.” (Female, study 3).

“Cyber-bullying is basically still verbal bullying and is definitely psychological bullying. Any bullying is psychological though, really. And any bullying is going to be harmful.” (Female, study 2).

Aspects of indirect bullying (social exclusion) were features of studies one and three. For the most part, the research reviewed in study one found that as young people got older they were less likely to consider characteristics of social exclusion in their definitions of bullying. In study three, when discussing the school’s anti-bullying policy, study participants raised questions about “ isolating a student from a friendship group .” Some contested this statement as a form of bullying:

“…. there is avoiding, as in, not actively playing a role in trying to be friends which I don’t really see as bullying I see this as just not getting someone to join your friendship group. Whereas if you were actually leaving him out and rejecting him if he tries to be friends then I think I would see that as malicious and bullying.” (Male, study 3).

“Isolating a student from a friendship group – I believe there are various reasons for which a student can be isolated from a group – including by choice.” (Female, study 3).

Cyber-bullying was explored in detail in study two but less so in the other three studies. Most study two participants considered that cyber-bullying was just as harmful, or in some cases worse than, ‘traditional’ bullying due to the use of similar forms of “harassment,” “antagonizing,” “tormenting,” and ‘threatening’ through online platforms. Some young people believed that the physical distance between the victim and the bully is an important aspect of cyber-bullying:

“I think it’s worse because people find it easier to abuse someone when not face to face.” (Male, study 2).

“I think it could be worse, because lots of other people can get involved, whereas when it’s physical bullying it’s normally just between one or two or a smaller group, things could escalate too because especially Facebook, they’ve got potential to escalate.” (Female, study 2).

Other participants in study two spoke about bullying at school which transfers to an online platform highlighting no “escape” for some. In addition, it was made clearer that some young people considered distancing in relation to bullying and how this influences perceptions of severity:

“…when there’s an argument it can continue when you’re not at school or whatever and they can continue it over Facebook and everyone can see it then other people get involved.” (Female, study 2).

“I was cyber-bullied on Facebook, because someone put several hurtful comments in response to my status updates and profile pictures. This actually was extended into school by the bully…” (Male, study 2).

Impact of Bullying on Victim

Although bullying behaviors were a primary consideration of young people’s understanding of bullying, many considered the consequences associated with bullying and in particular, the impact on mental health. In these examples, the specifics of the bullying event were irrelevant to young people and the focus was on how the behavior was received by the recipient.

In study two, young people divulged how cyber-bullying had adversely affected their ability to go to school and to socialize outside school. Indeed some young people reported the affects it had on their confidence and self-esteem:

“I developed anorexia nervosa. Although not the single cause of my illness, bullying greatly contributed to my low self-esteem which led to becoming ill.” (Female, study 2).

“It hurts people’s feelings and can even lead to committing suicide….” (Female, study 2).

Across the studies, young people who had been bullied themselves shared their individual experiences:

“….you feel insecure and it just builds up and builds up and then in the end you have no self-confidence.” (Female, study 2).

“…it was an everyday thing I just couldn’t take it and it was causing me a lot of anxiety.” (Male, study 4).

“I am different to everyone in my class …. I couldn’t take it no more I was upset all the time and it made me feel anxious and I wasn’t sleeping but spent all my time in bed being sad and unhappy.” (Male, study 4).

Young people who had not experienced bullying themselves agreed that the impact it had on a person was a large determiner of whether bullying had happened:

“When your self-confidence is severely affected and you become shy. Also when you start believing what the bullies are saying about you and start to doubt yourself.” (Female, study 3).

“…it makes the victim feel bad about themselves which mostly leads to depression and sadness.” (Male, study 2).

Further evidence around the impact of bullying was apparent in the data in terms of how relational aspects can affect perceived severity. In the case of cyber-bullying, young people suggested a sense of detachment because the bullying takes place online. Consequently, as the relational element is removed bullying becomes easier to execute:

“…because people don’t have to face them over a computer so it’s so much easier. It’s so much quicker as well cos on something like Facebook it’s not just you, you can get everyone on Facebook to help you bully that person.” (Female, study 2).

“Due to technology being cheaper, it is easier for young people to bully people in this way because they don’t believe they can be tracked.” (Male, study 2).

“The effects are the same and often the bullying can be worse as the perpetrator is unknown or can disguise their identity. Away from the eyes of teachers etc., more can be done without anyone knowing.” (Female, study 2).

Relational aspects of bullying were further highlighted with regards to how “banter” was understood, particularly with in-group bullying and how the same example can either be seen as “banter” or bullying depending on the nature of the relationship:

“…we’ve just been joking about, but it’s never been anything harsh it’s just been like having a joke. well, I haven’t done it but I’ve been in a crowd where people do it, so I don’t want to get involved just in case it started an argument.” (Female, study 3).

“But it also depends…who your groups with, for example, if I spoke to my friends from [School]… I wouldn’t like use taboo language with them because to them it may seem inappropriate and probably a bit shocked, but if I was with my friends outside of school we use taboo language, we’ll be ourselves and we’ll be comfortable with it, and if a stranger walked past and heard us obviously they’d be thinking that we’re being bullied ourselves.” (Female, study 3).

Furthermore, how individuals are perceived by others tended to influence whether they were believed or not. In study four for example, participants suggested that who the bullies were within the school might have impacted how complaints were acted upon by school officials:

“When I went to the school about it, the students said I had attacked them – all eight of them! I just realized that no one believes me….” (Female, study 4).

While in study three, a characteristic of bullying was the influence the aggressor has over the victim:

“When the victim starts to feel in danger or start to fear the other person. Consequently he or she tries to avoid the bad guy (or girl!)” (Male, study 3).

These relational and contextual issues also influenced a young person’s ability to report bullying.

Reporting Bullying

Young people were more likely to report bullying when they considered it was ‘serious’ enough. Just under half of participants in study two sought emotional/practical support if they worried about, or were affected by cyber-bullying, with most talking to their parents. In study three, young people were less likely to seek support but when they did, most went to their teachers. In study four, all participants reported bullying in school where they did not feel supported.

Fear of making the bullying worse was captured across the studies as a reason for not reporting it:

“I’m scared that if I tell then the bullying will still go on and they will do more.” (Female, study 3).

“The bully might bully you if he finds out.” (Male, study 3).

Being able to deal with the incident themselves was also a reason for non-reporting:

“…it’s embarrassing and not necessary, my friends help me through it, adults never seem to understand.” (Female, study 2).

“I don’t tend to talk to anyone about it, I just keep it to myself and obviously that’s the worst thing you should ever do, you should never keep it to yourself, because I regret keeping it to myself to be honest….” (Female, study 3).

“…but I think I’d deal with it myself ‘cos. I was quite insecure but now I’m quite secure with myself, so I’ll sort it out myself. I think it’s just over time I’ve just sort of hardened to it.” (Male, study 3).

Most young people seeking support for bullying said they spoke to an adult but the helpfulness of this support varied. This finding is important for understanding relationships between young people and adults. Those who felt supported by their teachers for example, suggested that they took the time to listen and understood what they were telling them. They also reassured young people who in turn believed that the adult they confided in would know what to do:

“So I think the best teacher to talk to is [Miss A] and even though people are scared of her I would recommend it, because she’s a good listener and she can sense when you don’t want to talk about something, whereas the other teachers force it out of you.” (Female, study 3).

“My school has had assemblies about cyber-bullying and ways you can stop it or you can report it anonymously…. you can write your name or you can’t, it’s all up to YOU.” (Male, study 2).

Others however had a negative experience of reporting bullying and a number of reasons were provided as to why. Firstly, young people stated that adults did not believe them which made the bullying worse on some level:

“I went to the teachers a couple of times but, no, I don’t think they could do anything. I did sort of go three times and it still kept on going, so I just had to sort of deal with it and I sort of took it on the cheek….” (Male, study 3).

Secondly, young people suggested that adults did not always listen to their concerns, or in some cases did not take their concerns seriously enough:

“…I had had a really bad day with the girls so I came out and I explained all this to my head of year and how it was affecting me but instead of supporting me he put me straight into isolation.” (Male, study 4).

“I could understand them thinking I maybe got the wrong end of the stick with one incident but this was 18 months of me constantly reporting different incidents.” (Female, study 4).

“If cyber-bullying is brought to our school’s attention, usually, they expect printed proof of the situation and will take it into their own hand depending on its seriousness. However this is usually a couple of detentions. And it’s just not enough.” (Female, study 2).

Finally, some young people suggested that teachers did not always know what to do when bullying concerns were raised and consequently punished those making the complaint:

“I think I would have offered support instead of punishment to someone who was suffering with anxiety. I wouldn’t have seen anxiety as bad behavior I think that’s quite ignorant but they saw it as bad behavior.” (Male, study 4).

It is worth reiterating, that the majority of young people across the studies did not report bullying to anybody , which further underscores the contextual issues underpinning bullying and its role in enabling or disabling bullying behaviors. Some considered it was “pointless” reporting the bullying and others feared the situation would be made worse if they did:

“My school hide and say that bullying doesn’t go on cos they don’t wanna look bad for Ofsted.” (Male, study 2).

“My school is oblivious to anything that happens, many things against school rules happen beneath their eyes but they either refuse to acknowledge it or are just not paying attention so we must suffer.” (Female, study 2).

“That’s why I find that when you get bullied you’re scared of telling because either, in most cases the teacher will – oh yeah, yeah, don’t worry, we’ll sort it out and then they don’t tend to, and then they get bullied more for it.” (Female, study 3).

Young people were concerned that reporting bullying would have a negative impact on their friendship groups. Some were anxious about disrupting the status quo within:

“I think everyone would talk about me behind my back and say I was mean and everyone would hate me.” (Female, study 3).

Others expressed concern about the potential vulnerability they were likely to experience if they raised concerns of bullying:

“I was worried it might affect my other friendships.”(Boy, study 2).

“I’m scared that if I tell, then the bullying will still go on and they will do more.” (Female, study 3).

“….because they might tell off the bullies and then the bullies will like get back at you.” (Female, study 3).

These findings underscore the importance of contextual and relational factors in understanding bullying from the perspectives of young people and how these factors influence a young person’s ability or willingness to report bullying.

Finally one young person who had self-excluded from school due to severe bullying suggested that schools:

“…need to be looking out for their students’ mental wellbeing – not only be there to teach them but to support and mentor them. Keep them safe really… I missed out on about three years of socializing outside of school because I just couldn’t do it. I think it’s important that students are encouraged to stand up for each other.” (Female, study 4).

The studies presented in this paper illustrate the multitude of perceptions underpinning young people’s understandings of what constitutes bullying, both in terms of the behavior and also the impact that this behavior has on an individual. In turn, the ambiguity of what constitutes bullying had an impact on a young person’s ability to seek support. Discrepancies in bullying perceptions within and between young people’s groups are shown, highlighting the fluid and changing roles that occur within a bullying situation. Findings from quantitative studies have demonstrated the differing perceptions of bullying by adults and young people (see for example Smith et al., 2002 ; Vaillancourt et al., 2008 ; Maunder et al., 2010 ; Cuadrado-Gordillo, 2012 ). However, by combining findings from participatory research, new understandings of the relational and contextual factors important to young people come to the fore.

Young people participating in these four studies had unique knowledge and experiences of bullying and the social interactions of other young people in their schools and wider friendship groups. The underpinning participatory design enabled me to work alongside young people to analyze and understand their unique perspectives of bullying in more detail. The research teams were therefore able to construct meaning together, based not entirely on our own assumptions and ideologies, but including the viewpoint of the wider research participant group ( Thomson and Gunter, 2008 ). Together, through the process of co-constructing bullying knowledge, we were able to build on what is already known in this field and contribute to the view that bullying is socially constructed through the experiences of young people and the groups they occupy ( Schott and Sondergaard, 2014 ).

With regards to understanding what bullying is, the findings from these studies corroborate those of the wider literature from both paradigms of inquiry (for example Naylor et al., 2001 ; Canty et al., 2016 ); that being the discrepancies in definitions between adults and young people and also between young people themselves. Yet, findings here suggest that young people’s bullying definitions are contextually and relationally contingent. With the exception of physical bullying, young people did not differentiate between direct or indirect behaviors, instead they tended to agree that other contextual and relational factors played a role in deciding if particular behaviors were bullying (or not). The participatory research design enabled reflection and further investigation of the ideas that were particularly important to young people such as repetition and intentionality. Repetition was generally seen as being indicative of bullying being “serious,” and therefore more likely to be reported, and without repetition, a level of normality was perceived. This finding contradicts some work on bullying definitions, Cuadrado-Gordillo (2012) for example found that regardless of the role played by young people in a bullying episode (victim, aggressor or witness), the criteria of ‘repetition’ was not important in how they defined bullying.

Relational factors underpinning young people’s perception of bullying and indeed it’s “seriousness” were further reflected in their willingness or otherwise to report it. Fear of disrupting the status quo of the wider friendship group, potentially leading to their own exclusion from the group, was raised as a concern by young people. Some were concerned their friends would not support them if they reported bullying, while others feared further retaliation as a result. Friendship groups have been identified as a source of support for those who have experienced bullying and as a protective factor against further bullying ( Allen, 2014 ). Although participants did not suggest their friendship groups are unsupportive it is possible that group dynamics underscore seeking (or not) support for bullying. Other literature has described such practices as evidence of a power imbalance ( Olweus, 1995 ; Cuadrado-Gordillo, 2012 ) but young people in these studies did not describe these unequal relationships in this way and instead focused on the outcomes and impacts of bullying. Indeed Cuadrado-Gordillo (2012) also found that young people in their quantitative study did not consider “power imbalance” in their understanding of bullying and were more likely to consider intention. This paper, however, underscores the relational aspects of definitions of bullying and, how the dynamics of young people’s friendships can shift what is understood as bullying or not. Without such nuances, some behaviors may be overlooked as bullying, whereas other more obvious behaviors draw further attention. This paper also shows that contextual issues such as support structures can shift how young people see bullying. Contextual factors were evident across the four studies through the recognition of bullying being enabled or disabled by institutional factors, including a school’s ability to respond appropriately to bullying concerns. Young people suggested that schools could be influenced by bullies, perceiving them as non-threatening and consequently not dealing appropriately with the situation. Indeed some young people reported that their schools placed the onus on them as victims to change, consequently placing the “blame” on victims instead. These findings raise questions about who young people feel able to confide in about bullying as well as issues around training and teacher preparedness to deal with bullying in schools. Evidenced in these four studies, is that young people feel somewhat disconnected from adults when they have bullying concerns. Those who did report bullying, identified particular individuals they trusted and knew would support them. Novick and Isaacs (2010) identified teachers who young people felt comfortable in approaching to report bullying and described them as “most active, engaged and responsive.” (p. 291). The bullying literature suggests that as young people get older they are more likely to confide in friends than adults ( Moore and Maclean, 2012 ; Allen, 2014 ). However, findings from this paper indicate that although fewer young people reported bullying, those who did confided in an adult. Young people have identified that a variety of supports are required to tackle bullying and that adults need to listen and work with them so nuanced bullying behaviors are not recognized as “normal” behaviors. Within the data presented in this paper, “banter” was portrayed as “normal” behavior. Young people did not specify what behaviors they regarded as “banter,” but suggested that when banter is repeated and intentional the lines are blurred about what is bullying and what is banter.

Exploring bullying nuances in this paper, was enhanced by the involvement of young people in the research process who had a unique “insider” perspective about what it is like to be a young person now and how bullying is currently affecting young people. In studies one and four, young people were “active respondents” ( Bragg and Fielding, 2005 ) and provided adults with their own unique perspectives on bullying. It could be argued that study one did not involve the participation of young people. However, this study informed the basis of the subsequent studies due to the discrepancies noted in the literature about how bullying is understood between adults and young people, as well as the lack of young people’s voice and opportunity to participate in the reviewed research. Accordingly, young people’s data as “active respondents” informed adult understanding and led to future work involving more active research engagement from other young people. Participation in study four provided an opportunity for young people to contribute to future participatory research based on lived experiences as well as informing policy makers of the effects bullying has on the lives of young people ( O’Brien, 2017 ). In studies two and three, young people were involved further along Bragg and Fielding (2005) continuum as “co-researchers” and “students as researchers” with these roles shifting and moving dependent on the context of the project at the time ( O’Brien et al., 2018a ). These young researchers brought unique knowledge to the projects ( Bradbury-Jones et al., 2018 ) that could not be accessed elsewhere. Perspectives offered by the young researchers supported adults in understanding more about traditional and cyber-bullying from their perspectives. Furthermore, this knowledge can be added to other, quantitative studies to further understand why bullying happens alongside bullying prevalence, risk and protective factors, and negative outcomes.

