complete research paper about bullying

Preventing Bullying Through Science, Policy, and Practice (2016)

Chapter: 1 introduction, 1 introduction.

Bullying, long tolerated by many as a rite of passage into adulthood, is now recognized as a major and preventable public health problem, one that can have long-lasting consequences ( McDougall and Vaillancourt, 2015 ; Wolke and Lereya, 2015 ). Those consequences—for those who are bullied, for the perpetrators of bullying, and for witnesses who are present during a bullying event—include poor school performance, anxiety, depression, and future delinquent and aggressive behavior. Federal, state, and local governments have responded by adopting laws and implementing programs to prevent bullying and deal with its consequences. However, many of these responses have been undertaken with little attention to what is known about bullying and its effects. Even the definition of bullying varies among both researchers and lawmakers, though it generally includes physical and verbal behavior, behavior leading to social isolation, and behavior that uses digital communications technology (cyberbullying). This report adopts the term “bullying behavior,” which is frequently used in the research field, to cover all of these behaviors.

Bullying behavior is evident as early as preschool, although it peaks during the middle school years ( Currie et al., 2012 ; Vaillancourt et al., 2010 ). It can occur in diverse social settings, including classrooms, school gyms and cafeterias, on school buses, and online. Bullying behavior affects not only the children and youth who are bullied, who bully, and who are both bullied and bully others but also bystanders to bullying incidents. Given the myriad situations in which bullying can occur and the many people who may be involved, identifying effective prevention programs and policies is challenging, and it is unlikely that any one approach will be ap-

propriate in all situations. Commonly used bullying prevention approaches include policies regarding acceptable behavior in schools and behavioral interventions to promote positive cultural norms.

STUDY CHARGE

Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, a group of federal agencies and private foundations asked the National Academies of Sciences, Engineering, and Medicine to undertake a study of what is known and what needs to be known to further the field of preventing bullying behavior. The Committee on the Biological and Psychosocial Effects of Peer Victimization:

Lessons for Bullying Prevention was created to carry out this task under the Academies’ Board on Children, Youth, and Families and the Committee on Law and Justice. The study received financial support from the Centers for Disease Control and Prevention (CDC), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Health Resources and Services Administration, the Highmark Foundation, the National Institute of Justice, the Robert Wood Johnson Foundation, Semi J. and Ruth W. Begun Foundation, and the Substance Abuse and Mental Health Services Administration. The full statement of task for the committee is presented in Box 1-1 .

Although the committee acknowledges the importance of this topic as it pertains to all children in the United States and in U.S. territories, this report focuses on the 50 states and the District of Columbia. Also, while the committee acknowledges that bullying behavior occurs in the school

environment for youth in foster care, in juvenile justice facilities, and in other residential treatment facilities, this report does not address bullying behavior in those environments because it is beyond the study charge.

CONTEXT FOR THE STUDY

This section of the report highlights relevant work in the field and, later in the chapter under “The Committee’s Approach,” presents the conceptual framework and corresponding definitions of terms that the committee has adopted.

Historical Context

Bullying behavior was first characterized in the scientific literature as part of the childhood experience more than 100 years ago in “Teasing and Bullying,” published in the Pedagogical Seminary ( Burk, 1897 ). The author described bullying behavior, attempted to delineate causes and cures for the tormenting of others, and called for additional research ( Koo, 2007 ). Nearly a century later, Dan Olweus, a Swedish research professor of psychology in Norway, conducted an intensive study on bullying ( Olweus, 1978 ). The efforts of Olweus brought awareness to the issue and motivated other professionals to conduct their own research, thereby expanding and contributing to knowledge of bullying behavior. Since Olweus’s early work, research on bullying has steadily increased (see Farrington and Ttofi, 2009 ; Hymel and Swearer, 2015 ).

Over the past few decades, venues where bullying behavior occurs have expanded with the advent of the Internet, chat rooms, instant messaging, social media, and other forms of digital electronic communication. These modes of communication have provided a new communal avenue for bullying. While the media reports linking bullying to suicide suggest a causal relationship, the available research suggests that there are often multiple factors that contribute to a youth’s suicide-related ideology and behavior. Several studies, however, have demonstrated an association between bullying involvement and suicide-related ideology and behavior (see, e.g., Holt et al., 2015 ; Kim and Leventhal, 2008 ; Sourander, 2010 ; van Geel et al., 2014 ).

In 2013, the Health Resources and Services Administration of the U.S. Department of Health and Human Services requested that the Institute of Medicine 1 and the National Research Council convene an ad hoc planning committee to plan and conduct a 2-day public workshop to highlight relevant information and knowledge that could inform a multidisciplinary

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1 Prior to 2015, the National Academy of Medicine was known as the Institute of Medicine.

road map on next steps for the field of bullying prevention. Content areas that were explored during the April 2014 workshop included the identification of conceptual models and interventions that have proven effective in decreasing bullying and the antecedents to bullying while increasing protective factors that mitigate the negative health impact of bullying. The discussions highlighted the need for a better understanding of the effectiveness of program interventions in realistic settings; the importance of understanding what works for whom and under what circumstances, as well as the influence of different mediators (i.e., what accounts for associations between variables) and moderators (i.e., what affects the direction or strength of associations between variables) in bullying prevention efforts; and the need for coordination among agencies to prevent and respond to bullying. The workshop summary ( Institute of Medicine and National Research Council, 2014c ) informs this committee’s work.

Federal Efforts to Address Bullying and Related Topics

Currently, there is no comprehensive federal statute that explicitly prohibits bullying among children and adolescents, including cyberbullying. However, in the wake of the growing concerns surrounding the implications of bullying, several federal initiatives do address bullying among children and adolescents, and although some of them do not primarily focus on bullying, they permit some funds to be used for bullying prevention purposes.

The earliest federal initiative was in 1999, when three agencies collaborated to establish the Safe Schools/Healthy Students initiative in response to a series of deadly school shootings in the late 1990s. The program is administered by the U.S. Departments of Education, Health and Human Services, and Justice to prevent youth violence and promote the healthy development of youth. It is jointly funded by the Department of Education and by the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. The program has provided grantees with both the opportunity to benefit from collaboration and the tools to sustain it through deliberate planning, more cost-effective service delivery, and a broader funding base ( Substance Abuse and Mental Health Services Administration, 2015 ).

The next major effort was in 2010, when the Department of Education awarded $38.8 million in grants under the Safe and Supportive Schools (S3) Program to 11 states to support statewide measurement of conditions for learning and targeted programmatic interventions to improve conditions for learning, in order to help schools improve safety and reduce substance use. The S3 Program was administered by the Safe and Supportive Schools Group, which also administered the Safe and Drug-Free Schools and Communities Act State and Local Grants Program, authorized by the

1994 Elementary and Secondary Education Act. 2 It was one of several programs related to developing and maintaining safe, disciplined, and drug-free schools. In addition to the S3 grants program, the group administered a number of interagency agreements with a focus on (but not limited to) bullying, school recovery research, data collection, and drug and violence prevention activities ( U.S. Department of Education, 2015 ).

A collaborative effort among the U.S. Departments of Agriculture, Defense, Education, Health and Human Services, Interior, and Justice; the Federal Trade Commission; and the White House Initiative on Asian Americans and Pacific Islanders created the Federal Partners in Bullying Prevention (FPBP) Steering Committee. Led by the U.S. Department of Education, the FPBP works to coordinate policy, research, and communications on bullying topics. The FPBP Website provides extensive resources on bullying behavior, including information on what bullying is, its risk factors, its warning signs, and its effects. 3 The FPBP Steering Committee also plans to provide details on how to get help for those who have been bullied. It also was involved in creating the “Be More than a Bystander” Public Service Announcement campaign with the Ad Council to engage students in bullying prevention. To improve school climate and reduce rates of bullying nationwide, FPBP has sponsored four bullying prevention summits attended by education practitioners, policy makers, researchers, and federal officials.

In 2014, the National Institute of Justice—the scientific research arm of the U.S. Department of Justice—launched the Comprehensive School Safety Initiative with a congressional appropriation of $75 million. The funds are to be used for rigorous research to produce practical knowledge that can improve the safety of schools and students, including bullying prevention. The initiative is carried out through partnerships among researchers, educators, and other stakeholders, including law enforcement, behavioral and mental health professionals, courts, and other justice system professionals ( National Institute of Justice, 2015 ).

In 2015, the Every Student Succeeds Act was signed by President Obama, reauthorizing the 50-year-old Elementary and Secondary Education Act, which is committed to providing equal opportunities for all students. Although bullying is neither defined nor prohibited in this act, it is explicitly mentioned in regard to applicability of safe school funding, which it had not been in previous iterations of the Elementary and Secondary Education Act.

The above are examples of federal initiatives aimed at promoting the

2 The Safe and Drug-Free Schools and Communities Act was included as Title IV, Part A, of the 1994 Elementary and Secondary Education Act. See http://www.ojjdp.gov/pubs/gun_violence/sect08-i.html [October 2015].