Findings from the four studies offer an alternative perspective to how bullying is understood by young people. Complexities in defining bullying have been further uncovered as understanding is informed by individual factors, as well as wider social and relational contexts ( Horton, 2011 ; Schott and Sondergaard, 2014 ). This has implications for the type of support young people require. This paper highlights how definitions of bullying shift in response to relational and contextual aspects deemed important to young people. Because of this, further nuances were uncovered through the research process itself as the respective studies showed discrepancies in bullying perceptions within and between young people’s groups.

These understandings can act as a starting point for young people and adults to collaborate in research which seeks to understand bullying and the context to which it occurs. Furthermore, such collaborations enable adults to theorize and understand the complexities associated with bullying from the perspective of those at the center. There is a need for additional participatory research projects involving such collaborations where adults and young people can learn from each other as well as combining findings from different methodologies to enable a more comprehensive picture of the issues for young people to emerge. Further research is needed to unravel the complexities of bullying among and between young people, specifically in relation to the contextual and relational factors underscoring perceptions of bullying.

Data Availability

The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

Ethics Statement

Ethical approval was granted for all four studies from the Faculty of Health, Education, Medicine and Social Care at the Anglia Ruskin University. The research was conducted on the premise of Gillick competency meaning that young people (in these studies over the age of 12 years) could consent for themselves to participate. Parents/carers were aware the study was happening and received information sheets explaining the process.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

These four studies were conducted at the Anglia Ruskin University. Study one was part of a wider masters degree funded by the Anglia Ruskin University, Study two was funded by a group of young people convened by the National Children’s Bureau with funding from the Wellcome Trust (United Kingdom). Study three was a wider Doctoral study funded by the Anglia Ruskin University and Study four was also funded by the Anglia Ruskin University.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I would like to thank Dr. Grace Spencer, Ruskin Fellow at the Anglia Ruskin University for providing the critical read of this manuscript and offering constructive feedback. I would also like to thank the two independent reviewers for their feedback on the drafts of this manuscript.

• ^ These findings focus on perceptions and data from the young people in the four studies. For a full discussion on adult perceptions please refer to the individual studies.

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Keywords : bullying, young people, participatory research, social constructionism, young people as researchers, collaboration, bullying supports

Citation: O’Brien N (2019) Understanding Alternative Bullying Perspectives Through Research Engagement With Young People. Front. Psychol. 10:1984. doi: 10.3389/fpsyg.2019.01984

Received: 28 February 2019; Accepted: 13 August 2019; Published: 28 August 2019.

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*Correspondence: Niamh O’Brien, [email protected]

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• Research article
• Open access
• Published: 14 December 2021

Bullying at school and mental health problems among adolescents: a repeated cross-sectional study

• Håkan Källmén 1 &
• Mats Hallgren   ORCID: orcid.org/0000-0002-0599-2403 2  

Child and Adolescent Psychiatry and Mental Health volume  15 , Article number:  74 ( 2021 ) Cite this article

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To examine recent trends in bullying and mental health problems among adolescents and the association between them.

A questionnaire measuring mental health problems, bullying at school, socio-economic status, and the school environment was distributed to all secondary school students aged 15 (school-year 9) and 18 (school-year 11) in Stockholm during 2014, 2018, and 2020 (n = 32,722). Associations between bullying and mental health problems were assessed using logistic regression analyses adjusting for relevant demographic, socio-economic, and school-related factors.

The prevalence of bullying remained stable and was highest among girls in year 9; range = 4.9% to 16.9%. Mental health problems increased; range = + 1.2% (year 9 boys) to + 4.6% (year 11 girls) and were consistently higher among girls (17.2% in year 11, 2020). In adjusted models, having been bullied was detrimentally associated with mental health (OR = 2.57 [2.24–2.96]). Reports of mental health problems were four times higher among boys who had been bullied compared to those not bullied. The corresponding figure for girls was 2.4 times higher.

Conclusions

Exposure to bullying at school was associated with higher odds of mental health problems. Boys appear to be more vulnerable to the deleterious effects of bullying than girls.

Introduction

Bullying involves repeated hurtful actions between peers where an imbalance of power exists [ 1 ]. Arseneault et al. [ 2 ] conducted a review of the mental health consequences of bullying for children and adolescents and found that bullying is associated with severe symptoms of mental health problems, including self-harm and suicidality. Bullying was shown to have detrimental effects that persist into late adolescence and contribute independently to mental health problems. Updated reviews have presented evidence indicating that bullying is causative of mental illness in many adolescents [ 3 , 4 ].

There are indications that mental health problems are increasing among adolescents in some Nordic countries. Hagquist et al. [ 5 ] examined trends in mental health among Scandinavian adolescents (n = 116, 531) aged 11–15 years between 1993 and 2014. Mental health problems were operationalized as difficulty concentrating, sleep disorders, headache, stomach pain, feeling tense, sad and/or dizzy. The study revealed increasing rates of adolescent mental health problems in all four counties (Finland, Sweden, Norway, and Denmark), with Sweden experiencing the sharpest increase among older adolescents, particularly girls. Worsening adolescent mental health has also been reported in the United Kingdom. A study of 28,100 school-aged adolescents in England found that two out of five young people scored above thresholds for emotional problems, conduct problems or hyperactivity [ 6 ]. Female gender, deprivation, high needs status (educational/social), ethnic background, and older age were all associated with higher odds of experiencing mental health difficulties.

Bullying is shown to increase the risk of poor mental health and may partly explain these detrimental changes. Le et al. [ 7 ] reported an inverse association between bullying and mental health among 11–16-year-olds in Vietnam. They also found that poor mental health can make some children and adolescents more vulnerable to bullying at school. Bayer et al. [ 8 ] examined links between bullying at school and mental health among 8–9-year-old children in Australia. Those who experienced bullying more than once a week had poorer mental health than children who experienced bullying less frequently. Friendships moderated this association, such that children with more friends experienced fewer mental health problems (protective effect). Hysing et al. [ 9 ] investigated the association between experiences of bullying (as a victim or perpetrator) and mental health, sleep disorders, and school performance among 16–19 year olds from Norway (n = 10,200). Participants were categorized as victims, bullies, or bully-victims (that is, victims who also bullied others). All three categories were associated with worse mental health, school performance, and sleeping difficulties. Those who had been bullied also reported more emotional problems, while those who bullied others reported more conduct disorders [ 9 ].

As most adolescents spend a considerable amount of time at school, the school environment has been a major focus of mental health research [ 10 , 11 ]. In a recent review, Saminathen et al. [ 12 ] concluded that school is a potential protective factor against mental health problems, as it provides a socially supportive context and prepares students for higher education and employment. However, it may also be the primary setting for protracted bullying and stress [ 13 ]. Another factor associated with adolescent mental health is parental socio-economic status (SES) [ 14 ]. A systematic review indicated that lower parental SES is associated with poorer adolescent mental health [ 15 ]. However, no previous studies have examined whether SES modifies or attenuates the association between bullying and mental health. Similarly, it remains unclear whether school related factors, such as school grades and the school environment, influence the relationship between bullying and mental health. This information could help to identify those adolescents most at risk of harm from bullying.

To address these issues, we investigated the prevalence of bullying at school and mental health problems among Swedish adolescents aged 15–18 years between 2014 and 2020 using a population-based school survey. We also examined associations between bullying at school and mental health problems adjusting for relevant demographic, socioeconomic, and school-related factors. We hypothesized that: (1) bullying and adolescent mental health problems have increased over time; (2) There is an association between bullying victimization and mental health, so that mental health problems are more prevalent among those who have been victims of bullying; and (3) that school-related factors would attenuate the association between bullying and mental health.

Participants

The Stockholm school survey is completed every other year by students in lower secondary school (year 9—compulsory) and upper secondary school (year 11). The survey is mandatory for public schools, but voluntary for private schools. The purpose of the survey is to help inform decision making by local authorities that will ultimately improve students’ wellbeing. The questions relate to life circumstances, including SES, schoolwork, bullying, drug use, health, and crime. Non-completers are those who were absent from school when the survey was completed (< 5%). Response rates vary from year to year but are typically around 75%. For the current study data were available for 2014, 2018 and 2020. In 2014; 5235 boys and 5761 girls responded, in 2018; 5017 boys and 5211 girls responded, and in 2020; 5633 boys and 5865 girls responded (total n = 32,722). Data for the exposure variable, bullied at school, were missing for 4159 students, leaving 28,563 participants in the crude model. The fully adjusted model (described below) included 15,985 participants. The mean age in grade 9 was 15.3 years (SD = 0.51) and in grade 11, 17.3 years (SD = 0.61). As the data are completely anonymous, the study was exempt from ethical approval according to an earlier decision from the Ethical Review Board in Stockholm (2010-241 31-5). Details of the survey are available via a website [ 16 ], and are described in a previous paper [ 17 ].

Students completed the questionnaire during a school lesson, placed it in a sealed envelope and handed it to their teacher. Student were permitted the entire lesson (about 40 min) to complete the questionnaire and were informed that participation was voluntary (and that they were free to cancel their participation at any time without consequences). Students were also informed that the Origo Group was responsible for collection of the data on behalf of the City of Stockholm.

Study outcome

Mental health problems were assessed by using a modified version of the Psychosomatic Problem Scale [ 18 ] shown to be appropriate for children and adolescents and invariant across gender and years. The scale was later modified [ 19 ]. In the modified version, items about difficulty concentrating and feeling giddy were deleted and an item about ‘life being great to live’ was added. Seven different symptoms or problems, such as headaches, depression, feeling fear, stomach problems, difficulty sleeping, believing it’s great to live (coded negatively as seldom or rarely) and poor appetite were used. Students who responded (on a 5-point scale) that any of these problems typically occurs ‘at least once a week’ were considered as having indicators of a mental health problem. Cronbach alpha was 0.69 across the whole sample. Adding these problem areas, a total index was created from 0 to 7 mental health symptoms. Those who scored between 0 and 4 points on the total symptoms index were considered to have a low indication of mental health problems (coded as 0); those who scored between 5 and 7 symptoms were considered as likely having mental health problems (coded as 1).

Primary exposure

Experiences of bullying were measured by the following two questions: Have you felt bullied or harassed during the past school year? Have you been involved in bullying or harassing other students during this school year? Alternatives for the first question were: yes or no with several options describing how the bullying had taken place (if yes). Alternatives indicating emotional bullying were feelings of being mocked, ridiculed, socially excluded, or teased. Alternatives indicating physical bullying were being beaten, kicked, forced to do something against their will, robbed, or locked away somewhere. The response alternatives for the second question gave an estimation of how often the respondent had participated in bullying others (from once to several times a week). Combining the answers to these two questions, five different categories of bullying were identified: (1) never been bullied and never bully others; (2) victims of emotional (verbal) bullying who have never bullied others; (3) victims of physical bullying who have never bullied others; (4) victims of bullying who have also bullied others; and (5) perpetrators of bullying, but not victims. As the number of positive cases in the last three categories was low (range = 3–15 cases) bully categories 2–4 were combined into one primary exposure variable: ‘bullied at school’.

Assessment year was operationalized as the year when data was collected: 2014, 2018, and 2020. Age was operationalized as school grade 9 (15–16 years) or 11 (17–18 years). Gender was self-reported (boy or girl). The school situation To assess experiences of the school situation, students responded to 18 statements about well-being in school, participation in important school matters, perceptions of their teachers, and teaching quality. Responses were given on a four-point Likert scale ranging from ‘do not agree at all’ to ‘fully agree’. To reduce the 18-items down to their essential factors, we performed a principal axis factor analysis. Results showed that the 18 statements formed five factors which, according to the Kaiser criterion (eigen values > 1) explained 56% of the covariance in the student’s experience of the school situation. The five factors identified were: (1) Participation in school; (2) Interesting and meaningful work; (3) Feeling well at school; (4) Structured school lessons; and (5) Praise for achievements. For each factor, an index was created that was dichotomised (poor versus good circumstance) using the median-split and dummy coded with ‘good circumstance’ as reference. A description of the items included in each factor is available as Additional file 1 . Socio-economic status (SES) was assessed with three questions about the education level of the student’s mother and father (dichotomized as university degree versus not), and the amount of spending money the student typically received for entertainment each month (> SEK 1000 [approximately $120] versus less). Higher parental education and more spending money were used as reference categories. School grades in Swedish, English, and mathematics were measured separately on a 7-point scale and dichotomized as high (grades A, B, and C) versus low (grades D, E, and F). High school grades were used as the reference category.

Statistical analyses

The prevalence of mental health problems and bullying at school are presented using descriptive statistics, stratified by survey year (2014, 2018, 2020), gender, and school year (9 versus 11). As noted, we reduced the 18-item questionnaire assessing school function down to five essential factors by conducting a principal axis factor analysis (see Additional file 1 ). We then calculated the association between bullying at school (defined above) and mental health problems using multivariable logistic regression. Results are presented as odds ratios (OR) with 95% confidence intervals (Cis). To assess the contribution of SES and school-related factors to this association, three models are presented: Crude, Model 1 adjusted for demographic factors: age, gender, and assessment year; Model 2 adjusted for Model 1 plus SES (parental education and student spending money), and Model 3 adjusted for Model 2 plus school-related factors (school grades and the five factors identified in the principal factor analysis). These covariates were entered into the regression models in three blocks, where the final model represents the fully adjusted analyses. In all models, the category ‘not bullied at school’ was used as the reference. Pseudo R-square was calculated to estimate what proportion of the variance in mental health problems was explained by each model. Unlike the R-square statistic derived from linear regression, the Pseudo R-square statistic derived from logistic regression gives an indicator of the explained variance, as opposed to an exact estimate, and is considered informative in identifying the relative contribution of each model to the outcome [ 20 ]. All analyses were performed using SPSS v. 26.0.

Prevalence of bullying at school and mental health problems

Estimates of the prevalence of bullying at school and mental health problems across the 12 strata of data (3 years × 2 school grades × 2 genders) are shown in Table 1 . The prevalence of bullying at school increased minimally (< 1%) between 2014 and 2020, except among girls in grade 11 (2.5% increase). Mental health problems increased between 2014 and 2020 (range = 1.2% [boys in year 11] to 4.6% [girls in year 11]); were three to four times more prevalent among girls (range = 11.6% to 17.2%) compared to boys (range = 2.6% to 4.9%); and were more prevalent among older adolescents compared to younger adolescents (range = 1% to 3.1% higher). Pooling all data, reports of mental health problems were four times more prevalent among boys who had been victims of bullying compared to those who reported no experiences with bullying. The corresponding figure for girls was two and a half times as prevalent.

Associations between bullying at school and mental health problems

Table 2 shows the association between bullying at school and mental health problems after adjustment for relevant covariates. Demographic factors, including female gender (OR = 3.87; CI 3.48–4.29), older age (OR = 1.38, CI 1.26–1.50), and more recent assessment year (OR = 1.18, CI 1.13–1.25) were associated with higher odds of mental health problems. In Model 2, none of the included SES variables (parental education and student spending money) were associated with mental health problems. In Model 3 (fully adjusted), the following school-related factors were associated with higher odds of mental health problems: lower grades in Swedish (OR = 1.42, CI 1.22–1.67); uninteresting or meaningless schoolwork (OR = 2.44, CI 2.13–2.78); feeling unwell at school (OR = 1.64, CI 1.34–1.85); unstructured school lessons (OR = 1.31, CI = 1.16–1.47); and no praise for achievements (OR = 1.19, CI 1.06–1.34). After adjustment for all covariates, being bullied at school remained associated with higher odds of mental health problems (OR = 2.57; CI 2.24–2.96). Demographic and school-related factors explained 12% and 6% of the variance in mental health problems, respectively (Pseudo R-Square). The inclusion of socioeconomic factors did not alter the variance explained.

Our findings indicate that mental health problems increased among Swedish adolescents between 2014 and 2020, while the prevalence of bullying at school remained stable (< 1% increase), except among girls in year 11, where the prevalence increased by 2.5%. As previously reported [ 5 , 6 ], mental health problems were more common among girls and older adolescents. These findings align with previous studies showing that adolescents who are bullied at school are more likely to experience mental health problems compared to those who are not bullied [ 3 , 4 , 9 ]. This detrimental relationship was observed after adjustment for school-related factors shown to be associated with adolescent mental health [ 10 ].

A novel finding was that boys who had been bullied at school reported a four-times higher prevalence of mental health problems compared to non-bullied boys. The corresponding figure for girls was 2.5 times higher for those who were bullied compared to non-bullied girls, which could indicate that boys are more vulnerable to the deleterious effects of bullying than girls. Alternatively, it may indicate that boys are (on average) bullied more frequently or more intensely than girls, leading to worse mental health. Social support could also play a role; adolescent girls often have stronger social networks than boys and could be more inclined to voice concerns about bullying to significant others, who in turn may offer supports which are protective [ 21 ]. Related studies partly confirm this speculative explanation. An Estonian study involving 2048 children and adolescents aged 10–16 years found that, compared to girls, boys who had been bullied were more likely to report severe distress, measured by poor mental health and feelings of hopelessness [ 22 ].

Other studies suggest that heritable traits, such as the tendency to internalize problems and having low self-esteem are associated with being a bully-victim [ 23 ]. Genetics are understood to explain a large proportion of bullying-related behaviors among adolescents. A study from the Netherlands involving 8215 primary school children found that genetics explained approximately 65% of the risk of being a bully-victim [ 24 ]. This proportion was similar for boys and girls. Higher than average body mass index (BMI) is another recognized risk factor [ 25 ]. A recent Australian trial involving 13 schools and 1087 students (mean age = 13 years) targeted adolescents with high-risk personality traits (hopelessness, anxiety sensitivity, impulsivity, sensation seeking) to reduce bullying at school; both as victims and perpetrators [ 26 ]. There was no significant intervention effect for bullying victimization or perpetration in the total sample. In a secondary analysis, compared to the control schools, intervention school students showed greater reductions in victimization, suicidal ideation, and emotional symptoms. These findings potentially support targeting high-risk personality traits in bullying prevention [ 26 ].

The relative stability of bullying at school between 2014 and 2020 suggests that other factors may better explain the increase in mental health problems seen here. Many factors could be contributing to these changes, including the increasingly competitive labour market, higher demands for education, and the rapid expansion of social media [ 19 , 27 , 28 ]. A recent Swedish study involving 29,199 students aged between 11 and 16 years found that the effects of school stress on psychosomatic symptoms have become stronger over time (1993–2017) and have increased more among girls than among boys [ 10 ]. Research is needed examining possible gender differences in perceived school stress and how these differences moderate associations between bullying and mental health.

Strengths and limitations

Strengths of the current study include the large participant sample from diverse schools; public and private, theoretical and practical orientations. The survey included items measuring diverse aspects of the school environment; factors previously linked to adolescent mental health but rarely included as covariates in studies of bullying and mental health. Some limitations are also acknowledged. These data are cross-sectional which means that the direction of the associations cannot be determined. Moreover, all the variables measured were self-reported. Previous studies indicate that students tend to under-report bullying and mental health problems [ 29 ]; thus, our results may underestimate the prevalence of these behaviors.

In conclusion, consistent with our stated hypotheses, we observed an increase in self-reported mental health problems among Swedish adolescents, and a detrimental association between bullying at school and mental health problems. Although bullying at school does not appear to be the primary explanation for these changes, bullying was detrimentally associated with mental health after adjustment for relevant demographic, socio-economic, and school-related factors, confirming our third hypothesis. The finding that boys are potentially more vulnerable than girls to the deleterious effects of bullying should be replicated in future studies, and the mechanisms investigated. Future studies should examine the longitudinal association between bullying and mental health, including which factors mediate/moderate this relationship. Epigenetic studies are also required to better understand the complex interaction between environmental and biological risk factors for adolescent mental health [ 24 ].

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Acknowledgements

Authors are grateful to the Department for Social Affairs, Stockholm, for permission to use data from the Stockholm School Survey.

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HK conceived the study and analyzed the data (with input from MH). HK and MH interpreted the data and jointly wrote the manuscript. All authors read and approved the final manuscript.

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Principal factor analysis description.

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Källmén, H., Hallgren, M. Bullying at school and mental health problems among adolescents: a repeated cross-sectional study. Child Adolesc Psychiatry Ment Health 15 , 74 (2021). https://doi.org/10.1186/s13034-021-00425-y

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Qualitative Methods in School Bullying and Cyberbullying Research: An Introduction to the Special Issue

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Introduction

School bullying research has a long history, stretching all the way back to a questionnaire study undertaken in the USA in the late 1800s (Burk, 1897 ). However, systematic school bullying research began in earnest in Scandinavia in the early 1970s with the work of Heinemann ( 1972 ) and Olweus ( 1978 ). Highlighting the extent to which research on bullying has grown exponentially since then, Smith et al. ( 2021 ) found that there were only 83 articles with the term “bully” in the title or abstract published in the Web of Science database prior to 1989. The numbers of articles found in the following decades were 458 (1990–1999), 1,996 (2000–2009), and 9,333 (2010–2019). Considering cyberbullying more specifically, Smith and Berkkun ( 2017 , cited in Smith et al., 2021 ) conducted a search of Web of Science with the terms “cyber* and bully*; cyber and victim*; electronic bullying; Internet bullying; and online harassment” until the year 2015 and found that while there were no articles published prior to 2000, 538 articles were published between 2000 and 2015, with the number of articles increasing every year (p. 49).

Numerous authors have pointed out that research into school bullying and cyberbullying has predominantly been conducted using quantitative methods, with much less use of qualitative or mixed methods (Hong & Espelage, 2012 ; Hutson, 2018 ; Maran & Begotti, 2021 ; Smith et al., 2021 ). In their recent analysis of articles published between 1976 and 2019 (in WoS, with the search terms “bully*; victim*; cyberbullying; electronic bullying; internet bullying; and online harassment”), Smith et al. ( 2021 , pp. 50–51) found that of the empirical articles selected, more than three-quarters (76.3%) were based on quantitative data, 15.4% were based on a combination of quantitative and qualitative data, and less than one-tenth (8.4%) were based on qualitative data alone. What is more, they found that the proportion of articles based on qualitative or mixed methods has been decreasing over the past 15 years (Smith et al., 2021 ). While the search criteria excluded certain types of qualitative studies (e.g., those published in books, doctoral theses, and non-English languages), this nonetheless highlights the extent to which qualitative research findings risk being overlooked in the vast sea of quantitative research.

School bullying and cyberbullying are complex phenomena, and a range of methodological approaches is thus needed to understand their complexity (Pellegrini & Bartini, 2000 ; Thornberg, 2011 ). Indeed, over-relying on quantitative methods limits understanding of the contexts and experiences of bullying (Hong & Espelage, 2012 ; Patton et al., 2017 ). Qualitative methods are particularly useful for better understanding the social contexts, processes, interactions, experiences, motivations, and perspectives of those involved (Hutson, 2018 ; Patton et al., 2017 ; Thornberg, 2011 ; Torrance, 2000 ).

Smith et al. ( 2021 ) suggest that the “continued emphasis on quantitative studies may be due to increasingly sophisticated methods such as structural equation modeling … network analysis … time trend analyses … latent profile analyses … and multi-polygenic score approaches” (p. 56). However, the authors make no mention of the range or sophistication of methods used in qualitative studies. Although there are still proportionately few qualitative studies of school bullying and cyberbullying in relation to quantitative studies, and this gap appears to be increasing, qualitative studies have utilized a range of qualitative data collection methods. These methods have included but are not limited to ethnographic fieldwork and participant observations (e.g., Eriksen & Lyng, 2018 ; Gumpel et al., 2014 ; Horton, 2019 ), digital ethnography (e.g., Rachoene & Oyedemi, 2015 ; Sylwander, 2019 ), meta-ethnography (e.g., Dennehy et al., 2020 ; Moretti & Herkovits, 2021 ), focus group interviews (e.g., Odenbring, 2022 ; Oliver & Candappa, 2007 ; Ybarra et al., 2019 ), semi-structured group and individual interviews (e.g., Forsberg & Thornberg, 2016 ; Lyng, 2018 ; Mishna et al., 2005 ; Varjas et al., 2013 ), vignettes (e.g., Jennifer & Cowie, 2012 ; Khanolainen & Semenova, 2020 ; Strindberg et al., 2020 ), memory work (e.g., Johnson et al., 2014 ; Malaby, 2009 ), literature studies (e.g., Lopez-Ropero, 2012 ; Wiseman et al., 2019 ), photo elicitation (e.g., Ganbaatar et al., 2021 ; Newman et al., 2006 ; Walton & Niblett, 2013 ), photostory method (e.g., Skrzypiec et al., 2015 ), and other visual works produced by children and young people (e.g., Bosacki et al., 2006 ; Gillies-Rezo & Bosacki, 2003 ).

This body of research has also included a variety of qualitative data analysis methods, such as grounded theory (e.g., Allen, 2015 ; Bjereld, 2018 ; Thornberg, 2018 ), thematic analysis (e.g., Cunningham et al., 2016 ; Forsberg & Horton, 2022 ), content analysis (e.g., Temko, 2019 ; Wiseman & Jones, 2018 ), conversation analysis (e.g., Evaldsson & Svahn, 2012 ; Tholander, 2019 ), narrative analysis (e.g., Haines-Saah et al., 2018 ), interpretative phenomenological analysis (e.g., Hutchinson, 2012 ; Tholander et al., 2020 ), various forms of discourse analysis (e.g., Ellwood & Davies, 2010 ; Hepburn, 1997 ; Ringrose & Renold, 2010 ), including discursive psychological analysis (e.g., Clarke et al., 2004 ), and critical discourse analysis (e.g., Barrett & Bound, 2015 ; Bethune & Gonick, 2017 ; Horton, 2021 ), as well as theoretically informed analyses from an array of research traditions (e.g., Davies, 2011 ; Jacobson, 2010 ; Søndergaard, 2012 ; Walton, 2005 ).

In light of the growing volume and variety of qualitative studies during the past two decades, we invited researchers to discuss and explore methodological issues related to their qualitative school bullying and cyberbullying research. The articles included in this special issue of the International Journal of Bullying Prevention discuss different qualitative methods, reflect on strengths and limitations — possibilities and challenges, and suggest implications for future qualitative and mixed-methods research.

Included Articles

Qualitative studies — focusing on social, relational, contextual, processual, structural, and/or societal factors and mechanisms — have formed the basis for several contributions during the last two decades that have sought to expand approaches to understanding and theorizing the causes of cyber/bullying. Some have also argued the need for expanding the commonly used definition of bullying, based on Olweus ( 1993 ) (e.g., Allen, 2015 ; Ellwood & Davies, 2010 Goldsmid & Howie, 2014 ; Ringrose & Rawlings,  2015 ; Søndergaard, 2012 ; Walton, 2011 ). In the first article of the special issue, Using qualitative methods to measure and understand key features of adolescent bullying: A call to action , Natalie Spadafora, Anthony Volk, and Andrew Dane instead discuss the usefulness of qualitative methods for improving measures and bettering our understanding of three specific key definitional features of bullying. Focusing on the definition put forward by Volk et al. ( 2014 ), they discuss the definitional features of power imbalance , goal directedness (replacing “intent to harm” in order not to assume conscious awareness, and to include a wide spectrum of goals that are intentionally and strategically pursued by bullies), and harmful impact (replacing “negative actions” in order to focus on the consequences for the victim, as well as circumventing difficult issues related to “repetition” in the traditional definition).

Acknowledging that these three features are challenging to capture using quantitative methods, Spadafora, Volk, and Dane point to existing qualitative studies that shed light on the features of power imbalance, goal directedness and harmful impact in bullying interactions — and put forward suggestions for future qualitative studies. More specifically, the authors argue that qualitative methods, such as focus groups, can be used to investigate the complexity of power relations at not only individual, but also social levels. They also highlight how qualitative methods, such as diaries and autoethnography, may help researchers gain a better understanding of the motives behind bullying behavior; from the perspectives of those engaging in it. Finally, the authors demonstrate how qualitative methods, such as ethnographic fieldwork and semi-structured interviews, can provide important insights into the harmful impact of bullying and how, for example, perceived harmfulness may be connected to perceived intention.

In the second article, Understanding bullying and cyberbullying through an ecological systems framework: The value of qualitative interviewing in a mixed methods approach , Faye Mishna, Arija Birze, and Andrea Greenblatt discuss the ways in which utilizing qualitative interviewing in mixed method approaches can facilitate greater understanding of bullying and cyberbullying. Based on a longitudinal and multi-perspective mixed methods study of cyberbullying, the authors demonstrate not only how qualitative interviewing can augment quantitative findings by examining process, context and meaning for those involved, but also how qualitative interviewing can lead to new insights and new areas of research. They also show how qualitative interviewing can help to capture nuances and complexity by allowing young people to express their perspectives and elaborate on their answers to questions. In line with this, the authors also raise the importance of qualitative interviewing for providing young people with space for self-reflection and learning.

In the third article, Q methodology as an innovative addition to bullying researchers’ methodological repertoire , Adrian Lundberg and Lisa Hellström focus on Q methodology as an inherently mixed methods approach, producing quantitative data from subjective viewpoints, and thus supplementing more mainstream quantitative and qualitative approaches. The authors outline and exemplify Q methodology as a research technique, focusing on the central feature of Q sorting. The authors further discuss the contribution of Q methodology to bullying research, highlighting the potential of Q methodology to address challenges related to gaining the perspectives of hard-to-reach populations who may either be unwilling or unable to share their personal experiences of bullying. As the authors point out, the use of card sorting activities allows participants to put forward their subjective perspectives, in less-intrusive settings for data collection and without disclosing their own personal experiences. The authors also illustrate how the flexibility of Q sorting can facilitate the participation of participants with limited verbal literacy and/or cognitive function through the use of images, objects or symbols. In the final part of the paper, Lundberg and Hellström discuss implications for practice and suggest future directions for using Q methodology in bullying and cyberbullying research, particularly with hard-to-reach populations.

In the fourth article, The importance of being attentive to social processes in school bullying research: Adopting a constructivist grounded theory approach , Camilla Forsberg discusses the use of constructivist grounded theory (CGT) in her research, focusing on social structures, norms, and processes. Forsberg first outlines CGT as a theory-methods package that is well suited to meet the call for more qualitative research on participants’ experiences and the social processes involved in school bullying. Forsberg emphasizes three key focal aspects of CGT, namely focus on participants’ main concerns; focus on meaning, actions, and processes; and focus on symbolic interactionism. She then provides examples and reflections from her own ethnographic and interview-based research, from different stages of the research process. In the last part of the article, Forsberg argues that prioritizing the perspectives of participants is an ethical stance, but one which comes with a number of ethical challenges, and points to ways in which CGT is helpful in dealing with these challenges.

In the fifth article, A qualitative meta-study of youth voice and co-participatory research practices: Informing cyber/bullying research methodologies , Deborah Green, Carmel Taddeo, Deborah Price, Foteini Pasenidou, and Barbara Spears discuss how qualitative meta-studies can be used to inform research methodologies for studying school bullying and cyberbullying. Drawing on the findings of five previous qualitative studies, and with a transdisciplinary and transformative approach, the authors illustrate and exemplify how previous qualitative research can be analyzed to gain a better understanding of the studies’ collective strengths and thus consider the findings and methods beyond the original settings where the research was conducted. In doing so, the authors highlight the progression of youth voice and co-participatory research practices, the centrality of children and young people to the research process and the enabling effect of technology — and discuss challenges related to ethical issues, resource and time demands, the role of gatekeepers, and common limitations of qualitative studies on youth voice and co-participatory research practices.

Taken together, the five articles illustrate the diversity of qualitative methods used to study school bullying and cyberbullying and highlight the need for further qualitative research. We hope that readers will find the collection of articles engaging and that the special issue not only gives impetus to increased qualitative focus on the complex phenomena of school bullying and cyberbullying but also to further discussions on both methodological and analytical approaches.

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Acknowledgements

We would like to thank the authors for sharing their work; Angela Mazzone, James O’Higgins Norman, and Sameer Hinduja for their editorial assistance; and Dorte Marie Søndergaard on the editorial board for suggesting a special issue on qualitative research in the journal.

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Horton, P., Lyng, S.T. Qualitative Methods in School Bullying and Cyberbullying Research: An Introduction to the Special Issue. Int Journal of Bullying Prevention 4 , 175–179 (2022). https://doi.org/10.1007/s42380-022-00139-5

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Continuing Education Activity

Bullying is a serious and widespread global problem with detrimental consequences for the physical and mental well-being of children. It is a repeated and deliberate pattern of aggressive or hurtful behavior targeting individuals perceived as less powerful. Bullying manifests in various forms, such as physical, verbal, social/relational, and cyberbullying, each with unique characteristics. Vulnerable youth at greater risk of being bullied are individuals who are perceived as "different,"  including those belonging to racial and ethnic minorities, immigrants, refugees, individuals with notable physical features or disabilities, and younger and defenseless children.

Healthcare professionals are uniquely positioned to identify and prevent bullying and intervene to mitigate its mental and physical health consequences. This activity reviews issues of particular importance to clinicians. It gives them practical tips to increase their awareness of bullying, enabling early recognition and effective management of this complex issue. Bullying is a problem that affects both the victims and the perpetrators, and this course equips learners with the knowledge and skills to positively impact the lives of the youth it affects.

Objectives:

• Identify signs and symptoms of bullying behavior, recognizing overt and subtle indications of victimization.
• Differentiate between various forms of bullying, including physical, verbal, social, and cyberbullying, to tailor appropriate intervention strategies.
• Assess the underlying causes of bullying behavior, including social and psychological factors, to develop prevention and intervention strategies.
• Collaborate with interprofessional team members to select appropriate therapeutic interventions and resources for victims and perpetrators of bullying.