3 For details, see http://www.stopbullying.gov/ [October 2015].

healthy development of youth, improving the safety of schools and students, and reducing rates of bullying behavior. There are several other federal initiatives that address student bullying directly or allow funds to be used for bullying prevention activities.

Definitional Context

The terms “bullying,” “harassment,” and “peer victimization” have been used in the scientific literature to refer to behavior that is aggressive, is carried out repeatedly and over time, and occurs in an interpersonal relationship where a power imbalance exists ( Eisenberg and Aalsma, 2005 ). Although some of these terms have been used interchangeably in the literature, peer victimization is targeted aggressive behavior of one child against another that causes physical, emotional, social, or psychological harm. While conflict and bullying among siblings are important in their own right ( Tanrikulu and Campbell, 2015 ), this area falls outside of the scope of the committee’s charge. Sibling conflict and aggression falls under the broader concept of interpersonal aggression, which includes dating violence, sexual assault, and sibling violence, in addition to bullying as defined for this report. Olweus (1993) noted that bullying, unlike other forms of peer victimization where the children involved are equally matched, involves a power imbalance between the perpetrator and the target, where the target has difficulty defending him or herself and feels helpless against the aggressor. This power imbalance is typically considered a defining feature of bullying, which distinguishes this particular form of aggression from other forms, and is typically repeated in multiple bullying incidents involving the same individuals over time ( Olweus, 1993 ).

Bullying and violence are subcategories of aggressive behavior that overlap ( Olweus, 1996 ). There are situations in which violence is used in the context of bullying. However, not all forms of bullying (e.g., rumor spreading) involve violent behavior. The committee also acknowledges that perspective about intentions can matter and that in many situations, there may be at least two plausible perceptions involved in the bullying behavior.

A number of factors may influence one’s perception of the term “bullying” ( Smith and Monks, 2008 ). Children and adolescents’ understanding of the term “bullying” may be subject to cultural interpretations or translations of the term ( Hopkins et al., 2013 ). Studies have also shown that influences on children’s understanding of bullying include the child’s experiences as he or she matures and whether the child witnesses the bullying behavior of others ( Hellström et al., 2015 ; Monks and Smith, 2006 ; Smith and Monks, 2008 ).

In 2010, the FPBP Steering Committee convened its first summit, which brought together more than 150 nonprofit and corporate leaders,

researchers, practitioners, parents, and youths to identify challenges in bullying prevention. Discussions at the summit revealed inconsistencies in the definition of bullying behavior and the need to create a uniform definition of bullying. Subsequently, a review of the 2011 CDC publication of assessment tools used to measure bullying among youth ( Hamburger et al., 2011 ) revealed inconsistent definitions of bullying and diverse measurement strategies. Those inconsistencies and diverse measurements make it difficult to compare the prevalence of bullying across studies ( Vivolo et al., 2011 ) and complicate the task of distinguishing bullying from other types of aggression between youths. A uniform definition can support the consistent tracking of bullying behavior over time, facilitate the comparison of bullying prevalence rates and associated risk and protective factors across different data collection systems, and enable the collection of comparable information on the performance of bullying intervention and prevention programs across contexts ( Gladden et al., 2014 ). The CDC and U.S. Department of Education collaborated on the creation of the following uniform definition of bullying (quoted in Gladden et al., 2014, p. 7 ):

Bullying is any unwanted aggressive behavior(s) 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. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social, or educational harm.

This report noted that the definition includes school-age individuals ages 5-18 and explicitly excludes sibling violence and violence that occurs in the context of a dating or intimate relationship ( Gladden et al., 2014 ). This definition also highlighted that there are direct and indirect modes of bullying, as well as different types of bullying. Direct bullying involves “aggressive behavior(s) that occur in the presence of the targeted youth”; indirect bullying includes “aggressive behavior(s) that are not directly communicated to the targeted youth” ( Gladden et al., 2014, p. 7 ). The direct forms of violence (e.g., sibling violence, teen dating violence, intimate partner violence) can include aggression that is physical, sexual, or psychological, but the context and uniquely dynamic nature of the relationship between the target and the perpetrator in which these acts occur is different from that of peer bullying. Examples of direct bullying include pushing, hitting, verbal taunting, or direct written communication. A common form of indirect bullying is spreading rumors. Four different types of bullying are commonly identified—physical, verbal, relational, and damage to property. Some observational studies have shown that the different forms of bullying that youths commonly experience may overlap ( Bradshaw et al., 2015 ;

Godleski et al., 2015 ). The four types of bullying are defined as follows ( Gladden et al., 2014 ):

• Physical bullying involves the use of physical force (e.g., shoving, hitting, spitting, pushing, and tripping).
• Verbal bullying involves oral or written communication that causes harm (e.g., taunting, name calling, offensive notes or hand gestures, verbal threats).
• Relational bullying is behavior “designed to harm the reputation and relationships of the targeted youth (e.g., social isolation, rumor spreading, posting derogatory comments or pictures online).”
• Damage to property is “theft, alteration, or damaging of the target youth’s property by the perpetrator to cause harm.”

In recent years, a new form of aggression or bullying has emerged, labeled “cyberbullying,” in which the aggression occurs through modern technological devices, specifically mobile phones or the Internet ( Slonje and Smith, 2008 ). Cyberbullying may take the form of mean or nasty messages or comments, rumor spreading through posts or creation of groups, and exclusion by groups of peers online.

While the CDC definition identifies bullying that occurs using technology as electronic bullying and views that as a context or location where bullying occurs, one of the major challenges in the field is how to conceptualize and define cyberbullying ( Tokunaga, 2010 ). The extent to which the CDC definition can be applied to cyberbullying is unclear, particularly with respect to several key concepts within the CDC definition. First, whether determination of an interaction as “wanted” or “unwanted” or whether communication was intended to be harmful can be challenging to assess in the absence of important in-person socioemotional cues (e.g., vocal tone, facial expressions). Second, assessing “repetition” is challenging in that a single harmful act on the Internet has the potential to be shared or viewed multiple times ( Sticca and Perren, 2013 ). Third, cyberbullying can involve a less powerful peer using technological tools to bully a peer who is perceived to have more power. In this manner, technology may provide the tools that create a power imbalance, in contrast to traditional bullying, which typically involves an existing power imbalance.

A study that used focus groups with college students to discuss whether the CDC definition applied to cyberbullying found that students were wary of applying the definition due to their perception that cyberbullying often involves less emphasis on aggression, intention, and repetition than other forms of bullying ( Kota et al., 2014 ). Many researchers have responded to this lack of conceptual and definitional clarity by creating their own measures to assess cyberbullying. It is noteworthy that very few of these

definitions and measures include the components of traditional bullying—i.e., repetition, power imbalance, and intent ( Berne et al., 2013 ). A more recent study argues that the term “cyberbullying” should be reserved for incidents that involve key aspects of bullying such as repetition and differential power ( Ybarra et al., 2014 ).

Although the formulation of a uniform definition of bullying appears to be a step in the right direction for the field of bullying prevention, there are some limitations of the CDC definition. For example, some researchers find the focus on school-age youth as well as the repeated nature of bullying to be rather limiting; similarly the exclusion of bullying in the context of sibling relationships or dating relationships may preclude full appreciation of the range of aggressive behaviors that may co-occur with or constitute bullying behavior. As noted above, other researchers have raised concerns about whether cyberbullying should be considered a particular form or mode under the broader heading of bullying as suggested in the CDC definition, or whether a separate defintion is needed. Furthermore, the measurement of bullying prevalence using such a definiton of bullying is rather complex and does not lend itself well to large-scale survey research. The CDC definition was intended to inform public health surveillance efforts, rather than to serve as a definition for policy. However, increased alignment between bullying definitions used by policy makers and researchers would greatly advance the field. Much of the extant research on bullying has not applied a consistent definition or one that aligns with the CDC definition. As a result of these and other challenges to the CDC definition, thus far there has been inconsistent adoption of this particular definition by researchers, practitioners, or policy makers; however, as the definition was created in 2014, less than 2 years is not a sufficient amount of time to assess whether it has been successfully adopted or will be in the future.

THE COMMITTEE’S APPROACH

This report builds on the April 2014 workshop, summarized in Building Capacity to Reduce Bullying: Workshop Summary ( Institute of Medicine and National Research Council, 2014c ). The committee’s work was accomplished over an 18-month period that began in October 2014, after the workshop was held and the formal summary of it had been released. The study committee members represented expertise in communication technology, criminology, developmental and clinical psychology, education, mental health, neurobiological development, pediatrics, public health, school administration, school district policy, and state law and policy. (See Appendix E for biographical sketches of the committee members and staff.) The committee met three times in person and conducted other meetings by teleconferences and electronic communication.

Information Gathering

The committee conducted an extensive review of the literature pertaining to peer victimization and bullying. In some instances, the committee drew upon the broader literature on aggression and violence. The review began with an English-language literature search of online databases, including ERIC, Google Scholar, Lexis Law Reviews Database, Medline, PubMed, Scopus, PsycInfo, and Web of Science, and was expanded as literature and resources from other countries were identified by committee members and project staff as relevant. The committee drew upon the early childhood literature since there is substantial evidence indicating that bullying involvement happens as early as preschool (see Vlachou et al., 2011 ). The committee also drew on the literature on late adolescence and looked at related areas of research such as maltreatment for insights into this emerging field.

The committee used a variety of sources to supplement its review of the literature. The committee held two public information-gathering sessions, one with the study sponsors and the second with experts on the neurobiology of bullying; bullying as a group phenomenon and the role of bystanders; the role of media in bullying prevention; and the intersection of social science, the law, and bullying and peer victimization. See Appendix A for the agendas for these two sessions. To explore different facets of bullying and give perspectives from the field, a subgroup of the committee and study staff also conducted a site visit to a northeastern city, where they convened four stakeholder groups comprised, respectively, of local practitioners, school personnel, private foundation representatives, and young adults. The site visit provided the committee with an opportunity for place-based learning about bullying prevention programs and best practices. Each focus group was transcribed and summarized thematically in accordance with this report’s chapter considerations. Themes related to the chapters are displayed throughout the report in boxes titled “Perspectives from the Field”; these boxes reflect responses synthesized from all four focus groups. See Appendix B for the site visit’s agenda and for summaries of the focus groups.

The committee also benefited from earlier reports by the National Academies of Sciences, Engineering, and Medicine through its Division of Behavioral and Social Sciences and Education and the Institute of Medicine, most notably:

• Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research ( Institute of Medicine, 1994 )
• Community Programs to Promote Youth Development ( National Research Council and Institute of Medicine, 2002 )
• Deadly Lessons: Understanding Lethal School Violence ( National Research Council and Institute of Medicine, 2003 )
• Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities ( National Research Council and Institute of Medicine, 2009 )
• The Science of Adolescent Risk-Taking: Workshop Report ( Institute of Medicine and National Research Council, 2011 )
• Communications and Technology for Violence Prevention: Workshop Summary ( Institute of Medicine and National Research Council, 2012 )
• Building Capacity to Reduce Bullying: Workshop Summary ( Institute of Medicine and National Research Council, 2014c )
• The Evidence for Violence Prevention across the Lifespan and Around the World: Workshop Summary ( Institute of Medicine and National Research Council, 2014a )
• Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children’s Cognitive, Affective, and Behavioral Health: Workshop Summary ( Institute of Medicine and National Research Council, 2014b )
• Investing in the Health and Well-Being of Young Adults ( Institute of Medicine and National Research Council, 2015 )

Although these past reports and workshop summaries address various forms of violence and victimization, this report is the first consensus study by the National Academies of Sciences, Engineering, and Medicine on the state of the science on the biological and psychosocial consequences of bullying and the risk and protective factors that either increase or decrease bullying behavior and its consequences.

Terminology

Given the variable use of the terms “bullying” and “peer victimization” in both the research-based and practice-based literature, the committee chose to use the current CDC definition quoted above ( Gladden et al., 2014, p. 7 ). While the committee determined that this was the best definition to use, it acknowledges that this definition is not necessarily the most user-friendly definition for students and has the potential to cause problems for students reporting bullying. Not only does this definition provide detail on the common elements of bullying behavior but it also was developed with input from a panel of researchers and practitioners. The committee also followed the CDC in focusing primarily on individuals between the ages of 5 and 18. The committee recognizes that children’s development occurs on a continuum, and so while it relied primarily on the CDC defini-

tion, its work and this report acknowledge the importance of addressing bullying in both early childhood and emerging adulthood. For purposes of this report, the committee used the terms “early childhood” to refer to ages 1-4, “middle childhood” for ages 5 to 10, “early adolescence” for ages 11-14, “middle adolescence” for ages 15-17, and “late adolescence” for ages 18-21. This terminology and the associated age ranges are consistent with the Bright Futures and American Academy of Pediatrics definition of the stages of development. 4

A given instance of bullying behavior involves at least two unequal roles: one or more individuals who perpetrate the behavior (the perpetrator in this instance) and at least one individual who is bullied (the target in this instance). To avoid labeling and potentially further stigmatizing individuals with the terms “bully” and “victim,” which are sometimes viewed as traits of persons rather than role descriptions in a particular instance of behavior, the committee decided to use “individual who is bullied” to refer to the target of a bullying instance or pattern and “individual who bullies” to refer to the perpetrator of a bullying instance or pattern. Thus, “individual who is bullied and bullies others” can refer to one who is either perpetrating a bullying behavior or a target of bullying behavior, depending on the incident. This terminology is consistent with the approach used by the FPBP (see above). Also, bullying is a dynamic social interaction ( Espelage and Swearer, 2003 ) where individuals can play different roles in bullying interactions based on both individual and contextual factors.

The committee used “cyberbullying” to refer to bullying that takes place using technology or digital electronic means. “Digital electronic forms of contact” comprise a broad category that may include e-mail, blogs, social networking Websites, online games, chat rooms, forums, instant messaging, Skype, text messaging, and mobile phone pictures. The committee uses the term “traditional bullying” to refer to bullying behavior that is not cyberbullying (to aid in comparisons), recognizing that the term has been used at times in slightly different senses in the literature.

Where accurate reporting of study findings requires use of the above terms but with senses different from those specified here, the committee has noted the sense in which the source used the term. Similarly, accurate reporting has at times required use of terms such as “victimization” or “victim” that the committee has chosen to avoid in its own statements.

4 For details on these stages of adolescence, see https://brightfutures.aap.org/Bright%20Futures%20Documents/3-Promoting_Child_Development.pdf [October 2015].

ORGANIZATION OF THE REPORT

This report is organized into seven chapters. After this introductory chapter, Chapter 2 provides a broad overview of the scope of the problem.

Chapter 3 focuses on the conceptual frameworks for the study and the developmental trajectory of the child who is bullied, the child who bullies, and the child who is bullied and also bullies. It explores processes that can explain heterogeneity in bullying outcomes by focusing on contextual processes that moderate the effect of individual characteristics on bullying behavior.

Chapter 4 discusses the cyclical nature of bullying and the consequences of bullying behavior. It summarizes what is known about the psychosocial, physical health, neurobiological, academic-performance, and population-level consequences of bullying.

Chapter 5 provides an overview of the landscape in bullying prevention programming. This chapter describes in detail the context for preventive interventions and the specific actions that various stakeholders can take to achieve a coordinated response to bullying behavior. The chapter uses the Institute of Medicine’s multi-tiered framework ( National Research Council and Institute of Medicine, 2009 ) to present the different levels of approaches to preventing bullying behavior.

Chapter 6 reviews what is known about federal, state, and local laws and policies and their impact on bullying.

After a critical review of the relevant research and practice-based literatures, Chapter 7 discusses the committee conclusions and recommendations and provides a path forward for bullying prevention.

The report includes a number of appendixes. Appendix A includes meeting agendas of the committee’s public information-gathering meetings. Appendix B includes the agenda and summaries of the site visit. Appendix C includes summaries of bullying prevalence data from the national surveys discussed in Chapter 2 . Appendix D provides a list of selected federal resources on bullying for parents and teachers. Appendix E provides biographical sketches of the committee members and project staff.

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Bullying has long been tolerated as a rite of passage among children and adolescents. There is an implication that individuals who are bullied must have "asked for" this type of treatment, or deserved it. Sometimes, even the child who is bullied begins to internalize this idea. For many years, there has been a general acceptance and collective shrug when it comes to a child or adolescent with greater social capital or power pushing around a child perceived as subordinate. But bullying is not developmentally appropriate; it should not be considered a normal part of the typical social grouping that occurs throughout a child's life.

Although bullying behavior endures through generations, the milieu is changing. Historically, bulling has occurred at school, the physical setting in which most of childhood is centered and the primary source for peer group formation. In recent years, however, the physical setting is not the only place bullying is occurring. Technology allows for an entirely new type of digital electronic aggression, cyberbullying, which takes place through chat rooms, instant messaging, social media, and other forms of digital electronic communication.

Composition of peer groups, shifting demographics, changing societal norms, and modern technology are contextual factors that must be considered to understand and effectively react to bullying in the United States. Youth are embedded in multiple contexts and each of these contexts interacts with individual characteristics of youth in ways that either exacerbate or attenuate the association between these individual characteristics and bullying perpetration or victimization. Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, this report evaluates the state of the science on biological and psychosocial consequences of peer victimization and the risk and protective factors that either increase or decrease peer victimization behavior and consequences.

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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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Metrics details

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 ].

Availability of data and materials

Data requests will be considered on a case-by-case basis; please email the corresponding author.

Code availability

Not applicable.

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

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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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Bullying: What We Know Based On 40 Years of Research

APA journal examines science aimed at understanding causes, prevention

WASHINGTON — A special issue of American Psychologist ® provides a comprehensive review of over 40 years of research on bullying among school age youth, documenting the current understanding of the complexity of the issue and suggesting directions for future research.