Introduction

Bullying is a significant and pervasive yet preventable public health problem with detrimental consequences for children's physical and mental well-being. Bullying is a repeated and deliberate pattern of aggressive or hurtful behavior targeting individuals perceived as less powerful. [1] The CDC's formal and somewhat unwieldy definition is "any unwanted aggressive behavior by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated."[CDC. Fast Facts: Preventing Bullying ] In Australia, the National Center Against Bullying defines bullying as an "ongoing and deliberate misuse of power in relationships through repeated verbal, physical or social behavior that intends to cause physical, social, or psychological harm." This activity focuses on children and youth younger than 18 and does not address adult or workplace bullying. 

Historically, bullying has been seen as a "rite of passage" in childhood, and even today, there often is a tacit acceptance of bullying behavior. Many healthcare professionals struggle to accept bullying as a public health issue. An increased awareness of the long-term consequences on physical and mental health necessitates a shift in these attitudes.[Campbell, Kristin. Bullying and Victimization . AAP] Populations at greater risk are those perceived as "different," including racial, religious, and ethnic minorities, immigrants, refugees, individuals with notable physical features or disabilities, and younger or more vulnerable children. Bullying episodes are usually unprovoked and deliberate, and bullies often seek visibility and prestige through their actions.

Healthcare professionals play a vital role in preventing and identifying bullying and assisting with mitigating its mental and physical health consequences. This overview provides clinicians with the knowledge and tools to increase their awareness of bullying, enabling early recognition and effective intervention. Bullying is a problem that affects victims, perpetrators, and bystanders, and this overview equips clinicians with the skills to improve the lives of affected youth.

Bullying can happen anywhere, although it is most common in and around schools. Bullying usually occurs in relatively unstructured situations and minimally supervised areas such as playgrounds, cafeterias, hallways, bus stops, and buses. Bullying manifests in various forms, such as physical, verbal, social/relational, and cyberbullying, each having unique characteristics. Verbal bullying, including name-calling and taunting, is the most frequent.

Cyberbullying has received much attention in the past few years, as children and teens now have easy access to digital devices and social media sites. Cyberbullying manifests as text messages, social media posts, emails, online forums, and other platforms, and the risk increases considerably with the duration of a child's online activity. The term was first coined in the 1990s but has only become a significant concern in the 21st century as rates have risen, especially during the COVID-19 pandemic when electronic media use soared during lockdowns. Name-calling occurs most frequently, but 15% of youth bullied online describe being scared. Teens also report receiving unsolicited and explicit images meant to intimidate them.[Vogels, Emily. Teens and Cyberbullying 2022 ]

Artificial intelligence (AI) has complicated this issue. The Wall Street Journal wrote about a group of high school boys who used an online tool powered by AI to create nude photographs of female classmates, which they spread electronically. Although this might have been an isolated event, these fake nude likenesses will persist in cyberspace indefinitely and are likely to cause irreparable adverse effects.[WSJ. Nov 4-5, 2023, p1] Despite these growing concerns, only 11% of teens talk with their parents or caregivers about their cyberbullying experiences.[Security.org. Cyberbullying ] Identifying this form of bullying is challenging because the episodes may be less repetitive than typical verbal or physical bullying. [2]  In many instances, perpetrators remain anonymous, allowing them to engage in behavior they might not display face-to-face with their victims. Because online content is easily preserved and disseminated, cyberbullying results in ongoing suffering, especially when hurtful messages "go viral." Cyberbullying differs from traditional bullying as it does not rely on physical proximity or a specific location and can occur at any time of day or night. Traditional bullying at school usually does not extend to the home setting, but victims of cyberbullying may feel they cannot escape since their electronic devices are turned on 24/7. Like traditional bullying, cyberbullying can cause profound adverse psychological effects.

Relational or social bullying occurs when the aggressor manipulates social relationships to harm or control the victim. Unlike physical and verbal bullying, which involve direct acts of aggression, relational bullying is more subtle. The aggressors often rely on tactics such as spreading rumors, excluding victims from social groups, and manipulating social dynamics to damage reputations or relationships. In social bullying, the bully aims to isolate, hurt, or control the victim emotionally, which can result in psychological and emotional sequelae. Social bullying is no longer restricted to the schoolyard but frequently takes the form of cyberbullying.

Clinicians play a crucial role in identifying bullying and treating the children it impacts. They screen patients for risk factors, educate families about coping skills, and advocate in their communities and local schools. School anti-bullying measures can help prevent bullying and empower youth to intervene when they are bystanders. This overview describes how clinicians can address bullying in an outpatient setting to improve child well-being and reduce its physical, psychological, social, and educational harms.

What creates a bully? Bullying results from a complex combination of individual, social, and environmental factors, and many youths who engage in it have specific backgrounds and qualities. Likewise, victims often share similar traits. 

Exposure to adverse childhood events increases the likelihood of becoming a bully. Associated characteristics include aggression, frustration, lack of empathy, poor impulse control, a tendency to blame others for their problems, an inability to accept responsibility for one's actions, a desire for power, the perception that others are hostile, and having friends who are bullies. Bullies have also been noted to exhibit more antisocial behaviors and use more marijuana and alcohol than their peers. [3]  Bullies do not always need to be physically stronger than their victims. The perceived power imbalance is derived from many factors, including popularity, socioeconomic status, peer group, and cognitive ability. Bullies frequently use their behavior to gain social status within their peer group. [4]  Some perpetrators may not consciously consider themselves bullies, especially those previously victimized. 

Bullying affects all socioeconomic groups, and lower socioeconomic status (SES) has been associated with higher rates of victimization. Still, higher SES does not necessarily prevent an individual from being targeted. [5] [6]  Children from dysfunctional families or those exposed to violence at home are more vulnerable. However, protective factors include being connected with a supportive family or caring adult, strong peer relationships, and having close friends. [7] [Bass, P and Scholar, S. How to Identify and Treat Bullying . Contemporary PEDS Journal] Empowering children with skills to cope with their feelings has been shown to shield them somewhat from bullying's negative effects. [8]  

Children perceived as "different" from their peers are more likely to experience bullying. [9]  This includes youth from racial and ethnic minorities, who may also be disproportionately impacted by other factors associated with bullying, such as adverse community and school environments. A strong ethnic identity and positive cultural and family values, however, may protect these children from the hurtful effects of bullying. [10]  Likewise, youth from religious minorities or immigrant and refugee groups are targeted more often than their peers. Other examples include children with noticeable physical features, such as birthmarks, tall or short stature, disabilities, and chronic medical conditions, including severe acne, seizures, neurofibromatosis, autism spectrum disorder, attention deficit disorder (ADHD), and obesity. [11]  Teens with obesity are twice as likely to be bullied as their normal-weight peers. [12]  Children who are socially isolated, unpopular, lacking in interpersonal skills, or those with few friends are vulnerable as well. 

Bullying frequently serves to enforce perceived social norms within adolescent peer groups, such as heterosexual relationships and traditional gender roles. Students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ)  often find themselves the targets of bias-based bullying, with a reported incidence nearly twice that of other students. They experience higher rates of verbal bullying, physical bullying, and cyberbullying, leading to injuries, emotional distress, and even suicide.[Earnshaw et al. LBGTQ Bullying . AAP] 

Some individuals who engage in bullying behavior may have experienced bullying or victimization themselves. These "bully victims" are at even higher risk of psychosomatic and behavioral problems than their uninvolved peers and report increased rates of suicidal ideation and attempts.[Flannery et al. Bullying and School Violence. Pediatrics Clinics of North America ] 

Epidemiology

According to the National Center for Educational Statistics' School Crime Supplement (2019), 22% of students aged 12 to 18 report being bullied at school. Teachers and academic administrators consider it a frequent disciplinary problem, with 14% saying they deal with it daily or at least weekly. The types of bullying reported include being the subject of rumors (15%), verbal taunting (14%), exclusion from activities (6%), being pushed, shoved, tripped, or spit on (5%), physical threats (4%), and coercion for students to do things they did not want to or the destruction of their possessions. (2%)

The CDC (Preventing Bullying, 2023) reports that about 20% of US high school students report being bullied at school, with 17% overall and as many as 30% of girls reporting cyberbullying. Half say that cyberbullying is a "major problem."[Vogels, Emily.  Teens and Cyberbullying 2022 ]

About 40% of children report witnessing bullying at their school. [13]  This is a global issue, with cited rates internationally ranging from 5% to 45%. [14]  Most studies report a greater prevalence among boys than girls, especially among middle school children. For boys, physical and verbal bullying is typical, but girls experience more verbal and social bullying. [15]  Traditional bullying peaks around age 12 and then gradually declines. Recent research suggests that social and cyberbullying continue to increase during adolescence. [15] [16]  Racial, religious, and ethnic minority youth are disproportionately influenced by bullying, and Black teens experience bullying more than other groups. [17] [18]  They are twice as likely as Hispanic or White teens to report they feel their race made them a target of cyberbullying.[Vogels, Emily.  Teens and Cyberbullying 2022 ]

Approximately 40% of high school students who identify as lesbian, gay, bisexual, or unsure of their sexual identity report being bullied, while 22% of bisexual high school students report being targeted. LGBTQ students are bullied twice as often as their heterosexual and cisgender peers and are less likely to report it. [19] [20]

History and Physical

Bullying may be the chief complaint for an appointment in a clinical setting. However, many children do not disclose they are targets of bullying, and clinicians should be suspicious when the review of systems is positive for somatic complaints and nonspecific symptoms or warning signs appear in the social history. Bullied children can present with insomnia, nightmares, bedwetting, appetite changes, headaches, and stomachaches. When asked, they may endorse mood swings, feelings of helplessness, poor self-esteem, or suicidal thoughts. Children who are bullied may exhibit psychosomatic symptoms or have previously been diagnosed with anxiety or depression. [21] [22]  Social history clues include school absenteeism, declining grades, loss of friends, and lost or damaged belongings such as school books and clothing. 

Recognizing at-risk children early may avert long-term consequences. Identifying risk factors can help prevent bullying, and early detection is the first step in intervention. Clinicians who screen for bullying can support affected families and direct them to appropriate resources. They can utilize validated screening tools such as the HEADDS (Home, Education/employment, Activities, Drugs, Sexuality, Suicide/depression) assessment [23]  or the Bright Futures questionnaires from the American Academy of Pediatrics.[Hagen et al. Bright Futures. AAP] The Bullying, Cyberbullying, and Social Media Use Pediatric Checklist is available online from the Massachusetts Aggression Reduction Center (www.MARCcenter.org) and is free for clinicians. Identifying victims can be tricky since many children do not readily disclose their involvement in bullying. Clinicians should, therefore, foster an inclusive and affirming healthcare environment where youth feel safe discussing their identities and experiences. [24]  This is especially important for LGBTQ patients who may not view their homes or schools as supportive.

About 70% of victims do not want to admit it to an adult, and indirect questioning during the medical history-taking may yield additional information. Inquiring about how school is going or if kids have friends to sit with at lunch may provide insight into how bullying might be a problem. [25]

Physical examination is usually unremarkable, but weight gain or loss alerts clinicians to possible appetite issues, and unexplained bruises or cuts may indicate physical altercations or self-inflicted injuries, necessitating further evaluation. 

Primary care clinicians are often asked to evaluate children for learning or behavior problems, including possible ADHD. An example is a teen boy who previously was a strong student, active in sports, and a musician in the school band who presents with declining grades. The teacher questions attention issues since he no longer completes his homework and says he "forgets to do it."  Further questioning reveals that a classmate has been confronting him daily after school, grabbing his backpack and dumping its contents. Therefore, he leaves his bag in his locker to avoid these unpleasant encounters and no longer finishes or turns in his assignments. He will not require an educational or psychiatric evaluation for ADHD once the clinician identifies that bullying is the underlying cause of his declining grades. 

Another example is a teen immigrant girl with weight loss whose mother is concerned she does not like American school lunches. However, a thorough history and physical examination reveal she has been feeling isolated, and she reports that kids tease her incessantly about her lack of English language skills. No one will sit with her at lunchtime, so she avoids the cafeteria. She admits to mood swings, and the physical examination is notable for self-inflicted cutting scars on her forearms. The clinician must elicit further information to determine if she is at risk of suicidal ideation or behavior before developing a management plan and arranging follow-up.

Bullying belongs to the spectrum of recurrent traumatic experiences of childhood, with similar physiologic, psychologic, social, and cognitive outcomes as child maltreatment or family violence.[Campbell, Kristin.  Bullying and Victimization . AAP] According to the American Academy of Pediatrics (AAP), trauma-informed care is medical care that recognizes the results of traumatic stress on children and their families. Clinicians are often the first professionals who interact with those affected by trauma and have the opportunity and obligation to respond sensitively. They can ensure a patient's safety and confidentiality, use respectful language, and support autonomy. [26]  A trauma-informed physical examination serves to establish trust and reduce feelings of vulnerability or potential triggers of prior traumatic events. [27] [28]  In the case of the teen with cutting scars, this may be the first occasion anyone has seen her skin lesions that are usually covered by her clothing. Performing the examination calmly and privately will foster confidence and encourage the girl to relate further relevant details about her unfortunate experiences.

When bullying is suspected or confirmed, the clinician should first speak with the child directly and privately to assess the severity of the problem. Because this may be the first time sharing such sensitive information, the clinician should create a safe space for the child to feel comfortable, using open-ended questions, active listening, and empathy, and ensuring confidentiality unless a situation mandates reporting to authorities. 

A simple approach is to ask these three questions:

• Are you being bullied?
• How often does this happen?
• How long has this been going on? [29]

Understanding the nature and extent of the episodes is essential for effective intervention. The clinician must differentiate between physical, verbal, social, and cyberbullying, as each requires a unique approach. Assessing the severity of the incidents helps prioritize support and resources and determine if a child's welfare is threatened and if reporting to child protective services is mandated. Clinicians should also inquire about other forms of victimization, such as child maltreatment and domestic violence, during the confidential interview. 

Further evaluation usually co-occurs with treatment and management, as presented in the next section. 

Treatment / Management

How can clinicians manage bullying? When bullying is suspected or confirmed, they should gather additional information about the circumstances and context from the patient, caregivers, and teachers if indicated. Next, they must decide whether to provide anticipatory guidance, direct families to helpful resources, refer them to a mental health specialist, or contact the school or appropriate law enforcement authorities. [8]  In all cases, clinicians should first ensure the child's safety. Most cases of bullying are not emergencies, but at times, a child is in imminent danger, has been the victim of physical or sexual abuse, or has expressed thoughts of suicidal ideation. Clinicians must know when to elevate the level of care and facilitate transporting such children to the nearest emergency facility for evaluation. [8]

When clinicians treat victims of bullying in an outpatient setting, they must first ensure that children feel safe and realize that they are not at fault. Clinicians can teach them skills to use when confronted by bullies. Children should tell the bully to stop, then walk away and notify a trusted adult. They must inform another adult if they have already reported the circumstances and nothing was done. Clinicians can participate in brief role-playing activities with their patients and encourage parents and caregivers to rehearse successful, assertive behaviors at home with their children. Many parents do not know where to start when their child is a target of bullying and appreciate information from trusted clinicians about the signs and effects of bullying and how to convey their concerns to teachers and counselors. Caregivers can be directed to valuable resources such as stopbullying.org  and marccenter.org  and encouraged to promote youth activities that build self-esteem, such as sports and hobbies. Clinicians can advise parents and caregivers not to call the bully's parents or try to retaliate but allow the school to investigate. Parents may also benefit from training to discuss bullying and other issues with their children. [25] They must monitor children's online activity, discuss the possible consequences of their media use, and ask if they have experienced any problems online. Clinicians can recommend never forwarding or responding to hurtful messages and advise keeping evidence of inappropriate digital media, blocking cyberbullies, and always informing a trusted adult about inappropriate content. Clinicians can arrange counseling and mental health services when indicated and work with schools and other agencies as applicable to protect victims from further harm. 

Most structured bullying interventions occur in academic settings, and clinicians should know about local programs when caregivers and schools seek their expertise in addressing bullying. All states in the US require schools to develop anti-bullying policies and procedures, and similar initiatives exist in many other countries. [14]  Clinicians should understand their community's statutes and develop step-by-step strategies to investigate reports when necessary. [30]  School-based initiatives vary, but successful programs promote empathy for victims, strengthen coping and socialization skills, educate staff and families, and foster a schoolwide anti-bullying culture. [31]  Schools can empower bystanders to intervene when they witness bullying. In one study, 57% of episodes ceased within ten seconds when an onlooker spoke up, but they only did so 15-20% of the time. [32] .[Salmivalli, C. Bullying and the Peer Group . Aggression and Violent Behavior.] On the other hand, bystanders who actively support or encourage bullies can empower them to continue their aggressive behavior. Multidisciplinary interventions targeting peer groups rather than individuals involving families, schools, and communities may have the most impact. [33] [34]  Unfortunately, such multifaceted programs are costly, and the effects are difficult to measure. [35]  A meta-analysis of such school initiatives reported a mean decrease of approximately 20% in bullying rates, demonstrating room for improvement. [36]  

Outside their practices, clinicians can advocate locally, in their states, and nationally to support anti-bullying initiatives. They can work to improve community education and services and lobby to strengthen anti-bullying laws and evidence-based policies that prohibit bullying based on racial, ethnic, or sexual stereotypes.

Clinicians are also likely to care for the perpetrators of bullying. It is essential to denounce the behavior but not the child. Bullies themselves may well have been victims and need to tell their stories. Clinicians should listen without interrupting, remain nonconfrontational, and express concern for the victim. They can set boundaries for acceptable behavior, ask the patient to describe their actions, and suggest ways to improve. Effective clinicians communicate that bullying is always inappropriate and will not be tolerated, but also seek to appreciate the underlying causes or circumstances. They can recommend consistent disciplinary consequences, such as removing privileges or making reparations. They can connect with the child's school and advocate for penalties such as mandated community service rather than suspension or expulsion, which should be reserved for youth exhibiting severely disruptive or aggressive behavior. Overly harsh policies often ignore the underlying social and behavioral issues contributing to bullying and may lead students to abandon formal education early. Bullies should be assessed for psychosocial problems and offered mental health counseling if indicated. Some children may even cease bullying when they become aware of the hurt they have caused others and learn alternative coping methods for their feelings. 

Differential Diagnosis

Clinicians can usually elicit a history of bullying if they take the time to ask relevant questions and listen carefully to the patient's responses. However, symptoms frequently associated with bullying may be nonspecific and result from other concerning circumstances, such as peer conflict, dating violence, family dysfunction, harassment, or hazing. [37]  These issues must be addressed and treated accordingly. When bullying is identified as the problem, clinicians should evaluate victims for mental health consequences, including posttraumatic stress disorder, anxiety, depression, and suicidal ideation, understanding that the presence of multiple coexisting issues may worsen the patient's physical and emotional health.  

In the medical model, prognosis predicts disease outcomes, such as recovery, recurrence, and death. Bullying, however, is not a disease, and the focus centers on consequences and complications rather than prognosis. In general use, however, the word prognosis forecasts a likely outcome. The medical and educational literature indicates that unless effective prevention and intervention measures are adopted, the prognosis for bullying is grim, and it will continue to take its toll on children and youth around the globe. 

Complications

Bullying is associated with short and long-term adverse physical and mental health outcomes. [38] [39]  Even when adequately treated, some physical injuries may cause lingering disabilities. Victims often experience academic difficulties, such as worsening grades, absenteeism, and concentration problems. In recent years, unfavorable consequences have been increasingly recognized for both victims and bullies, including social isolation, anxiety, depression, suicidality, and illicit substance use. [40] [41]  These sequelae often continue into adulthood. Stigma-based bullying has been even more strongly associated with health problems than bullying in general. [24]

Victims of severe bullying may feel threatened and depressed and are at risk of developing post-traumatic stress disorder. As adults, they are more likely to carry weapons and have higher rates of suicide attempts and poor psychosocial adjustment. [42] [43]  In one study, victims of bullying in grade 5 used more tobacco, marijuana, and alcohol in grade 10. [44] The self-medication hypothesis suggests these substances are consumed to cope with painful emotions related to psychological trauma. [44]  Depression, anxiety, relationship problems, poor health, failing academic performance, suicidal ideation and attempts, and sleep problems have all been associated with being bullied. [45] [46]  Another study demonstrated homophobic name-calling by nonfriends was linked with increased psychological distress among LGBTQ students, and LGBTQ youth who commit suicide are nearly five times as likely to have been bullied compared with their non-LGBTQ peers who take their own lives. [47] [May 26, 2020. 10.1001/jamapediatrics.2020.0940]   LGBTQ bullying is also associated with increased rates of adolescent substance use, including tobacco, alcohol, marijuana, and illicit drugs [48]  

Teens who have been physically threatened or in a fight are more likely to bring a weapon to school than other bullying victims or nonvictims. They are also more inclined to display violent behaviors at school, contributing to an unsafe academic environment.[Pham et al. Weapon Carrying Among Victims of Bullying . AAP]

Youth who bully often exhibit a negative attitude towards school and may leave before graduating, especially if they are punished by expulsion. Long-term associated consequences include criminal activities and arrests, intimate partner violence, delinquency, and antisocial behavior. [49] ]

Youth who are "bully victims" may experience even worse outcomes than their peers. They have been reported to have higher rates of child mental health issues, more thoughts of self-harm and suicidality, and increased substance use. [50] [51] [52]  Supportive adults at home and school may serve to buffer youth from the effects of bullying on future substance use. Still, controlled studies are lacking because it is difficult to separate bullying from other issues contributing to substance use, such as anxiety or other significant traumatic childhood events. 

Consultations

Several school and community bullying prevention centers provide resources and specialized support to counter bullying. In addition, helplines for bullying and cyberbullying are available in many countries.

The following resources are confidential, free, and available 24/7:

Stop Bullying Now Hotline

• 1-800-273-8255 or www.stopbullying.gov 
• Established by the US Department of Health and Human Services
• Available to adults and children

The Massachusetts Aggression Reduction Center 

www.MARCcenter.org Bullying And Cyberbullying Prevention and Advocacy Collaborative (BACPAC) at Children's Hospital Boston: www.childrenshospital.org/BACPAC

Childline 

• 0800 1111 (United Kingdom)
• Available to children under 18 years
• Offers advice and counseling to young people in distress or abusive situations

Kids Helpline

• 1-800-55-1800 (Australia)
• Provides advice to children, parents, and schools

Deterrence and Patient Education

Bullying prevention programs, usually found in school systems, may deter bullying and its effects. Few randomized controlled trials evaluate their efficacy, and it is unlikely that one approach will work in every school or community.[Flnnery et al. Bullying and School Violence.  Pediatrics Clinics of North America ] Successful strategies include an academic culture that does not tolerate bullying, involves bystanders, encourages classroom discussions with role-playing, improves supervision in less-structured areas like playgrounds, and offers educational programs for parents and caregivers. Isolated curriculum interventions are less effective than multidisciplinary programs that allow teachers and all school ancillary staff to participate, including cafeteria workers, administrators, custodians, and bus drivers. [53]  Some schools use focus groups to guide program content and strategize to understand children's perspectives. [54]

Schools with gay-straight alliance clubs demonstrate increased well-being among LGBTQ students. An example of a statewide effort is the Massachusetts Safe Schools Program for LGBTQ Students, a joint initiative between the  Department of Elementary and Secondary Education and the Massachusetts Commission on LGBTQ Youth. It includes classroom instruction, student activities, teacher proficiency workshops, and opportunities for policy development. [24] [55]  Clinicians can recommend that communities and schools use ideas from this and similar programs as models when developing their guidelines.

Pearls and Other Issues

Bullying is not primarily a law enforcement issue, but all 50 states in the US have enacted school anti-bullying legislation or policies. Bullying may also appear in the criminal code related to other crimes, such as aggravated harassment or stalking, and may apply to juveniles, depending upon the locale. Clinicians should be informed about the laws in their communities, report incidents when legally required to do so, and continue to advocate for their young patients.

Enhancing Healthcare Team Outcomes

How can the interprofessional team come together to prevent and intervene with bullying? Pediatricians and other primary care clinicians who care for children are the team leaders for identifying and treating youth affected by bullying. They are experts in advocating for their patients and working with medical specialists, nurses, mental health professionals, teachers, school administrators, parents, and other caregivers. 

The first step is to routinely screen youth for bullying exposure and identify subtle indicators when patients do not readily disclose they are victims. The American Academy of Pediatrics recommends violence prevention counseling for school-age children and screening at well-child visits beginning at age 6. [56]  Clinicians and nurses identify and assess victims and perpetrators of bullying and counsel youth and their caregivers about practical actions. Next, clinicians decide when a referral to a mental health provider or social worker is indicated and arrange appropriate and timely follow-up after the initial consultation. [57]  

Clinicians and mental health specialists teach parents and caregivers communication skills and positive discipline strategies since it is known that children from supportive families are more resistant to bullying and less likely to become perpetrators. Family therapists work on reducing anger and improving interpersonal relationships in dysfunctional families since bullying is often only one symptom of maladjustment in the home.

Clinicians advocate for children at school and assist parents and caregivers in connecting with teachers and administrators. They advise schools on the mental and physical health consequences of bullying and serve as a resource when schools establish and promote policies and academic environments that condemn bullying. These programs teach children who are bystanders to intervene and potentially dissuade bullies, who may feel pressure to conform to the behavior of the majority. [58] [59] [57]  Schools that foster a culture of empathy and encourage students to report bullying may be more successful in reducing its prevalence and consequences. Teachers, administrators, and school nurses often are firsthand witnesses who communicate their concerns to primary care clinicians who assess children for physical and mental health sequelae. The interprofessional team supporting children's welfare includes child protection agencies and law enforcement officials. Clinicians engage with them to coordinate care when necessary to safeguard at-risk children.

In summary, identifying and addressing bullying takes an interprofessional team led by primary care clinicians, including medical, mental health, educational, law enforcement, and community specialists, who work together to achieve optimal health outcomes for youth experiencing this all-too-frequent public health problem.

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Disclosure: Muhammad Waseem declares no relevant financial relationships with ineligible companies.

Disclosure: Amanda Nickerson declares no relevant financial relationships with ineligible companies.

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Cyberbullying Among Adolescents and Children: A Comprehensive Review of the Global Situation, Risk Factors, and Preventive Measures

Chengyan zhu.

1 School of Political Science and Public Administration, Wuhan University, Wuhan, China

Shiqing Huang

2 School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Richard Evans

3 College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, United Kingdom

Associated Data

The original contributions presented in the study are included in the article/ Supplementary Material , further inquiries can be directed to the corresponding author/s.

Background: Cyberbullying is well-recognized as a severe public health issue which affects both adolescents and children. Most extant studies have focused on national and regional effects of cyberbullying, with few examining the global perspective of cyberbullying. This systematic review comprehensively examines the global situation, risk factors, and preventive measures taken worldwide to fight cyberbullying among adolescents and children.

Methods: A systematic review of available literature was completed following PRISMA guidelines using the search themes “cyberbullying” and “adolescent or children”; the time frame was from January 1st, 2015 to December 31st, 2019. Eight academic databases pertaining to public health, and communication and psychology were consulted, namely: Web of Science, Science Direct, PubMed, Google Scholar, ProQuest, Communication & Mass Media Complete, CINAHL, and PsycArticles. Additional records identified through other sources included the references of reviews and two websites, Cyberbullying Research Center and United Nations Children's Fund. A total of 63 studies out of 2070 were included in our final review focusing on cyberbullying prevalence and risk factors.

Results: The prevalence rates of cyberbullying preparation ranged from 6.0 to 46.3%, while the rates of cyberbullying victimization ranged from 13.99 to 57.5%, based on 63 references. Verbal violence was the most common type of cyberbullying. Fourteen risk factors and three protective factors were revealed in this study. At the personal level, variables associated with cyberbullying including age, gender, online behavior, race, health condition, past experience of victimization, and impulsiveness were reviewed as risk factors. Likewise, at the situational level, parent-child relationship, interpersonal relationships, and geographical location were also reviewed in relation to cyberbullying. As for protective factors, empathy and emotional intelligence, parent-child relationship, and school climate were frequently mentioned.

Conclusion: The prevalence rate of cyberbullying has increased significantly in the observed 5-year period, and it is imperative that researchers from low and middle income countries focus sufficient attention on cyberbullying of children and adolescents. Despite a lack of scientific intervention research on cyberbullying, the review also identified several promising strategies for its prevention from the perspectives of youths, parents and schools. More research on cyberbullying is needed, especially on the issue of cross-national cyberbullying. International cooperation, multi-pronged and systematic approaches are highly encouraged to deal with cyberbullying.

Introduction

Childhood and adolescence are not only periods of growth, but also of emerging risk taking. Young people during these periods are particularly vulnerable and cannot fully understand the connection between behaviors and consequences ( 1 ). With peer pressures, the heat of passion, children and adolescents usually perform worse than adults when people are required to maintain self-discipline to achieve good results in unfamiliar situations. Impulsiveness, sensation seeking, thrill seeking, and other individual differences cause adolescents to risk rejecting standardized risk interventions ( 2 ).

About one-third of Internet users in the world are children and adolescents under the age of 18 ( 3 ). Digital technology provide a new form of interpersonal communication ( 4 ). However, surveys and news reports also show another picture in the Internet Age. The dark side of young people's internet usage is that they may bully or suffer from others' bullying in cyberspace. This behavior is also acknowledged as cyberbullying ( 5 ). Based on Olweus's definition, cyberbullying is usually regarded as bullying implemented through electronic media ( 6 , 7 ). Specifically, cyberbullying among children and adolescents can be summarized as the intentional and repeated harm from one or more peers that occurs in cyberspace caused by the use of computers, smartphones and other devices ( 4 , 8 – 12 ). In recent years, new forms of cyberbullying behaviors have emerged, such as cyberstalking and online dating abuse ( 13 – 15 ).

Although cyberbullying is still a relatively new field of research, cyberbullying among adolescents is considered to be a serious public health issue that is closely related to adolescents' behavior, mental health and development ( 16 , 17 ). The increasing rate of Internet adoption worldwide and the popularity of social media platforms among the young people have worsened this situation with most children and adolescents experiencing cyberbullying or online victimization during their lives. The confines of space and time are alleviated for bullies in virtual environments, creating new venues for cyberbullying with no geographical boundaries ( 6 ). Cyberbullying exerts negative effects on many aspects of young people's lives, including personal privacy invasion and psychological disorders. The influence of cyberbullying may be worse than traditional bullying as perpetrators can act anonymously and connect easily with children and adolescents at any time ( 18 ). In comparison with traditional victims, those bullied online show greater levels of depression, anxiety and loneliness ( 19 ). Self-esteem problems and school absenteeism have also proven to be related to cyberbullying ( 20 ).

Due to changes in use and behavioral patterns among the youth on social media, the manifestations and risk factors of cyberbullying have faced significant transformation. Further, as the boundaries of cyberbullying are not limited by geography, cyberbullying may not be a problem contained within a single country. In this sense, cyberbullying is a global problem and tackling it requires greater international collaboration. The adverse effects caused by cyberbullying, including reduced safety, lower educational attainment, poorer mental health and greater unhappiness, led UNICEF to state that “no child is absolutely safe in the digital world” ( 3 ).

Extant research has examined the prevalence and risk factors of cyberbullying to unravel the complexity of cyberbullying across different countries and their corresponding causes. However, due to variations in cyberbullying measurement and methodologies, no consistent conclusions have been drawn ( 21 ). Studies into inconsistencies in prevalence rates of cyberbullying, measured in the same country during the same time period, occur frequently. Selkie et al. systematically reviewed cyberbullying among American middle and high school students aged 10–19 years old in 2015, and revealed that the prevalence of cyberbullying victimization ranged from 3 to 72%, while perpetration ranged from 1 to 41% ( 22 ). Risk and protective factors have also been broadly studied, but confirmation is still needed of those factors which have more significant effects on cyberbullying among young people. Clarification of these issues would be useful to allow further research to recognize cyberbullying more accurately.

This review aims to extend prior contributions and provide a comprehensive review of cyberbullying of children and adolescents from a global perspective, with the focus being on prevalence, associated risk factors and protective factors across countries. It is necessary to provide a global panorama based on research syntheses to fill the gaps in knowledge on this topic.

Search Strategies

This study strictly employed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We consulted eight academic databases pertaining to public health, and communication and psychology, namely: Web of Science, Science Direct, PubMed, Google Scholar, ProQuest, Communication & Mass Media Complete, CINAHL, and PsycArticles. Additional records identified through other sources included the references of reviews and two websites, Cyberbullying Research Center and United Nations Children's Fund. With regard to the duration of our review, since most studies on cyberbullying arose around 2015 ( 9 , 21 ), this study highlights the complementary aspects of the available information about cyberbullying during the recent 5 year period from January 1st, 2015 to December 31st, 2019.

One researcher extracted keywords and two researchers proposed modifications. We used two sets of subject terms to review articles, “cyberbullying” and “child OR adolescent.” Some keywords that refer to cyberbullying behaviors and young people are also included, such as threat, harass, intimidate, abuse, insult, humiliate, condemn, isolate, embarrass, forgery, slander, flame, stalk, manhunt, as well as teen, youth, young people and student. The search formula is (cyberbullying OR cyber-bullying OR cyber-aggression OR ((cyber OR online OR electronic OR Internet) AND (bully * OR aggres * OR violence OR perpetrat * OR victim * OR threat * OR harass * OR intimidat * OR * OR insult * OR humiliate * OR condemn * OR isolate * OR embarrass * OR forgery OR slander * OR flame OR stalk * OR manhunt))) AND (adolescen * OR child OR children OR teen? OR teenager? OR youth? OR “young people” OR “elementary school student * ” OR “middle school student * ” OR “high school student * ”). The main search approach is title search. Search strategies varied according to the database consulted, and we did not limit the type of literature for inclusion. Journals, conference papers and dissertations are all available.