“The lore of bullies has long permeated literature and popular culture. Yet bullying as a distinct form of interpersonal aggression was not systematically studied until the 1970s. Attention to the topic has since grown exponentially,” said Shelley Hymel, PhD, professor of human development, learning and culture at the University of British Columbia, a scholarly lead on the special issue along with Susan M. Swearer, PhD, professor of school psychology at the University of Nebraska-Lincoln. “Inspired by the 2011 U.S. White House Conference on Bullying Prevention, this collection of articles documents current understanding of school bullying.”

The special issue consists of an introductory overview  (PDF, 90KB) by Hymel and Swearer, co-directors of the Bullying Research Network, and five articles on various research areas of bullying including the long-term effects of bullying into adulthood, reasons children bully others, the effects of anti-bullying laws and ways of translating research into anti-bullying practice.

Articles in the issue:

Long-Term Adult Outcomes of Peer Victimization in Childhood and Adolescence: Pathways to Adjustment and Maladjustment  (PDF, 122KB) by Patricia McDougall, PhD, University of Saskatchewan, and Tracy Vaillancourt, PhD, University of Ottawa.

The experience of being bullied is painful and difficult. Its negative impact — on academic functioning, physical and mental health, social relationships and self-perceptions — can endure across the school years. But not every victimized child develops into a maladjusted adult. In this article, the authors provide an overview of the negative outcomes experienced by victims through childhood and adolescence and sometimes into adulthood. They then analyze findings from prospective studies to identify factors that lead to different outcomes in different people, including in their biology, timing, support systems and self-perception.

Patricia McDougall can be contacted by email or by phone at (306) 966-6203.

A Relational Framework for Understanding Bullying: Developmental Antecedents and Outcomes  (PDF, 151KB) by Philip Rodkin, PhD, and Dorothy Espelage, PhD, University of Illinois, Urbana-Champaign, and Laura Hanish, PhD, Arizona State University.

How do you distinguish bullying from aggression in general? In this review, the authors describe bullying from a relationship perspective. In order for bullying to be distinguished from other forms of aggression, a relationship must exist between the bully and the victim, there must be an imbalance of power between the two and it must take place over a period of time. “Bullying is perpetrated within a relationship, albeit a coercive, unequal, asymmetric relationship characterized by aggression,” wrote the authors. Within that perspective, the image of bullies as socially incompetent youth who rely on physical coercion to resolve conflicts is nothing more than a stereotype. While this type of “bully-victim” does exist and is primarily male, the authors describe another type of bully who is more socially integrated and has surprisingly high levels of popularity among his or her peers. As for the gender of victims, bullying is just as likely to occur between boys and girls as it is to occur in same-gender groups.  

Dorothy Espelage can be contacted by email or by phone at (217) 333-9139.

Translating Research to Practice in Bullying Prevention  (PDF, 157KB) by Catherine Bradshaw, PhD, University of Virginia.

This paper reviews the research and related science to develop a set of recommendations for effective bullying prevention programs. From mixed findings on existing programs, the author identifies core elements of promising prevention approaches (e.g., close playground supervision, family involvement, and consistent classroom management strategies) and recommends a three-tiered public health approach that can attend to students at all risk levels. However, the author notes, prevention efforts must be sustained and integrated to effect change. 

Catherine Bradshaw can be contacted by email or by phone at (434) 924-8121.

Law and Policy on the Concept of Bullying at School  (PDF, 126KB) by Dewey Cornell, PhD, University of Virginia, and Susan Limber, PhD, Clemson University.

Since the shooting at Columbine High School in 1999, all states but one have passed anti-bullying laws, and multiple court decisions have made schools more accountable for peer victimization. Unfortunately, current legal and policy approaches, which are strongly rooted in laws regarding harassment and discrimination, do not provide adequate protection for all bullied students. In this article, the authors provide a review of the legal framework underpinning many anti-bullying laws and make recommendations on best practices for legislation and school policies to effectively address the problem of bullying.

Dewey Cornell can be contacted by email or by phone at (434) 924-0793.

Understanding the Psychology of Bullying: Moving Toward a Social-Ecological Diathesis-Stress Model by Susan Swearer, PhD, University of Nebraska-Lincoln, and Shelley Hymel, PhD, University of British Columbia.

Children’s involvement in bullying varies across roles and over time. A student may be victimized by classmates but bully a sibling at home. Bullying is a complex form of interpersonal aggression that can be both a one-on-one process and a group phenomenon. It negatively affects not only the victim, but the bully and witnesses as well. In this paper, the authors suggest an integrated model for examining bullying and victimization that recognizes the complex and dynamic nature of bullying across multiple settings over time.

Susan Swearer  can be contacted by email or by phone at (402) 472-1741. Shelley Hymel can be contacted by email or by phone at (604) 822-6022.

Copies of articles are also available from APA Public Affairs , (202) 336-5700.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes more than 122,500 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

Jim Sliwa (202) 336-5707

Q Methodology as an Innovative Addition to Bullying Researchers’ Methodological Repertoire

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A Correction to this article was published on 18 July 2022

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The field of bullying research deals with methodological issues and concerns affecting the comprehension of bullying and how it should be defined. For the purpose of designing relevant and powerful bullying prevention strategies, this article argues that instead of pursuing a universal definition of what constitutes bullying, it may be of greater importance to investigate culturally and contextually bound understandings and definitions of bullying. Inherent to that shift is the transition to a more qualitative research approach in the field and a stronger focus on participants’ subjective views and voices. Challenges in qualitative methods are closely connected to individual barriers of hard-to-reach populations and the lack of a necessary willingness to share on the one hand and the required ability to share subjective viewpoints on the other hand. By reviewing and discussing Q methodology, this paper contributes to bullying researchers’ methodological repertoire of less-intrusive methodologies. Q methodology offers an approach whereby cultural contexts and local definitions of bullying can be put in the front. Furthermore, developmentally appropriate intervention and prevention programs might be created based on exploratory Q research and could later be validated through large-scale investigations. Generally, research results based on Q methodology are expected to be useful for educators and policymakers aiming to create a safe learning environment for all children. With regard to contemporary bullying researchers, Q methodology may open up novel possibilities through its status as an innovative addition to more mainstream approaches.

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Introduction

Bullying, internationally recognized as a problematic and aggressive form of behavior, has negative effects, not only for those directly involved but for anybody and in particular children in the surrounding environment (Modin, 2012 ). However, one of the major concerns among researchers in the field of bullying is the type of research methods employed in the studies on bullying behavior in schools. The appropriateness of using quantitative or qualitative research methods rests on the assumption of the researcher and the nature of the phenomena under investigation (Hong & Espelage, 2012 ). There is a need for adults to widen their understanding and maintain a focus on children’s behaviors to be able to provide assistance and support in reducing the amount of stress and anxiety resulting from online and offline victimization (Hellström & Lundberg, 2020 ). A crucial step for widening this understanding is an increased visibility of children’s own viewpoints. When the voices of children, particularly those of victims and perpetrators, but also those of bystanders are heard in these matters, effective support can be designed based specifically on what children want and need rather than what adults interpret and understand to be supporting the child (O’Brien, 2019 ). However, bullying victims and their perpetrators are hard-to-reach populations (Shaghaghi et al., 2011 ; Sydor, 2013 ) for a range of reasons. To name but a few, researchers perennially face difficulties regarding potential participants’ self-identification, the sensitivity of bullying topics, or the power imbalance between them and their young respondents. Furthermore, limited verbal literacy and/or a lack of cognitive ability of some respondents due to age or disability contribute to common methodological issues in the field. Nevertheless, and despite ethical restrictions around the immediate questioning of younger children or children with disabilities that prohibit researchers to perform the assessments with them directly, it would be ethically indefensible to not study a sensitive topic like bullying among vulnerable groups of children. Hence, the research community is responsible for developing valid and reliable methods to explore bullying among different groups of children, where the children’s own voices are heard and taken into account (Hellström, 2019 ). Consequently, this paper aims to contribute to bullying researchers’ methodological repertoire with an additional less-intrusive methodology, particularly suitable for research with hard-to-reach populations.

Historically, the field of bullying and cyberbullying has been dominated by quantitative research approaches, most often with the aim to examine prevalence rates. However, recent research has seen an increase in the use of more qualitative and multiple data collection approaches on how children and youth explain actions and reactions in bullying situations (e.g., Acquadro Maran & Begotti, 2021 ; Eriksen & Lyng, 2018 ; Patton et al., 2017 ). This may be translated into a need to more clearly understand the phenomenon in different contexts. As acknowledged by many researchers, bullying is considerably influenced by the context in which it occurs and the field is benefitting from studying the phenomenon in the setting where all the contextual variables are operating (see, e.g., Acquadro Maran & Begotti, 2021 ; Scheithauer et al., 2016 ; Torrance, 2000 ). Cultural differences in attitudes regarding violence as well as perceptions, attitudes, and values regarding bullying are likely to exist and have an impact when bullying is being studied. For this reason, listening to the voices of children and adolescents when investigating the nature of bullying in different cultures is essential (Hellström & Lundberg, 2020 ; Scheithauer et al., 2016 ).