Specifically, the inclusion criteria for our study were as follows: (a). reported or evaluated the prevalence and possible risk factors associated with cyberbullying, (b). respondents were students under the age of 18 or in primary, junior or senior high schools, and (c). studies were written in English. Exclusion criteria were: (a). respondents came from specific groups, such as clinical samples, children with disabilities, sexual minorities, specific ethnic groups, specific faith groups or samples with cross-national background, (b). review studies, qualitative studies, conceptual studies, book reviews, news reports or abstracts of meetings, and (c). studies focused solely on preventive measures that were usually meta-analytic and qualitative in nature. Figure 1 presents the details of the employed screening process, showing that a total of 63 studies out of 2070 were included in our final review.

PRISMA flow chart diagram showing the process of study selection for inclusion in the systematic review on children and adolescents cyberbullying.

Meta-analysis was not conducted as the limited research published within the 5 years revealed little research which reported odds ratio. On the other hand, due to the inconsistency of concepts, measuring instruments and recall periods, considerable variation could be found in research quality ( 23 ). Meta-analysis is not a preferred method.

Coding Scheme

For coding, we created a comprehensive code scheme to include the characteristics. For cyberbullying, we coded five types proposed by Willard ( 24 – 26 ), which included verbal violence, group violence, visual violence, impersonating and account forgery, and other behaviors. Among them, verbal violence is considered one of the most common types of cyberbullying and refers to the behavior of offensive responses, insults, mocking, threats, slander, and harassment. Group violence is associated with preventing others from joining certain groups or isolating others, forcing others to leave the group. Visual violence relates to the release and sharing of embarrassing photos and information without the owners' consent. Impersonating and account forgery refers to identity theft, stealing passwords, violating accounts and the creation of fake accounts to fraudulently present the behavior of others. Other behaviors include disclosure of privacy, sexual harassment, and cyberstalking. To comprehensively examine cyberbullying, we coded cyberbullying behaviors from both the perspectives of cyberbullying perpetrators and victims, if mentioned in the studies.

In relation to risk factors, we drew insights from the general aggression model, which contributes to the understanding of personal and situational factors in the cyberbullying of children and adolescents. We chose the general aggression model because (a) it contains more situational factors than other models (e.g., social ecological models) - such as school climate ( 9 ), and (b) we believe that the general aggression model is more suitable for helping researchers conduct a systematic review of cyberbullying risk and protective factors. This model provides a comprehensive framework that integrates domain specific theories of aggression, and has been widely applied in cyberbullying research ( 27 ). For instance, Kowalski and colleagues proposed a cyberbullying encounter through the general aggression model to understand the formation and development process of youth cyberbullying related to both victimization and perpetration ( 9 ). Victims and perpetrators enter the cyberbullying encounter with various individual characteristics, experiences, attitudes, desires, personalities, and motives that intersect to determine the course of the interaction. Correspondingly, the antecedents pertaining to cyberbullying are divided into two broad categories, personal factors and situational factors. Personal factors refer to individual characteristics, such as gender, age, motivation, personality, psychological states, socioeconomic status and technology use, values and perceptions, and other maladaptive behaviors. Situational factors focus on the provocation/support, parental involvement, school climate, and perceived anonymity. Consequently, our coders related to risk factors consisting of personal factors and situational factors from the perspectives of both cyberbullying perpetrators and victims.

We extracted information relating to individual papers and sample characteristics, including authors, year of publication, country, article type, sampling procedures, sample characteristics, measures of cyberbullying, and prevalence and risk factors from both cyberbullying perpetration and victimization perspectives. The key words extraction and coding work were performed twice by two trained research assistants in health informatics. The consistency test results are as follows: the Kappa value with “personal factors” was 0.932, and the Kappa value with “situational factors” was 0.807. The result shows that the coding consistency was high enough and acceptable. Disagreements were resolved through discussion with other authors.

Quality Assessment of Studies

The quality assessment of the studies is based on the recommended tool for assessing risk of bias, Cochrane Collaboration. This quality assessment tool focused on seven items: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias ( 28 ). We assessed each item as “low risk,” “high risk,” and “unclear” for included studies. A study is considered of “high quality” when it meets three or more “low risk” requirements. When one or more main flaw of a study may affect the research results, the study is considered as “low quality.” When a lack of information leads to a difficult judgement, the quality is considered to be “unclear.” Please refer to Appendix 1 for more details.

This comprehensive systematic review comprised a total of 63 studies. Appendices 2 , 3 show the descriptive information of the studies included. Among them, 58 (92%) studies measured two or more cyberbullying behavior types. The sample sizes of the youths range from several hundred to tens of thousands, with one thousand to five thousand being the most common. As for study distribution, the United States of America, Spain and China were most frequently mentioned. Table 1 presents the detail.

Descriptive information of studies included (2015–2019).

Prevalence of Global Cyberbullying

Prevalence across countries.

Among the 63 studies included, 22 studies reported on cyberbullying prevalence and 20 studies reported on prevalence from victimization and perpetration perspectives, respectively. Among the 20 studies, 11 national studies indicated that the prevalence of cyberbullying victimization and cyberbullying perpetration ranged from 14.6 to 52.2% and 6.3 to 32%, respectively. These studies were conducted in the United States of America ( N = 4) ( 29 – 32 ), South Korea ( N = 3) ( 33 – 35 ), Singapore ( N = 1) ( 36 ), Malaysia ( N = 1) ( 37 ), Israel ( N = 1) ( 38 ), and Canada ( N = 1) ( 39 ). Only one of these 11 national studies is from an upper middle income country, and the rest are from highincome countries identified by the World Bank ( 40 ). By combining regional and community-level studies, the prevalence of cyberbullying victimization and cyberbullying perpetration ranged from 13.99 to 57.5% and 6.0 to 46.3%, respectively. Spain reported the highest prevalence of cyberbullying victimization (57.5%) ( 41 ), followed by Malaysia (52.2%) ( 37 ), Israel (45%) ( 42 ), and China (44.5%) ( 43 ). The lowest reported victim rates were observed in Canada (13.99%) and South Korea (14.6%) ( 34 , 39 ). The reported prevalence of cyberbullying victimization in the United States of America ranged from 15.5 to 31.4% ( 29 , 44 ), while in Israel, rates ranged from 30 to 45% ( 26 , 42 ). In China, rates ranged from 6 to 46.3% with the country showing the highest prevalence of cyberbullying perpetration (46.30%) ( 15 , 43 , 45 , 46 ). Canadian and South Korean studies reported the lowest prevalence of cyberbullying perpetration at 7.99 and 6.3%, respectively ( 34 , 39 ).

A total of 10 studies were assessed as high quality studies. Among them, six studies came from high income countries, including Canada, Germany, Italy, Portugal, and South Korea ( 13 , 34 , 39 , 46 – 48 ). Three studies were from upper middle income countries, including Malaysia and China ( 37 , 43 ) and one from a lower middle income country, Nigeria ( 49 ). Figures 2 , ​ ,3 3 describe the prevalence of cyberbullying victimization and perpetration respectively among high quality studies.

The prevalence of cyberbullying victimization of high quality studies.

The prevalence of cyberbullying perpetration of high quality studies.

Prevalence of Various Cyberbullying Behaviors

For the prevalence of cyberbullying victimization and perpetration, the data were reported in 18 and 14 studies, respectively. Figure 4 shows the distribution characteristics of the estimated value of prevalence of different cyberbullying behaviors with box plots. The longer the box, the greater the degree of variation of the numerical data and vice versa. The rate of victimization and crime of verbal violence, as well as the rate of victimization of other behaviors, such as cyberstalking and digital dating abuse, has a large degree of variation. Among the four specified types of cyberbullying behaviors, verbal violence was regarded as the most commonly reported behaviors in both perpetration and victimization rates, with a wide range of prevalence, ranging from 5 to 18%. Fewer studies reported the prevalence data for visual violence and group violence. Studies also showed that the prevalence of impersonation and account forgery were within a comparatively small scale. Specific results were as follows.

Cyberbullying prevalence across types (2015–2019).

Verbal Violence

A total of 13 studies reported verbal violence prevalence data ( 15 , 26 , 34 , 37 – 39 , 42 , 43 , 47 , 48 , 50 , 51 ). Ten studies reported the prevalence of verbal violence victimization ranging from 2.8 to 47.5%, while seven studies claimed perpetration prevalence ranging from 1.5 to 31.8%. Malaysia reported the highest prevalence of verbal violence victimization (47.5%) ( 37 ), followed by China (32%) ( 43 ). China reported that the prevalence of verbal violence victimization ranged from 5.1 to 32% ( 15 , 43 ). Israel reported that the prevalence of verbal violence victimization ranged from 3.4 to 18% ( 26 , 38 , 42 ). For perpetration rate, Malaysia reported the highest level at 31.8% ( 37 ), while a study for Spain reported the lowest, ranging from 3.2 to 6.4% ( 51 ).

Group Violence

The prevalence of group violence victimization was explored within 4 studies and ranged from 5 to 17.8% ( 26 , 34 , 42 , 43 ), while perpetration prevalence was reported in three studies, ranging from 10.1 to 19.07% ( 34 , 43 , 47 ). An Israeli study suggested that 9.8% of respondents had been excluded from the Internet, while 8.9% had been refused entry to a group or team ( 26 ). A study in South Korea argued that the perpetration prevalence of group violence was 10.1% ( 34 ), while a study in Italy reported that the rate of online group violence against others was 19.07% ( 47 ).

Visual Violence

The prevalence of visual violence victimization was explored within three studies and ranged from 2.6 to 12.1% ( 26 , 34 , 43 ), while the perpetration prevalence reported in four studies ranged from 1.7 to 6% ( 34 , 43 , 47 , 48 ). For victimization prevalence, a South Korean study found that 12.1% of respondents reported that their personal information was leaked online ( 34 ). An Israel study reported that the prevalence of outing the picture was 2.6% ( 26 ). For perpetration prevalence, a South Korean study found that 1.7% of respondents had reported that they had disclosed someone's personal information online ( 34 ). A German study reported that 6% of respondents had written a message (e.g., an email) to somebody using a fake identity ( 48 ).

Impersonating and Account Forgery

Four studies reported on the victimization prevalence of impersonating and account forgery, ranging from 1.1 to 10% ( 15 , 42 , 43 ), while five studies reported on perpetration prevalence, with the range being from 1.3 to 9.31% ( 15 , 43 , 47 , 48 , 51 ). In a Spanish study, 10% of respondents reported that their accounts had been infringed by others or that they could not access their account due to stolen passwords. In contrast, 4.5% of respondents reported that they had infringed other people's accounts or stolen passwords, with 2.5% stating that they had forged other people's accounts ( 51 ). An Israeli study reported that the prevalence of being impersonated was 7% ( 42 ), while in China, a study reported this to be 8.6% ( 43 ). Another study from China found that 1.1% of respondents had been impersonated to send dating-for-money messages ( 15 ).

Other Behaviors

The prevalence of disclosure of privacy, sexual harassment, and cyberstalking were also explored by scholars. Six studies reported the victimization prevalence of other cyberbullying behaviors ( 13 , 15 , 34 , 37 , 42 , 43 ), and four studies reported on perpetration prevalence ( 34 , 37 , 43 , 48 ). A study in China found that 1.2% of respondents reported that their privacy had been compromised without permission due to disputes ( 15 ). A study from China reported the prevalence of cyberstalking victimization was 11.9% ( 43 ), while a Portuguese study reported that this was 62% ( 13 ). In terms of perpetration prevalence, a Malaysian study reported 2.7% for sexual harassment ( 37 ).

Risk and Protective Factors of Cyberbullying

In terms of the risk factors associated with cyberbullying among children and adolescents, this comprehensive review highlighted both personal and situational factors. Personal factors referred to age, gender, online behavior, race, health conditions, past experiences of victimization, and impulsiveness, while situational factors consisted of parent-child relationship, interpersonal relationships, and geographical location. In addition, protective factors against cyberbullying included: empathy and emotional intelligence, parent-child relationship, and school climate. Table 2 shows the risk and protective factors for child and adolescent cyberbullying.

Risk and protective factors of cyberbullying among children and adolescents.

In terms of the risk factors associated with cyberbullying victimization at the personal level, many studies evidenced that females were more likely to be cyberbullied than males ( 13 , 26 , 29 , 38 , 43 , 52 , 54 , 55 , 58 ). Meanwhile, adolescents with mental health problems ( 61 ), such as depression ( 33 , 62 ), borderline personality disorder ( 63 ), eating disorders ( 41 ), sleep deprivation ( 56 ), and suicidal thoughts and suicide plans ( 64 ), were more likely to be associated with cyberbullying victimization. As for Internet usage, researchers agreed that youth victims were probably those that spent more time online than their counterparts ( 32 , 36 , 43 , 45 , 48 , 49 , 60 ). For situational risk factors, some studies have proven the relationship between cyberbullying victims and parental abuse, parental neglect, family dysfunction, inadequate monitoring, and parents' inconsistency in mediation, as well as communication issues ( 33 , 64 , 68 , 73 ). In terms of geographical location, some studies have reported that youths residing in city locations are more likely to be victims of cyberbullying than their peers from suburban areas ( 61 ).

Regarding the risk factors of cyberbullying perpetration at the personal level, it is generally believed that older teenagers, especially those aged over 15 years, are at greater risk of becoming cyberbullying perpetrators ( 55 , 67 ). When considering prior cyberbullying experiences, evidence showed that individuals who had experienced cyberbullying or face-to-face bullying tended to be aggressors in cyberbullying ( 35 , 42 , 49 , 51 , 55 ); in addition, the relationship between impulsiveness and cyberbullying perpetration was also explored by several pioneering scholars ( 55 , 72 , 80 ). The situational factors highlight the role of parents and teachers in cyberbullying experiences. For example, over-control and authoritarian parenting styles, as well as inharmonious teacher-student relationships ( 61 ) are perceived to lead to cyberbullying behaviors ( 74 , 75 ). In terms of differences in geographical locations, students residing in cities have a higher rate of online harassment than students living in more rural locations ( 49 ).

In terms of the protective factors in child and adolescent cyberbullying, scholars have focused on youths who have limited experiences of cyberbullying. At the personal level, high emotional intelligence, an ability for emotional self-control and empathy, such as cognitive empathy ability ( 44 , 55 ), were associated with lower rates of cyberbullying ( 57 ). At the situational level, a parent's role is seen as critical. For example, intimate parent-child relationships ( 46 ) and open active communication ( 19 ) were demonstrated to be related to lower experiences of cyberbullying and perpetration. Some scholars argued that parental supervision and monitoring of children's online activities can reduce their tendency to participate in some negative activities associated with cyberbullying ( 31 , 46 , 73 ). They further claimed that an authoritative parental style protects youths against cyberbullying ( 43 ). Conversely, another string of studies evidenced that parents' supervision of Internet usage was meaningless ( 45 ). In addition to conflicting roles of parental supervision, researchers have also looked into the role of schools, and posited that positive school climates contribute to less cyberbullying experiences ( 61 , 79 ).

Some risk factors may be protective factors under another condition. Some studies suggest that parental aggressive communication is related to severe cyberbullying victims, while open communication is a potential protective factor ( 19 ). Parental neglect, parental abuse, parental inconsistency in supervision of adolescents' online behavior, and family dysfunction are related to the direct or indirect harm of cyberbullying ( 33 , 68 ). Parental participation, a good parental-children relationship, communication and dialogue can enhance children's school adaptability and prevent cyberbullying behaviors ( 31 , 74 ). When parental monitoring reaches a balance between control and openness, it could become a protective factor against cyberbullying, and it could be a risk factor, if parental monitoring is too low or over-controlled ( 47 ).

Despite frequent discussion about the risk factors associated with cyberbullying among children and adolescents, some are still deemed controversial factors, such as age, race, gender, and the frequency of suffering on the internet. For cyberbullying victims, some studies claim that older teenagers are more vulnerable to cyberbullying ( 15 , 38 , 52 , 53 ), while other studies found conflicting results ( 26 , 33 ). As for student race, Alhajji et al. argued that non-white students were less likely to report cyberbullying ( 29 ), while Morin et al. observed no significant correlation between race and cyberbullying ( 52 ). For cyberbullying perpetration, Alvarez-Garcia found that gender differences may have indirect effects on cyberbullying perpetration ( 55 ), while others disagreed ( 42 , 61 , 68 – 70 ). Specifically, some studies revealed that males were more likely to become cyberbullying perpetrators ( 34 , 39 , 56 ), while Khurana et al. presented an opposite point of view, proposing that females were more likely to attack others ( 71 ). In terms of time spent on the Internet, some claimed that students who frequently surf the Internet had a higher chance of becoming perpetrators ( 49 ), while others stated that there was no clear and direct association between Internet usage and cyberbullying perpetration ( 55 ).

In addition to personal and situational factors, scholars have also explored other specific factors pertaining to cyberbullying risk and protection. For instance, mindfulness and depression were found to be significantly related to cyber perpetration ( 76 ), while eating disorder psychopathology in adolescents was associated with cyber victimization ( 41 ). For males who were familiar with their victims, such as family members, friends and acquaintances, they were more likely to be cyberstalking perpetrators than females or strangers, while pursuing desired closer relationships ( 13 ). In the school context, a lower social likability in class was identified as an indirect factor for cyberbullying ( 48 ).

This comprehensive review has established that the prevalence of global childhood and adolescent victimization from cyberbullying ranges from 13.99 to 57.5%, and that the perpetration prevalence ranges from 6.0 to 46.3%. Across the studies included in our research, verbal violence is observed as one of the most common acts of cyberbullying, including verbal offensive responses, insults, mocking, threats, slander, and harassment. The victimization prevalence of verbal violence is reported to be between 5 and 47.5%, and the perpetration prevalence is between 3.2 and 26.1%. Personal factors, such as gender, frequent use of social media platforms, depression, borderline personality disorder, eating disorders, sleep deprivation, and suicidal tendencies, were generally considered to be related to becoming a cyberbullying victim. Personal factors, such as high school students, past experiences, impulse, improperly controlled family education, poor teacher-student relationships, and the urban environment, were considered risk factors for cyberbullying perpetration. Situational factors, including parental abuse and neglect, improper monitoring, communication barriers between parents and children, as well as the urban environment, were also seen to potentially contribute to higher risks of both cyberbullying victimization and perpetration.

Increasing Prevalence of Global Cyberbullying With Changing Social Media Landscape and Measurement Alterations

This comprehensive review suggests that global cyberbullying rates, in terms of victimization and perpetration, were on the rise during the 5 year period, from 2015 to 2019. For example, in an earlier study conducted by Modecki et al. the average cyberbullying involvement rate was 15% ( 81 ). Similar observations were made by Hamm et al. who found that the median rates of youth having experienced bullying or who had bullied others online, was 23 and 15.2%, respectively ( 82 ). However, our systematic review summarized global children and adolescents cyberbullying in the last 5 years and revealed an average cyberbullying perpetration rate of 25.03%, ranging from 6.0 to 46.3%, while the average victimization was 33.08%, ranging from 13.99 to 57.5%. The underlying reason for increases may be attributed to the rapid changing landscape of social media and, in recent years, the drastic increase in Internet penetration rates. With the rise in Internet access, youths have greater opportunities to participate in online activities, provided by emerging social media platforms.

Although our review aims to provide a broader picture of cyberbullying, it is well-noted in extant research that difficulties exist in accurately estimating variations in prevalence in different countries ( 23 , 83 ). Many reasons exist to explain this. The first largely relates poor or unclear definition of the term cyberbullying; this hinders the determination of cyberbullying victimization and perpetration ( 84 ). Although traditional bullying behavior is well-defined, the definition cannot directly be applied to the virtual environment due to the complexity in changing online interactions. Without consensus on definitions, measurement and cyberbullying types may vary noticeably ( 83 , 85 ). Secondly, the estimation of prevalence of cyberbullying is heavily affected by research methods, such as recall period (lifetime, last year, last 6 months, last month, or last week etc.), demographic characteristics of the survey sample (age, gender, race, etc.), perspectives of cyberbullying experiences (victims, perpetrators, or both victim and perpetrator), and instruments (scales, study-specific questions) ( 23 , 84 , 86 ). The variety in research tools and instruments used to assess the prevalence of cyberbullying can cause confusion on this issue ( 84 ). Thirdly, variations in economic development, cultural backgrounds, human values, internet penetration rates, and frequency of using social media may lead to different conclusions across countries ( 87 ).

Acknowledging the Conflicting Role of the Identified Risk Factors With More Research Needed to Establish the Causality

Although this review has identified many personal and situational factors associated with cyberbullying, the majority of studies adopted a cross-sectional design and failed to reveal the causality ( 21 ). Nevertheless, knowledge on these correlational relationships provide valuable insights for understanding and preventing cyberbullying incidents. In terms of gender differences, females are believed to be at a higher risk of cyberbullying victimization compared to males. Two reasons may help to explain this. First, the preferred violence behaviors between two genders. females prefer indirect harassment, such as the spreading of rumors, while males tend toward direct bullying (e.g., assault) ( 29 ) and second, the cultural factors. From the traditional gender perspective, females tended to perceive a greater risk of communicating with others on the Internet, while males were more reluctant to express fear, vulnerability and insecurity when asked about their cyberbullying experiences ( 46 ). Females were more intolerant when experiencing cyberstalking and were more likely to report victimization experiences than males ( 13 ). Meanwhile, many researchers suggested that females are frequent users of emerging digital communication platforms, which increases their risk of unpleasant interpersonal contact and violence. From the perspective of cultural norms and masculinity, the reporting of cyberbullying is also widely acknowledged ( 37 ). For example, in addition, engaging in online activities is also regarded as a critical predictor for cyberbullying victimization. Enabled by the Internet, youths can easily find potential victims and start harassment at any time ( 49 ). Participating in online activities directly increases the chance of experiencing cyberbullying victimization and the possibility of becoming a victim ( 36 , 45 ). As for age, earlier involvement on social media and instant messaging tools may increase the chances of experiencing cyberbullying. For example, in Spain, these tools cannot be used without parental permission before the age of 14 ( 55 ). Besides, senior students were more likely to be more impulsive and less sympathetic. They may portray more aggressive and anti-social behaviors ( 55 , 72 ); hence senior students and students with higher impulsivity were usually more likely to become cyberbullying perpetrators.

Past experiences of victimization and family-related factors are another risk for cyberbullying crime. As for past experiences, one possible explanation is that young people who had experienced online or traditional school bullying may commit cyberbullying using e-mails, instant messages, and text messages for revenge, self-protection, or improving their social status ( 35 , 42 , 49 , 55 ). In becoming a cyberbullying perpetrator, the student may feel more powerful and superior, externalizing angry feelings and relieving the feelings of helplessness and sadness produced by past victimization experiences ( 51 ). As for family related factors, parenting styles are proven to be highly correlated to cyberbullying. In authoritative families, parents focus on rational behavioral control with clear rules and a high component of supervision and parental warmth, which have beneficial effects on children's lifestyles ( 43 ). Conversely, in indulgent families, children's behaviors are not heavily restricted and parents guide and encourage their children to adapt to society. The characteristics of this indulgent style, including parental support, positive communication, low imposition, and emotional expressiveness, possibly contribute to more parent-child trust and less misunderstanding ( 75 ). The protective role of warmth/affection and appropriate supervision, which are common features of authoritative or indulgent parenting styles, mitigate youth engagement in cyberbullying. On the contrary, authoritarian and neglectful styles, whether with excessive or insufficient control, are both proven to be risk factors for being a target of cyberbullying ( 33 , 76 ). In terms of geographical location, although several studies found that children residing in urban areas were more likely to be cyberbullying victims than those living in rural or suburban areas, we cannot draw a quick conclusion here, since whether this difference attributes to macro-level differences, such as community safety or socioeconomic status, or micro-level differences, such as teacher intervention in the classroom, courses provided, teacher-student ratio, is unclear across studies ( 61 ). An alternative explanation for this is the higher internet usage rate in urban areas ( 49 ).

Regarding health conditions, especially mental health, some scholars believe that young people with health problems are more likely to be identified as victims than people without health problems. They perceive health condition as a risk factor for cyberbullying ( 61 , 63 ). On the other hand, another group of scholars believe that cyberbullying has an important impact on the mental health of adolescents which can cause psychological distress consequences, such as post-traumatic stress mental disorder, depression, suicidal ideation, and drug abuse ( 70 , 87 ). It is highly possible that mental health could be risk factors, consequences of cyberbullying or both. Mental health cannot be used as standards, requirements, or decisive responses in cyberbullying research ( 13 ).

The Joint Effort Between Youth, Parents, Schools, and Communities to Form a Cyberbullying-Free Environment

This comprehensive review suggests that protecting children and adolescents from cyberbullying requires joint efforts between individuals, parents, schools, and communities, to form a cyberbullying-free environment. For individuals, young people are expected to improve their digital technology capabilities, especially in the use of social media platforms and instant messaging tools ( 55 ). To reduce the number of cyberbullying perpetrators, it is necessary to cultivate emotional self-regulation ability through appropriate emotional management training. Moreover, teachers, counselors, and parents are required to be armed with sufficient knowledge of emotional management and to develop emotional management capabilities and skills. In this way, they can be alert to the aggressive or angry emotions expressed by young people, and help them mediate any negative emotions ( 45 ), and avoid further anti-social behaviors ( 57 ).

For parents, styles of parenting involving a high level of parental involvement, care and support, are desirable in reducing the possibility of children's engagement in cyberbullying ( 74 , 75 ). If difficulties are encountered, open communication can contribute to enhancing the sense of security ( 73 ). In this vein, parents should be aware of the importance of caring, communicating and supervising their children, and participate actively in their children's lives ( 71 ). In order to keep a balance between control and openness ( 47 ), parents can engage in unbiased open communication with their children, and reach an agreement on the usage of computers and smart phones ( 34 , 35 , 55 ). Similarly, it is of vital importance to establish a positive communication channel with children ( 19 ).

For schools, a higher priority is needed to create a safe and positive campus environment, providing students with learning opportunities and ensuring that every student is treated equally. With a youth-friendly environment, students are able to focus more on their academic performance and develop a strong sense of belonging to the school ( 79 ). For countries recognizing collectivist cultural values, such as China and India, emphasizing peer attachment and a sense of collectivism can reduce the risk of cyberbullying perpetration and victimization ( 78 ). Besides, schools can cooperate with mental health agencies and neighboring communities to develop preventive programs, such as extracurricular activities and training ( 44 , 53 , 62 ). Specifically, school-based preventive measures against cyberbullying are expected to be sensitive to the characteristics of young people at different ages, and the intersection of race and school diversity ( 29 , 76 ). It is recommended that school policies that aim to embrace diversity and embody mutual respect among students are created ( 26 ). Considering the high prevalence of cyberbullying and a series of serious consequences, it is suggested that intervention against cyberbullying starts from an early stage, at about 10 years old ( 54 ). Schools can organize seminars to strengthen communication between teachers and students so that they can better understand the needs of students ( 61 ). In addition, schools should encourage cyberbullying victims to seek help and provide students with opportunities to report cyberbullying behaviors, such as creating online anonymous calls.

Conclusions and Limitations

The comprehensive study has reviewed related research on children and adolescents cyberbullying across different countries and regions, providing a positive understanding of the current situation of cyberbullying. The number of studies on cyberbullying has surged in the last 5 years, especially those related to risk factors and protective factors of cyberbullying. However, research on effective prevention is insufficient and evaluation of policy tools for cyberbullying intervention is a nascent research field. Our comprehensive review concludes with possible strategies for cyberbullying prevention, including personal emotion management, digital ability training, policy applicability, and interpersonal skills. We highlight the important role of parental control in cyberbullying prevention. As for the role of parental control, it depends on whether children believe their parents are capable of adequately supporting them, rather than simply interfering in their lives, restricting their online behavior, and controlling or removing their devices ( 50 ). In general, cyberbullying is on the rise, with the effectiveness of interventions to meet this problem still requiring further development and exploration ( 83 ).

Considering the overlaps between cyberbullying and traditional offline bullying, future research can explore the unique risk and protective factors that are distinguishable from traditional bullying ( 86 ). To further reveal the variations, researchers can compare the outcomes of interventions conducted in cyberbullying and traditional bullying preventions simultaneously, and the same interventions only targeting cyberbullying ( 88 ). In addition, cyberbullying also reflects a series of other social issues, such as personal privacy and security, public opinion monitoring, multinational perpetration and group crimes. To address this problem, efforts from multiple disciplines and novel analytical methods in the digital era are required. As the Internet provides enormous opportunities to connect young people from all over the world, cyberbullying perpetrators may come from transnational networks. Hence, cyberbullying of children and adolescents, involving multiple countries, is worth further attention.

Our study has several limitations. First, national representative studies are scarce, while few studies from middle and low income countries were included in our research due to language restrictions. Many of the studies included were conducted in schools, communities, provinces, and cities in high income countries. Meanwhile, our review only focused on victimization and perpetration. Future studies should consider more perspectives, such as bystanders and those with the dual identity of victim/perpetrator, to comprehensively analyze the risk and protective factors of cyberbullying.

Data Availability Statement

Author contributions.

SH, CZ, RE, and WZ conceived the study and developed the design. WZ analyzed the result and supervised the study. CZ and SH wrote the first draft. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2021.634909/full#supplementary-material

Bullying Research Paper

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Introduction

Bullying defined.

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Stability of Bullying Roles

• Gender Differences

The Bully-Victim

The peer group, parenting and home environment, sibling relationships, school factors, internalizing problems, academic performance, delinquency and criminality, impact beyond victims.

• Interventions

Future Directions and Conclusion

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Bullying has received worldwide attention in the last 30 years as a form of aggressive behavior that can have a significant negative impact on the physical, emotional, and academic development of victims. The first major contribution to the academic study of bullying was made by Dan Olweus, who wrote the first scholarly book in English to deal with bullying. The book was written in response to the suicide of three bullied boys in Norway and reported a high prevalence of school bullying (20 % of Norwegian children reported having some involvement) as well as discussed the success of the world’s first bullying prevention program (Olweus 1993). Olweus’ work opened the way for an explosion of research on bullying, which expanded from an initial interest in schools to include broader contexts such as the workplace, prisons, and sibling relationships. While much of this work is of interest, showing that bullying has the potential to affect a significant proportion of the population, this review focuses on school bullying, as this is the area that has attracted the most research interest to date.

The international literature is repleted with definitions of school bullying, most of which seem to accept that bullying is any type of negative action intended to cause distress or harm that is repeated and targeted against individuals who cannot defend themselves. When research on bullying started in the 1980s, bullying was perceived to comprise only episodes of physical or verbal aggression where the victim was physically attacked or called names. In recent years, the definition of bullying has broadened to include other forms of aggression that are relational in nature and aim to damage the victim’s peer relationships and their social status such as spreading of malicious gossip and social exclusion. Fighting between people of approximately equal strength, a one-time attack, or a good-natured teasing and play fighting are not counted as bullying.

The advent and widespread use of electronic means of communication such as mobile phones and the Internet has made it easier to bully anonymously, through the use of pseudonyms and temporary accounts, at any time and in any place involving a wide audience. This development has meant that the definition of bullying has had to be expanded to account for what the literature refers to as “cyber-bullying” or “electronic bullying.” A nationally representative survey of 7,508 adolescents in the United States in 2005 found that 8.3 % had bullied others and 9.8 % had been bullied electronically at least once in the last 2 months (Wang et al. 2009). In the same year in England and Wales, a survey of pupils aged 11–16 found that 22 % had been cyber-bullied at least once or twice in the last couple months (Smith et al. 2008). The most common form of cyber-bullying internationally is sending threatening and/or nasty text messages.

Bullying Prevalence and Continuity

National variation in bullying.

There are large variations across countries in the prevalence of bullying perpetration and victimization. In an international survey of health-related symptoms among school-aged children, the percentage of students who reported being frequently bullied during the current term ranged from a low of 5 % to 10 % in some countries to a high of 40 % in others (Due et al. 2005). The prevalence of bullies in primary school ranges, in most countries, between 7 % and 12 % and remains at those levels in secondary school (around 10 %). It is unclear whether these differences in prevalence reflect genuinely different levels of engagement in bullying among countries or, at least partly, result from different meanings of the term “bullying” in different countries and differences in methodologies and samples used.

An example of why valid comparisons between countries are not possible is Portugal where the bullying rate is high compared to other countries. Berger (2007) in her analysis found that one detail of educational policy in Portugal may account, among other things, for this higher rate of bullying. In Portuguese schools, children are asked to repeat sixth grade unless they pass a rigorous test. This practice results in at least 10 % of all sixth graders (more often boys) to be held back 2 years or more, and these older, bigger children are almost twice as likely to bully compared to the class average. This suggests that the difference in prevalence rates between countries may be, at least partly, accounted for by external factors including national differences in school policies and environments but also differences in the methodologies used (self-reports vs. peer and/or teacher reports), students’ differing levels of cognitive ability, cultural differences in reporting, and different meanings of the term “bullying” in different countries.