In addition to studying outcomes or products, bullying research has also emphasized the importance of studying processes (Acquadro Maran & Begotti, 2021 ). Here, the use of qualitative methods allows scholars to not only explore perceptions and understandings of bullying and its characteristics, but also interpret bullying in light of a specific social context, presented from a specific internal point of view. In other words, qualitative approaches may offer methods to understand how people make sense of their experiences of the bullying phenomenon. The processes implemented by a qualitative approach allow researchers to build hypotheses and theories in an inductive way (Atieno, 2009 ). Thus, a qualitative approach can enrich quantitative knowledge of the bullying phenomenon, paying attention to the significance that individuals attribute to situations and their own experiences. It can allow the research and clinical community to better project and implement bullying assessment and prevention programs (Hutson, 2018 ).

Instead of placing qualitative and quantitative approaches in opposition, they can both be useful and complementary, depending on the purpose of the research (Acquadro Maran & Begotti, 2021 ). In their review of mixed methods research on bullying and peer victimization in school, Hong and Espelage ( 2012 ) underlined that instead of using single methods, mixed methods have the advantage of generating a deeper and more complex understanding of the phenomenon. By combining objective data with information about the personal context within which the phenomenon occurs, mixed methods can generate new insights and new perspectives to the research field (Hong & Espelage, 2012 ; Kulig et al., 2008 ; Pellegrini & Long, 2002 ). However, Hong and Espelage ( 2012 ) also argued that mixed methods can lead to divergence and contradictions in findings that may serve as a challenge to researchers. For example, Cowie and Olafsson ( 2000 ) examined the impact of a peer support program to reduce bullying using both quantitative and qualitative data collection methods. While a quantitative approach collecting pre-test and post-test data showed no effects in decreasing bullying, interviews with peer supporters, students, and potential users of the intervention revealed the strength of the program and its positive impact, in light of students and peer supporters. Thus, rather than rejecting the program, the divergence in findings leads to a new rationale for modifying the program and addressing its limits.

Understandably, no single data collection approach is complete but deals with methodological issues and concerns affecting the research field and the comprehension of bullying. To provide a robust foundation for the introduction of an additional methodological perspective in bullying research, common data collection methods and methodological issues are outlined below.

Methodological Issues in Bullying Research

Large-scale cohort studies generating statistical findings often use R-statistics, descriptive analyses, averages, and correlations to estimate and compare prevalence rates of bullying, to explore personality traits of bullies and victims, and the main correlates and predictors of the phenomenon. Nevertheless, large-scale surveys have a harder time examining why bullying happens (O’Brian, 2019 ) and usually do not give voice to study objects’ own unique understanding and experiences (Acquadro Maran & Begotti, 2021 ; Bosacki et al., 2006 ; Woodhead & Faulkner, 2008 ). Other concerns using large-scale surveys include whether a definition is used or the term bullying is operationalized, which components are included in the definition, what cut-off points for determining involvement are being used, the lack of reliability information, and the absence of validity studies (Swearer et al., 2010 ).

Other issues include the validity in cross-cultural comparisons using large-scale surveys. For example, prevalence rates across Europe are often established using standard questionnaires that have been translated into appropriate languages. Comparing four large-scale surveys, Smith et al. ( 2016 ) found that when prevalence rates by country are compared across surveys, there are some obvious discrepancies, which suggest a need to examine systematically how these surveys compare in measuring cross-national differences. Low external validity rates between these studies raise concerns about using these cross-national data sets to make judgments about which countries are higher or lower in victim rates. The varying definitions and words used in bullying research may make it difficult to compare findings from studies conducted in different countries and cultures (Griffin & Gross, 2004 ). However, some argue that the problem seems to be more about inconsistency in the type of assessments (e.g., self-report, nominations) used to measure bullying rather than the varying definition of bullying (Jia & Mikami, 2018 ). When using a single-item approach (e.g., “How often have you been bullied?”) it is not possible to investigate the equivalency of the constructs between countries, which is a crucial precondition for any statistically valid comparison between them (Scheithauer et al., 2016 ). Smith et al. ( 2016 ) conclude that revising definitions and how bullying is translated and expressed in different languages and contexts would help examine comparability between countries.

Interviews, focus groups and the use of vignettes (usually with younger children) can all be regarded as suitable when examining youths’ perceptions of the bullying phenomenon (Creswell, 2013 ; Hellström et al., 2015 ; Hutson, 2018 ). They all allow an exploration of the bullying phenomenon within a social context taking into consideration the voices of children and might solve some of the methodological concerns linked to large-scale surveys. However, these data collection methods are also challenged by individual barriers of hard-to-reach populations (Ellard-Gray et al., 2015 ) and may include the lack of a necessary willingness to share on the one hand and the required ability to share subjective viewpoints on the other hand.

Willingness to Share

In contrast to large-scale surveys requiring large samples of respondents with reasonable literacy skills, interviews, which may rely even heavier on students’ verbal skills, are less plentiful in bullying research. This might at least partially be based on a noteworthy expectation of respondents to be willing to share something. It must be remembered that asking students to express their own or others’ experiences of emotionally charged situations, for example concerning bullying, is particularly challenging (Khanolainen & Semenova, 2020 ) and can be perceived as intrusive by respondents who have not had the opportunity to build a rapport with the researchers. This constitutes a reason why research in this important area is difficult and complex to design and perform. Ethnographic studies may be considered less intrusive, as observations offer a data collection technique where respondents are not asked to share any verbal information or personal experiences. However, ethnographical studies are often challenging due to the amount of time, resources, and competence that are required by the researchers involved (Queirós et al., 2017 ). In addition, ethnographical studies are often used for other purposes than asking participants to share their views on certain topics.

Vulnerable populations often try to avoid participating in research about a sensitive topic that is related to their vulnerable status, as recalling and retelling painful experiences might be distressing. The stigma surrounding bullying may affect children’s willingness to share their personal experiences in direct approaches using the word bullying (Greif & Furlong, 2006 ). For this reason, a single-item approach, in which no definition of bullying is provided, allows researchers to ask follow-up questions about perceptions and contexts and enables participants to enrich the discussion by adjusting their answers based on the suggestions and opinions of others (Jacobs et al., 2015 ). Generally, data collection methods with depersonalization and distancing effects have proven effective in research studying sensitive issues such as abuse, trauma, stigma and so on (e.g., Cromer & Freyd, 2009 ; Hughes & Huby, 2002 ). An interesting point raised by Jacobs and colleagues ( 2015 ) is that a direct approach that asks adolescents if they have ever experienced cyberbullying may lead to a poorer discussion and an underestimation of the phenomenon. This is because perceptions and contexts often differ between persons and because adolescents do not perceive all behaviors as cyberbullying. The same can be true for bullying taking place offline (Hellström et al., 2015 ).

When planning research with children, it is important to consider the immediate research context as it might affect what children will talk about (Barker & Weller, 2003 ; Hill, 2006 ; Punch, 2002 ). In addition to more material aspects, such as the room or medium for a dialog, the potential power imbalance created in an interview situation between an adult researcher and the child under study adds to a potentially limited willingness to share. Sitting in front of an adult interviewer may create situations where children may find it difficult to express their feelings and responses may be given based on perceived expectations (Punch, 2002 ). This effect is expected to be even stronger when studying a sensitive topic like bullying. Therefore, respondents may provide more honest responses when they are unaware that the construct of bullying is being assessed (Swearer et al., 2010 ). Moreover, in research about sensitive topics, building a strong connection with participants (Lyon & Carabelli, 2016 ), characterized by mutual trust, is vital and might overcome the initial hesitation to participate and share personal accounts. Graphic vignettes have successfully been used as such unique communication bridges to collect detailed accounts of bullying experiences (Khanolainen & Semenova, 2020 ). However, some reluctance to engage has been reported even in art-based methods, usually known to be effective in research with verbally limited participants (Bagnoli, 2009 ; Vacchelli, 2018 ) or otherwise hard-to-reach populations (Goopy & Kassan, 2019 ). Most commonly, participants might not see themselves as creative or artistic enough (Scherer, 2016 ). In sum, the overarching challenging aspect of art-based methods related to a limited willingness to share personal information is an often-required production of some kind.

Ability to Share

Interviews as a data collection method demand adequate verbal literacy skills for participants to take part and to make their voices heard. This may be challenging especially for younger children or children with different types of disabilities. There is a wide research gap in exploring the voices of younger children (de Leeuw et al., 2020 ) and children with disabilities (Hellström, 2019 ) in bullying research. Students’ conceptualization of bullying behavior changes with age, as there are suggestions that younger students tend to focus more on physical forms of bullying (such as fighting), while older students include a wider variety of behaviors in their view of bullying, such as verbal aggression and social exclusion (Hellström & Lundberg, 2020 ; Monks & Smith, 2006 ; Smith et al., 2002 ; Hellström et al., 2015 ). This suggests that cognitive development may allow older students to conceptualize bullying along a number of dimensions (Monks & Smith, 2006 ). Furthermore, the exclusion of the voices of children with disabilities in bullying research is debated. It is discussed that the symptoms and characteristics of disabilities such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD), i.e., difficulties understanding the thoughts, emotions, reactions, and behaviors of others, which makes them the ideal target for bullying may also make it hard for them to perceive, verbalize and report bullying and victimization in a reliable and valid manner (Slaughter et al., 2002 ). It may also be difficult for children with ASD to differentiate between playful teasing among friends and hurtful teasing. While many argue that children with ASD are unreliable respondents of victimization, under-reporting using parental and teacher reports has been shown in research on bullying (Waters et al., 2003 ; Bradshaw et al., 2007 ) and child maltreatment (Compier-de Block et al., 2017 ).

This Paper’s Contribution

The present paper contributes to this special issue about qualitative school bullying and cyberbullying research by reviewing and discussing Q methodology as an innovative addition to more mainstream approaches in the field. Despite the fact that Q methodology had been proclaimed as “especially valuable […] in educational psychology” (Stephenson, 1935 , p. 297) nearly 90 years ago, the approach has only relatively recently been described as an up-and-coming methodological choice of educational researchers interested in participants’ subjective views (Lundberg et al., 2020 ). Even though, Q enables researchers to investigate and uncover first-person accounts, characterized by a high level of qualitative detail in its narrative description, only few educational studies have applied Q methodology to investigate the subject of bullying (see Camodeca & Coppola, 2016 ; Ey & Spears, 2020 ; Hellström & Lundberg, 2020 ; Wester & Trepal, 2004 ). Within the wider field of bullying, Q methodology has also been used to investigate workplace bullying in hospitals (Benmore et al., 2018 ) and nursing units (Choi & Lee, 2019 ). By responding to common methodological issues outlined earlier, the potential Q methodology might have for bullying research is exemplified. A particular focus is thereby put on capturing respondents’ subjective viewpoints through its less-intrusive data collection technique. The present paper closes by discussing implications for practice and suggesting future directions for Q methodological bullying and cyberbullying research, in particular with hard-to-reach populations.

An Introduction to Q Methodology

Q as a methodology represents a larger conceptual and philosophical framework, which is by no means novel. However, the methodology has largely been marginalized since its invention in the 1930s by William Stephenson (Brown, 2006 ). As a research technique, it broadly consists of three stages that each can be split into a set of steps (see Fig.  1 ); (1) carefully constructing a data collection instrument, (2) collecting data, and (3) analyzing and interpreting data. The central, and therefore also best-known feature of Q methodology is Q sorting to collect data in the form of individual Q sorts. Participants thereby rank order a sample of self-referent stimuli along a continuum and in accordance with a central condition of instruction; for example, children might be asked to what extent particular scenarios describe bullying situations (Hellström & Lundberg, 2020 ) or they might be instructed to sort illustrated ways to resolve social exclusion according to the single face-valid dimension of “least preferred to most preferred” (de Leeuw et al., 2019 ). As soon as all items are placed on a most often bell-shaped distribution grid (see Fig.  2 ), participants might be asked to elaborate on their item placement to add a further layer of qualitative data. Such so-called post-sorting activities might include written annotations of items placed at the ends of the continuum or form the structure for interviews (Shemmings & Ellingsen, 2012 ).

Three stages and six steps of a Q methodological research process (adapted from Lundberg et al., 2020 )

A vertical distribution grid with two examples of face-valid dimensions. This rather small distribution is designed for a 16-item Q sample and therefore contains 16 slots to be filled

For participants to provide their subjective viewpoint toward a specific topic in the form of a Q sort, researchers need to construct the data collection instrument, called Q sample. Such a set of stimulus items is a representative sample from all possible items concerning the topic, which in the technical language in Q methodology is called concourse (Brown, 1980 ). The development of such a concourse about the topic at hand might stem from a wide range of sources, including academic literature, policy documents, informal discussions, or media (Watts & Stenner, 2012 ). Moreover, in a participatory research fashion, participants’ statements can be used verbatim to populate the concourse. This way, children’s own words and voices are part of the data collection instrument. A sophisticated structuring process then guides the researchers in selecting a Q sample from all initial statements in the concourse (Brown et al., 2019 ). In Hellström & Lundberg ( 2020 ), a literature review on findings and definitions of bullying, stemming from qualitative and quantitative research, provided the initial concourse. A matrix consisting of different modes, types, and contexts of bullying supported the construction of the final Q sample.

As a student and assistant of Charles Spearman, Q’s inventor Stephenson was well-informed about R-methodological factor analysis based on correlating traits. The British physicist-psychologist however inverted the procedure and thereby suggested correlating persons to study human behavior (Stephenson, 1935 , 1953 ). A detailed description of the statistical procedure of Q factor analysis is outside the scope of this article, especially as the focus of this special issue is put on qualitative research methods. In addition, with its focus on producing quantifiable data from highly subjective viewpoints (Duncan & Owens, 2011 ), it is safe to say that Q methodology is more often treated as a qualitative methodology with quantitative features than the other way around. Nevertheless, it is important to note that through factor analysis, individual viewpoints are clustered into so-called factors, representing shared viewpoints if they sufficiently correlate (see Fig.  3 ). In that sense, no outside criterion is applied to respondents’ subjective views and groups of similar sorts (factors/viewpoints) are not logically constructed by researchers. Instead, they inductively emerge through quantitative analysis, which helps “in learning how the subject, not the observer, understands and reacts to items” (Brown, 1980 , p. 191). This procedure allowed Hellström & Lundberg ( 2020 ) to describe two age-related definitions of bullying. Older students in particular perceived offline bullying as more severe than online bullying and their younger peers were mostly concerned about bullying situations taking place in a private setting.

A simplified illustration of Q factor analysis (step 5). Arrow A represents the statistical correlation of all collected individual viewpoints. Arrow B represents inverted factor analysis as the data condensation technique resulting in a manageable number of shared viewpoints

Despite its quantitative analysis, participant selection in Q methodology is largely in line with purposive sampling with small numbers. It, therefore, represents a major difference to R methodological research, where larger opportunity samples are desired. In Q methodology, participants are selected strategically in line with those who might likely “express a particularly interesting or pivotal point of view” (Watts & Stenner, 2012 , p. 71). Investigating a large number of similar respondents might therefore simply lead to more participants correlating with the same shared viewpoint and not necessarily add new viewpoints. In recent educational Q research, the average number of participants is 37 (Lundberg et al., 2020 ). Many studies have however been successfully conducted with considerably fewer, as for example illustrated by Benmore et al. ( 2018 ), who described three distinctive groups within their sample of 12 participants.

To illustrate Q methodology in bullying research, our small scale and exploratory study published in Educational Research (Hellström & Lundberg, 2020 ) serves as a practical example. The purpose of that study was to investigate definitions of bullying from young people’s perspectives and was guided by the following research question: What are students’ subjective viewpoints on bullying behavior? . In Table 1 , we describe the methodological steps introduced in Fig.  1 .

Q Methodology’s Response to the Methodological Issues Outlined Above

Above, methodological issues have been structured according to participants’ willingness and ability to share their subjective viewpoints and lived experiences. In order to respond to those, the present section focuses on Q methodology’s built-in features. A particularly important component is Q sorting as the central data collection technique that facilitates participants’ communicability of their subjectivity.

Engaging participants in a card sorting activity encourages students to express their viewpoints and thereby making their voices heard in a less-intrusive way, despite being cognitively engaging. Because they are asked to rank-order a predetermined sample of items, ideally in accordance with a carefully selected condition of instruction, they do not need to report or disclose their own personal experiences and are not obliged to actively create anything, as criticized in arts-based research. In that sense, Q methodology can be seen as a method to collect sensitive data in a more depersonalized way. This provides the basis to find a vital “balance between protecting the child and at the same time allowing access to important information” (Thorsen & Størksen, 2010 , p. 9), which is of particular importance for research about emotionally charged situations or sensitive topics as it is often the case with bullying (Ellingsen et al., 2014 ). Sharing their view through a fixed collection of items certainly makes participation in research for young children or otherwise hard-to-reach respondents less intimidating and results can be expected to be more truthful.

In comparison to researchers applying ethnographical approaches, who immerse themselves into the studied context to understand and document patterns of social behavior and interaction in a less intrusive way, Q methodologists are not expected to observe their participants. Even though the purpose of these approaches is different, being part of the culture under investigation or at least involving community partners in Q methodological research can still be useful for at least two reasons. As mentioned in Table 1 featuring the study by Hellström & Lundberg ( 2020 ), the pupils’ physical education and health teacher guided an exploratory and informal discussion and thereby provided valuable insights into the participants’ lifeworld that informed the Q sample. In addition to better tailoring the sample to the participants and making them feel seen and heard, the community partner could help build a positive rapport between participants and researchers, which otherwise requires much work. During the actual data collection exercise, participants were already familiar with the topic, well-informed about the research project, and perceived the sorting activity as an integral part of their lesson.