The Importance of Age in Bullying

Despite variations in prevalence, it is a universal finding that bullying victimization is more frequent among younger children and steadily declines with age. A range of explanations have been put forward to explain these age differences (Smith et al. 1999a, b). Compared to older children, younger children are less likely to have developed the appropriate skills and coping strategies to deal effectively with bullies and avert further victimization. Younger children are also less likely to refrain from bullying others due to socialization pressure. Finally, there is evidence that younger students adopt a more inclusive definition of bullying when responding to prevalence surveys, and this may, at least partly, account for the higher reported frequency of bullying victimization in primary school. For example, younger pupils might find it more difficult to distinguish between bullying and fighting, broadening the use of the term bullying to include aggressive behaviors that involve no imbalance of power. Within the general trend of decreasing bullying victimization over time, researchers have observed an abrupt increase in bullying during the transition from primary to secondary school which may reflect some students’ attempts to establish dominance hierarchies in the new school environment. Relational forms of bullying take precedence over physical modes of attack as children grow older and their social skills improve.

There is some controversy in the literature as to the stability of bullying victimization in primary school. Some studies have reported that bullying victimization is relatively stable over a period of up to 4 years in primary school and often continues in secondary school. Other studies have found that only a relatively small proportion of children (around 4–5 %) are victimized repeatedly over time in primary school.

In secondary school, the stability of both bully and victim roles is considerably higher than in primary school according to teacher, peer, and self-reports. It is estimated that two out of three male bullies remain in their role over a 1-year period. Despite the moderate to high stability of the victim and bully roles in secondary school, prevalence rates are lower than in primary school. This suggests that a small number of victims are targeted consistently and systematically in secondary school.

Stability in bullying victimization has been explained in two ways. Firstly, it has been observed that victims select social environments that reinforce the risk of victimization, for example, they are more likely to have friends who are less accepted by the peer group and often victimized themselves. Secondly, victims often lack the social skills to break through in new environments, and this increases the risk that they are labeled as victims and locked in that role over a long period of time. It is important, therefore, to acknowledge that although for some children bullying victimization will be situational, for others it will develop into a trait.

Gender Differences in Bullying

The view that males are more likely to bully and be bullied than females has been dismissed in recent years following a better understanding about the different forms aggressive behavior such as bullying can take. Although males are more likely to engage in physical forms of bullying such as pushing and hitting, females are, according to some studies, more adept at employing relational forms of aggression (e.g., social exclusion, spreading of nasty rumors) against their victims especially during adolescence. No consistent gender differences have been identified in the use of verbal bullying (e.g., calling names, nasty teasing). This suggests that overall gender differences are not as pronounced as originally thought and that bullying is not a male problem.

Characteristics of Children and Adolescents Involved in Bullying

There is some controversy in the literature about the profile of bullies. Initially, studies described children who bullied others as insecure, anxious individuals who have low self-esteem, are unpopular among their classmates, and use aggressive strategies to resolve conflicts. This stereotype was later disputed by research that suggested bullies are socially competent and have superior theory of mind skills (i.e., awareness of others’ mental functions and states) and good levels of social intelligence, knowing how to attain goals without damaging their reputation. Linked to this, there is also debate concerning whether bullies lack empathic skills. Some research suggests that bullies understand the emotions of others but do not share them. The inconsistencies across studies may be, at least partly, due to different definitions of bully status and different methodologies employed. Studies which have distinguished between “pure” bullies and bully/victims have revealed that “pure” bullies have few conduct problems, perform well at school, are popular among their classmates, and do not suffer from physical and psychosomatic health problems.

There is more consensus on the profile of “pure” victims. Research has identified that “pure” victims exhibit elevated levels of depression and anxiety, low self-esteem, and poor social skills. Hawker and Boulton’s (2000) meta-analysis found that peer victimization is more strongly concurrently associated with depression than with anxiety, loneliness, or self-esteem. Another meta-analysis by Card (2003) found that the strongest correlates of the victimization experience are low self-concept, low physical strength, low school enjoyment, poor social skills, and high internalizing and externalizing problems. It was unclear from these reviews of cross-sectional studies, however, whether internalizing problems lead to victimization or vice versa.

The recent body of longitudinal research on bullying and peer victimization more widely suggests that the relationship between internalizing problems such as depression, anxiety and loneliness, and victimization is more likely to be reciprocal, that is, internalizing problems contribute to victimization and vice versa. A metaanalysis of 18 longitudinal studies examining associations between peer victimization and internalizing problems in children and adolescents concluded that internalizing problems both precede and follow peer victimization experiences (Reijntjes et al. 2011). It is worth noting, however, that the path from psychological maladjustment to victimization has not been replicated in all studies. For instance, Bond et al. (2001) found no support for the hypothesis that emotional maladjustment invites victimization.

Recent work suggests that bullying might arise out of early cognitive deficits, including language problems, imperfect causal understanding, and poor inhibitory control that lead to decreased competence with peers, which over time develops into bullying. Research does not support the assertion that physical appearance (e.g., wearing glasses) is a risk factor for being bullied at school. The only physical characteristic that has been associated with an increased risk of victimization is low physical size and strength. There is less evidence on how equality characteristics influence victimization. There is no consistently robust evidence to suggest that ethnic minority children are more at risk of being bullied at school. Sexual orientation has rarely been investigated in longitudinal studies as a possible risk factor of bullying victimization, but there is some, mainly qualitative, evidence of sexual minorities being targeted in secondary schools. There is stronger evidence that children with disabilities are particularly vulnerable to victimization in mainstream settings, although it might be other characteristics of disabled children that make them more vulnerable to victimization such as lack of friends rather than the disability per se.

Olweus (1993) was the first researcher to identify a small proportion of victims of bullying that he called “provocative victims” or “bully-victims,” who bully other children as well as being bullied by them. Research has identified that bully-victims are the most troubled group among children and adolescents involved in bullying incidents. This group displays the highest levels of internalizing problems, including depression, anxiety, low selfesteem, and loneliness. At the same time, they score high on externalizing problems such as aggression, impulsivity, hyperactivity, and conduct problems. Other research has shown that bully-victims display higher levels of neuroticism and psychoticism than either bullies or victims. Bully-victims use aggressive strategies to cope with stressors at school that increase the risk of further victimization and rejection from peers.

Besides the traditional roles of bully, victim, and bully-victim, research has identified that all students take on a role when bullying episodes emerge. Salmivalli et al. (1996) distinguished between six different roles children can take in bullying situations: the bully (leader), the reinforcer (encourages and provides audience), the assistant (follower/helper, e.g., holds the child down), the defender (helps the victim and/or tells bullies to stop), the outsider (stays away from bullying situations), and the victim. Subsequent research established that the three roles of bully, reinforcer, and assistant are closely correlated with each other and, therefore, cannot usefully discriminate between children. In kindergarten, the three most commonly held roles are those of the bully, the victim, and the defender. Fewer students are defenders by middle school, and the majority becomes witnesses or bystanders when bullying takes place. Such passive behavior, although not directly encouraging of bullying, provides a permissive context for bullies that allows them to continue harassing their victims.

Environmental Influences on Bullying

There is clear evidence that parenting styles are related to bullying behavior. Studies indicate that bullies are more likely to have parents who are authoritarian and punitive, disagree more often, and are less supportive. The parents of bullies are more likely to have been bullies themselves when they were young. Victims, on the other hand, are more likely to have been reared in an overprotective family environment. Bully-victims tend to come from family backgrounds that are exposed to abuse and violence and favor the use of harsh, punitive, and restrictive discipline practices. This group reports little positive warmth in their families and more difficulties in communicating with parents.

Family characteristics are related to bullying victimization in different ways for boys and girls. Boys are more prone to victimization when the father is highly critical or absent in his relationship with his son, thus failing to provide a satisfactory role model. Victimization in boys is also associated with maternal overprotectiveness which may hinder boys’ search for autonomy and independence, whereas victimization in girls is more strongly related to maternal hostility which may lead to anxiety and decreased sense of connectedness in relationships.

Very little research has examined longitudinal associations between early home environment and subsequent bullying behavior. The few studies that exist suggest a link between low emotional support and subsequent bullying behavior at school. Parents who are disagreeable, hostile, cold, or rejecting tend to have children who are at risk of becoming aggressive in the future. In a small longitudinal study, Schwartz et al. (1997) found that bully-victims at 10 years were significantly more likely than the other groups to have had experiences with harsh, disorganized, and potentially abusive home environments 5 years earlier. Mother-child interactions at 5 years were characterized by hostile, restrictive, or overly punitive parenting. They were significantly exposed to higher levels of marital conflicts and more likely to come from marginally lower socioeconomic backgrounds. Bullies were found to be exposed to adult aggression and conflicts, but not victimization by adults, and were from lower socioeconomic backgrounds. These findings need to be replicated in larger samples before any safe conclusions can be drawn.

More recently, there has been interest in how sibling relationships affect the development of bullying behavior. There is international evidence that children who are victimized at school are more likely, compared to other groups, to be victimized by their siblings at home. Wolke and Samara (2004) found that more than half of victims of bullying by siblings (50.7 %) were also involved in bullying behavior at school compared to only 12.4 % of those not victimized by siblings, indicating a strong link between intrafamilial and extrafamilial peer relationships. Those who were both victimized at home and at school had the highest behavior problems and were the least prosocial. Similar evidence exists in relation to bullying perpetration, suggesting that those who bully at school tend to exhibit similar behaviors towards their siblings at home.

A number of school factors have also been implicated as correlates of bullying behavior. One of the most consistent findings in the international literature is that the number and quality of friends at school is one of the strongest, if not the strongest, protective factor against bullying victimization. Having friends is not sufficient in itself to protect against victimization. For instance, when at-risk children have friends with internalizing problems, who are physically weak or who themselves are victimized, the relation of children’s behavioral risk to victimization is exacerbated.

More recent work on the role of class structure and climate on bullying has shown that variations in peer structure and dominance hierarchies influence the stability of bullying victimization. For example, victims in primary school classes with a more pronounced hierarchical structure are less likely to escape their victim role compared to those in classes with less clearly marked hierarchies (Sch€afer et al. 2005).

Consequences of Bullying

There has been a growing interest in recent years to investigate the long-term effects of bullying involvement on children’s and adolescents’ social, emotional, behavioral, and academic development using longitudinal samples. The results of these studies suggest that victims and bully-victims manifest more adjustment problems than bullies. Victims and, especially, bully-victims are more likely to show elevated levels of depression, anxiety, and loneliness; perform less well academically; and display conduct problems. The only negative long-term outcome that has consistently been reported in the literature for bullies is their involvement in later offending. There is also some initial evidence that bullying perpetration is a significant risk factor of poor academic performance.

Several cross-sectional studies have demonstrated negative associations between peer victimization and a range of internalizing problems, including loneliness and low self-esteem. A meta-analysis of 23 cross-sectional studies of the association between peer victimization and psychological maladjustment found that peer victimization was more strongly concurrently associated with depression than with anxiety, loneliness, or self-esteem (Hawker and Boulton 2000).

Over the last decade, research on bullying is increasingly reliant on longitudinal methodologies to disentangle whether victimization contributes to internalizing problems or vice versa. It has been argued, for example, that children who display internalizing behaviors (e.g., anxiety or shyness) are more at risk of being targeted by peers due to their inability to cope effectively with provocation. The majority of longitudinal studies investigating associations between peer victimization and psychological maladjustment have found evidence for both directions.

There is some longitudinal evidence that bullying involvement has a negative impact on academic performance, although more studies are needed to reach a definitive conclusion. A US longitudinal study that began in 2002 with a sample of about 1,700 adolescents found that being a bully had a stronger negative effect on self-perceived academic competence over time than being a victim after controlling for demographic background variables and baseline academic competence (Ma et al. 2009). Furthermore, only bully status predicted lower self-reported grades.

Despite showing fewer adjustment problems than victims and bully-victims, bullies are at an increased risk of later delinquency and criminal offending. A recent meta-analysis of studies measuring school bullying and later offending found that school bullies were 2.5 times more likely than noninvolved students to engage in offending over an 11-year follow-up period (Ttofi et al. 2011). The risk was lower when major childhood risk factors were controlled for, but remained statistically significant. The effect of bullying on later offending was especially pronounced when bullying was assessed in older children. The longitudinal association between bullying perpetration and later offending has been replicated in many countries, including Australia, Canada, and Europe.

Finally, there is evidence that bullying and victimization have a negative impact not only on the individual children involved but also on bystanders. Children who witness bullying incidents report increased anxiety, less satisfaction with school, and lower academic achievement. There is also evidence that in school classes where a lot of victimization is taking place, school satisfaction among students is low.

Bullying Interventions

Following the development of the first anti-bullying program by Dan Olweus in Norway in the 1980s, a considerable number of anti-bullying interventions have flourished around the world to reduce bullying behaviors and protect victims. These fall under four broad categories: curriculum interventions generally designed to promote an anti-bullying attitude within the classroom; whole-school programs that intervene on the school, class, and individual level and address bullying as a systemic problem; social and behavioral skills training; and peer support programs including befriending and peer mediation. A systematic review conducted in 2004 evaluated the strength of scientific evidence in support of anti-bullying programs (Vreeman and Carroll 2007). The review concluded that only a small number of anti-bullying programs have been evaluated rigorously enough to permit strong conclusions about their effectiveness.

Whole-school interventions were found to be more effective in reducing victimization and bullying than interventions that focused only on curriculum changes or social and behavioral skills training. Targeting the whole school involves actions to improve the supervision of the playground, having regular meetings between parents and teachers, setting clear guidelines for dealing with bullying, and using role-playing and other techniques to teach students about bullying. The success of whole-school interventions, relative to other stand-alone approaches, supports the view that bullying is a systemic, sociocultural phenomenon derived from factors operating at the individual, class, school, family, and community level. Hence, interventions that target only one level are unlikely to have a significant impact.

A more recent systematic review of school-based anti-bullying programs found that, overall, these programs are effective in reducing bullying perpetration and victimization by an average of 20–23 % and 17–20 %, respectively (Farrington and Ttofi 2009). The interventions that were found to be most effective were those that incorporated parent training/meetings, disciplinary methods, and videos; targeted older children; and were delivered intensively and for longer. There is less robust evidence on the effectiveness of peer support programs that include activities such as befriending, peer counseling, conflict resolution, or mediation, and a systematic review suggested their use may lead to increases in bullying victimization.

More recently, there has been a growing interest in the use of virtual learning environments to reduce bullying at schools. The basic feature of these programs is a computer-based environment that creates a highly believable learning experience for children who find themselves “present” in the situation that causes emotional distress and, as a result, learn experientially how to deal with school problems. An example of such a program is “FearNot,” an intervention that was developed to help victims of bullying explore the success or otherwise of different coping strategies to dealing with bullying victimization through interactions with “virtual” victims of school bullying. The evaluation of this intervention found that the victims that received the intervention were more likely to escape victimization in the short term than victims in control schools who did not interact with the software (Sapouna et al. 2010). These results suggest that the use of virtual environments might be an engaging and useful component of whole-school anti-bullying policies that merits further testing. A key finding that emerged from this research is that interventions are more likely to be successful if they have the support of teachers and other school personnel and there is a strong commitment to reduce bullying in the school community. This is considered to be one of the reasons behind the huge success of the Olweus’ prevention program that has not been replicated to date.

Although an abundance of knowledge has emerged in recent years regarding the correlates of bullying behavior, there is still relatively little known about the causal processes and mechanisms associated with the bully and victim status. Longitudinal studies, which track bullies and victims over time, offer one of the best chances of disentangling the antecedents of bullying perpetration and victimization from its consequences, and these should form a key part of future research in this field. Another approach which shows much promise is the cutting-edge attempt to unravel the causes of bullying behavior made by researchers investigating biological and environmental influences and the way these influences interact.

One of these studies, involving 1,116 families with 10-year-old twins, found that the tendency for children to be bullied was largely explained by genetics (73 % of variance) and less so by environmental factors that were unique to each child (Ball et al. 2008). Another study of 506 six-year-old twins found that variance in victimization was accounted for only by shared and non-shared environmental influences (29 % and 71 %, respectively) and was not related to the child’s genetic predisposition (Brendgen et al. 2008). These discrepancies might be explained by differences in methodologies used, as studies drew on different informants to assess bullying victimization (mothers and peers, respectively). Although results to date have been contradictory, future breakthroughs in this area have the potential to transform radically the study of bullying.

To understand more fully how bullying behaviors develop, future research will also need to investigate in more depth how individual and classroom level factors interact to cause involvement in bullying. It is not currently understood whether the relationship between risk factors and bullying is the same across different school and class environments or the extent to which consequences of bullying and victimization are dependent on class-and school-level factors.

Finally, another area that would benefit from more attention is the investigation of resilience to bullying. Some initial evidence suggests that maternal warmth has an environmental effect in protecting children from negative outcomes associated with victimization (Bowes et al. 2010). However, we still know relatively little about the factors that promote resilience to bullying and victimization among at-risk children, and also what role bullying has to play in increasing resilience. We also know little about the factors that help victims cope better with the effects of victimization.

To conclude, what the recent flurry of research activity has highlighted is how complex the bullying phenomenon is and that, although much has been learned to date, there is clearly a great need to understand how variables describing the family, school, class, and community environment interact with individual characteristics to determine who gets bullied and who bullies others. Research should neither be blind to nor discouraged by these complexities.

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