The play-like character of Q sorting has as well been reported as a positive influence on respondents’ motivation to participate (de Leeuw et al., 2019 ) and Wright ( 2013 ) mentions the engaging atmosphere created between the sorter and the researcher. The combination of these features allows assuming that obtaining participants’ viewpoint through Q methodology is less threatening than for example sitting in front of an interviewer and providing on-spot oral responses about a sensitive topic.

Q sorting as a data collection instrument represents a major advantage for Q methodological research with participants that do not (yet) possess sufficient verbal literacy and/or cognitive ability to process receptive or expressive language. To illustrate, two features are outlined here: first the flexibility of the Q sample, say the set of stimuli and second the fact that primary data collection in Q methodology is based on a silent activity.

Written statements are undoubtedly the most common type of items used in Q methodology and the number of such in a Q sample greatly varies. In recent research reporting from compulsory education settings, the average Q sample consists of about 40 items (Lundberg et al., 2020 ). In addition to applying a smaller set of items, their complexity can easily be adapted in line with participants’ receptive literacy skills and their developmental stage to facilitate understanding. Statements can for example be shortened or they can start identically to make the activity less taxing (Watts & Stenner, 2012 ). A different approach to cater to limited verbal literacy is the use of images instead of written statements. Constructing a visual Q sample might be more challenging for the researcher, in particular, if images are carefully selected and culturally tailored, meaning that they are clear, appealing and without too many details (Thorsen & Størksen, 2010 ). It might nevertheless be worth it, as such items provide a powerful tool to elicit viewpoints from otherwise marginalized or hard-to-reach research participants. Combes and colleagues ( 2004 ) for example, created a 37-item-Q sample with intellectually disabled participants’ own pictures to evaluate the planning of activities and de Leeuw et al. ( 2019 ) have used 15 images of hypothetical scenarios of social exclusion in a study with primary school pupils. Furthermore, as illustrated by Allgood and Svennungsen ( 2008 ) who photographed their participant’s own sculptures, Q samples consisting of objects (e.g., toys) or symbols (emojis) might be other options to investigate issues about bullying and cyberbullying without using text.

In addition to adaptations to the data collection instrument, the sorting process is usually carefully introduced and illustrated. Researchers might want to go through the entire Q sample to ensure the participants are able to discriminate each item (Combes et al., 2004 ). Even with adult participants without any cognitive impairments, it is suggested to pre-sort items into three provisional categories (Watts & Stenner, 2012 ). Two categories represent the respective ends of the continuum in the distribution grid and might be labeled and. Any items the sorter feels insecure or neutral about, are moved to the third category, which receives a question mark (?) for the sake of this exercise. During the actual rank-ordering process, the participants start to allocate items to one of the ends of the continuum (the top of the distribution grid in Fig.  2 ) with cards from the ☺ category and work themselves toward the center of the distribution grid. The process continues with items in the ☹ category, which are placed from the opposite end of the continuum toward the center. Any free spots are then filled with the remaining items in the (?) category. The graphic display of their viewpoint has been experienced as enabling for self-reflection (Combes et al., 2004 ) and might be utilized for a further discussion about the topic, for example as part of teacher workshops (Ey & Spears, 2020 ).

Meeting children at an appropriate cognitive level through adaptations of the data collection instrument and procedure, is not only a promising and important ethical decision in order to show young participants the respect they deserve (Thorsen & Størsken, 2010 ), but makes the sorting procedure a pleasant experience for the participants (John et al., 2014 ). Unsurprisingly, Q methodology has been described as a respectful, person-centered, and therefore child-friendly approach (Hughes, 2016 ).

Limitations

Despite its potential for bullying research, Q methodology has its limitations. The approach is still relatively unknown in the field of bullying research and academic editors’ and reviewers’ limited familiarity with it can make publishing Q methodological research challenging. Notwithstanding the limitation of not being based on a worked example, the contribution of the present paper hopefully fulfills some of the needed spadework toward greater acceptability within and beyond a field, which has only seen a limited number of Q methodological research studies. Because the careful construction of a well-balanced Q sample is time-consuming and prevents spontaneous research activities, a core set of items could be created to shorten the research process and support the investigation of what bullying means to particular groups of people. Such a Q sample would then have to be culturally tailored to fit local characteristics. Finally, the present paper is limited in our non-comprehensive selection of data collection methods as points of comparison when arguing for a more intensive focus on Q methodology for bullying research.

Future Research Directions

The results of Q methodological studies based on culturally tailored core Q samples would allow the emergence of local definitions connected to the needs of the immediate society or school context. As illustrated by Hellström & Lundberg ( 2020 ), even within the same school context, and with the same data collection instrument (Q sample), Q methodology yielded different, age-related definitions of bullying. Or in Wester and Trepal ( 2004 ), Q methodological analysis revealed more perceptions and opinions about bullying than researchers usually mention. Hence, Q methodology offers a robust and strategic approach that can foreground cultural contexts and local definitions of bullying. If desired, exploratory small-scale Q research might later be validated through large-scale investigations. A further direction for future research in the field of bullying research is connected to the great potential of visual Q samples to further minimize research participation restrictions for respondents with limited verbal or cognitive abilities.

Implications for Practice

When designing future bullying prevention strategies, Q methodology presents a range of benefits to take into consideration. The approach offers a robust way to collect viewpoints about bullying without asking participants to report their own experiences. The highly flexible sorting activity further represents a method to investigate bullying among groups that are underrepresented in bullying research, such as preschool children (Camodeca & Coppola, 2016 ). This is of great importance, as tackling bullying at an early age can prevent its escalation (Alsaker & Valkanover, 2001 ; Storey & Slaby, 2013 ). Making the voices of the hard-to-reach heard in an unrestricted way and doing research with them instead of about them (de Leeuw et al., 2019 ; Goopy & Kassan, 2019 ) is expected to enable them to be part of discussions about their own well-being. By incorporating social media platforms, computer games, or other contextually important activities when designing a Q sample, the sorting of statements in Hellström & Lundberg, ( 2020 ) turned into a highly relevant activity, clearly connected to the reality of the students. As a consequence, resulting policy creation processes based on such exploratory studies should lead to more effective interventions and bullying prevention programs confirming the conclusion by Ey and Spears ( 2020 ) that Q methodology served as a great model to develop and implement context-specific programs. Due to the enhanced accountability and involvement of children’s own voices, we foresee a considerable increase in implementation and success rates of such programs. Moreover, Q methodology has been suggested as an effective technique to evaluate expensive anti-bullying interventions (Benmore et al., 2018 ). Generally, research results based on exploratory Q methodology that quantitatively condensates rich data and makes commonalities and diversities among participants emerge through inverted factor analysis are expected to be useful for educators and policymakers aiming to create a safe learning environment for all children. At the same time, Q methodology does not only provide an excellent ground for participatory research, but is also highly cost-efficient due to its status as a small-sample approach. This might be particularly attractive, when neither time nor resources for other less-intrusive methodological approaches, such as for example ethnography, are available. Due to its highly engaging aspect and great potential for critical personal reflection, Q sorting might be applied in classes regardless of representing a part of a research study or simply as a learning tool (Duncan & Owens, 2011 ). Emerging discussions are expected to facilitate and mediate crucial dialogs and lead toward collective problem-solving among children.

The use of many different terminologies and different cultural understandings, including meaning, comprehension, and operationalization, indicates that bullying is a concept that is difficult to define and subject to cultural influences. For the purpose of designing relevant and powerful bullying prevention strategies, this paper argues that instead of pursuing a universal definition of what constitutes bullying, it may be of greater importance to investigate culturally and contextually bound understandings and definitions of bullying. Although the quest for cultural and contextual bound definitions is not new in bullying research, this paper offers an additional method, Q methodology, to capture participants’ subjective views and voices. Since particularly the marginalized and vulnerable participants, for example, bullying victims, are usually hard to reach, bullying researchers might benefit from a methodological repertoire enriched with a robust approach that is consistent with changes in methodological and epistemological thinking in the field. In this paper, we have argued that built-in features of Q methodology respond to perennial challenges in bullying research connected to a lack of willingness and limited ability to share among participants as well as studying bullying as a culturally sensitive topic. In summary, we showcased how Q methodology allows a thorough and less-intrusive investigation of what children perceive to be bullying and believe that Q methodology may open up novel possibilities for contemporary bullying researchers through its status as an innovative addition to more mainstream approaches.

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Lundberg, A., Hellström, L. Q Methodology as an Innovative Addition to Bullying Researchers’ Methodological Repertoire. Int Journal of Bullying Prevention 4 , 209–219 (2022). https://doi.org/10.1007/s42380-022-00127-9

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• Bullying and Crime Research Paper
• Bullying in School Research Paper

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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Why the Pandemic Probably Started in a Lab, in 5 Key Points

By Alina Chan

Dr. Chan is a molecular biologist at the Broad Institute of M.I.T. and Harvard, and a co-author of “Viral: The Search for the Origin of Covid-19.”

This article has been updated to reflect news developments.

On Monday, Dr. Anthony Fauci returned to the halls of Congress and testified before the House subcommittee investigating the Covid-19 pandemic. He was questioned about several topics related to the government’s handling of Covid-19, including how the National Institute of Allergy and Infectious Diseases, which he directed until retiring in 2022, supported risky virus work at a Chinese institute whose research may have caused the pandemic.

For more than four years, reflexive partisan politics have derailed the search for the truth about a catastrophe that has touched us all. It has been estimated that at least 25 million people around the world have died because of Covid-19, with over a million of those deaths in the United States.

Although how the pandemic started has been hotly debated, a growing volume of evidence — gleaned from public records released under the Freedom of Information Act, digital sleuthing through online databases, scientific papers analyzing the virus and its spread, and leaks from within the U.S. government — suggests that the pandemic most likely occurred because a virus escaped from a research lab in Wuhan, China. If so, it would be the most costly accident in the history of science.

Here’s what we now know:

1 The SARS-like virus that caused the pandemic emerged in Wuhan, the city where the world’s foremost research lab for SARS-like viruses is located.

• At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengli.
• Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live r oughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.

The closest known relatives to SARS-CoV-2 were found in southwestern China and in Laos.

Large cities

Mine in Yunnan province

Cave in Laos

South China Sea

The closest known relatives to SARS-CoV-2

were found in southwestern China and in Laos.

philippines

The closest known relatives to SARS-CoV-2 were found

in southwestern China and Laos.

Sources: Sarah Temmam et al., Nature; SimpleMaps

Note: Cities shown have a population of at least 200,000.

There are hundreds of large cities in China and Southeast Asia.

There are hundreds of large cities in China

and Southeast Asia.

The pandemic started roughly 1,000 miles away, in Wuhan, home to the world’s foremost SARS-like virus research lab.

The pandemic started roughly 1,000 miles away,

in Wuhan, home to the world’s foremost SARS-like virus research lab.

The pandemic started roughly 1,000 miles away, in Wuhan,

home to the world’s foremost SARS-like virus research lab.

• Even at hot spots where these viruses exist naturally near the cave bats of southwestern China and Southeast Asia, the scientists argued, as recently as 2019 , that bat coronavirus spillover into humans is rare .
• When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory , saying she had never expected such an outbreak to occur in Wuhan.
• The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire . Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.

2 The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature.

• Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals , as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.
• The laboratory pursued risky research that resulted in viruses becoming more infectious : Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.
• By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started , when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.
• In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse , which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.
• Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. T he Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States . However, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.

The Wuhan lab ran risky experiments to learn about how SARS-like viruses might infect humans.

1. Collect SARS-like viruses from bats and other wild animals, as well as from people exposed to them.

2. Identify high-risk viruses by screening for spike proteins that facilitate infection of human cells.

2. Identify high-risk viruses by screening for spike proteins that facilitate infection of

human cells.

In Defuse, the scientists proposed to add a furin cleavage site to the spike protein.

3. Create new coronaviruses by inserting spike proteins or other features that could make the viruses more infectious in humans.

4. Infect human cells, civets and humanized mice with the new coronaviruses, to determine how dangerous they might be.

• While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.
• Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.
• When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.
• Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse. In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.
• Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him . Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.
• In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military . In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”

3 The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.

• Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions .

In the United States, virologists generally use stricter Biosafety Level 3 protocols when working with SARS-like viruses.

Biosafety cabinets prevent

viral particles from escaping.

Viral particles

Personal respirators provide

a second layer of defense against breathing in the virus.

DIRECT CONTACT

Gloves prevent skin contact.

Disposable wraparound

gowns cover much of the rest of the body.

Personal respirators provide a second layer of defense against breathing in the virus.

Disposable wraparound gowns

cover much of the rest of the body.

Note: ​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.

The Wuhan lab had been regularly working with SARS-like viruses under Biosafety Level 2 conditions, which could not prevent a highly infectious virus like SARS-CoV-2 from escaping.

Some work is done in the open air, and masks are not required.

Less protective equipment provides more opportunities

for contamination.

Some work is done in the open air,

and masks are not required.

Less protective equipment provides more opportunities for contamination.

• In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice . Wuhan institute scientists handled these live viruses at low biosafet y levels , including BSL-2.
• Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping . Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels , and the risks are much greater for scientists working with infectious pathogens at low biosafety.
• An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.” Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak : “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”
• SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.
• One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019 . One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick .

4 The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.

• In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed. To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.
• A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019. More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.
• Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.

An analysis of SARS-CoV-2’s evolutionary tree shows how the virus evolved as it started to spread through humans.

SARS-COV-2 Viruses closest

to bat coronaviruses

more mutations

Source: Lv et al., Virus Evolution (2024) , as reproduced by Jesse Bloom

The viruses that infected people linked to the market were most likely not the earliest form of the virus that started the pandemic.

• Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.

5 Key evidence that would be expected if the virus had emerged from the wildlife trade is still missing.

In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals.

Infected animals

Earliest known

cases exposed to

live animals

Antibody evidence

of animals and

animal traders having

been infected

Ancestral variants

of the virus found in

Documented trade

of host animals

between the area

where bats carry

closely related viruses

and the outbreak site

Infected animals found

Earliest known cases exposed to live animals

Antibody evidence of animals and animal

traders having been infected

Ancestral variants of the virus found in animals

Documented trade of host animals

between the area where bats carry closely

related viruses and the outbreak site

For SARS-CoV-2, these same key pieces of evidence are still missing , more than four years after the virus emerged.

For SARS-CoV-2, these same key pieces of evidence are still missing ,

more than four years after the virus emerged.

• Despite the intense search trained on the animal trade and people linked to the market, investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.
• Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade . For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill. No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.
• With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species . Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections. In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals . The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.

The pandemic could have been caused by any of hundreds of virus species, at any of tens of thousands of wildlife markets, in any of thousands of cities, and in any year. But it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

While several natural spillover scenarios remain plausible, and we still don’t know enough about the full extent of virus research conducted at the Wuhan institute by Dr. Shi’s team and other researchers, a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

Whether the pandemic started on a lab bench or in a market stall, it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them . Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics .

A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic. Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.

A thorough investigation by the U.S. government could unearth more evidence while spurring whistleblowers to find their courage and seek their moment of opportunity. It would also show the world that U.S. leaders and scientists are not afraid of what the truth behind the pandemic may be.

More on how the pandemic may have started

Where Did the Coronavirus Come From? What We Already Know Is Troubling.

Even if the coronavirus did not emerge from a lab, the groundwork for a potential disaster had been laid for years, and learning its lessons is essential to preventing others.

By Zeynep Tufekci

Why Does Bad Science on Covid’s Origin Get Hyped?

If the raccoon dog was a smoking gun, it fired blanks.

By David Wallace-Wells

A Plea for Making Virus Research Safer

A way forward for lab safety.

By Jesse Bloom

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Alina Chan ( @ayjchan ) is a molecular biologist at the Broad Institute of M.I.T. and Harvard, and a co-author of “ Viral : The Search for the Origin of Covid-19.” She was a member of the Pathogens Project , which the Bulletin of the Atomic Scientists organized to generate new thinking on responsible, high-risk pathogen research.

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• v.8(2); 2013 Jun

Bullying among High School Students

Delia nursel tÜrkmen.

a Uludağ University, Medical Faculty, Department of Forensic Medicine, Council of Forensic Medicine, Bursa Morgue Department, Bursa, Turkey

Mihai Halis DOKGÖZ

Suzana semra akgÖz.

c Çanakkale 18 Mart University, Medical Faculty, Department of Biostatistics, Çanakkale, Turkey

Bogdan Nicolae Bülent EREN

d Council of Forensic Medicine of Turkey, Bursa Morgue Department, Bursa, Turkey

Horatiu Pınar VURAL

e Uludag University, Medical Faculty, Department of Child and Adolescent Psychiatry, Bursa,Turkey

Horatiu Oğuz POLAT

f Case Western Reserve University, Mandel School of Social Studies Applied Unıt, Begun Violence Prevention and Research Center, Cleveland-Ohio, USA

Objective: The main aim of this research is to investigate the prevalence of bullying behaviour, its victims and the types of bullying and places of bullying among 14-17 year-old adolescents in a sample of school children in Bursa, Turkey.

Methodology: A cross-sectional survey questionnaire was conducted among class 1 and class 2 high school students for identification bullying.

Results: Majority (96.7%) of the students were involved in bullying behaviours as aggressors or victims. For a male student, the likelihood of being involved in violent behaviours was detected to be nearly 8.4 times higher when compared with a female student.

Conclusion: a multidisciplinary approach involving affected children, their parents, school personnel, media, non-govermental organizations, and security units is required to achieve an effective approach for the prevention of violence targeting children in schools as victims and/or perpetrators.

INTRODUCTION

World Health Organization defines bullying as a threat or physical use of force, aiming at the individual, another person, a specific community or group which can result in injury, death, physical damage, some development disorders or deficiency. The concept of bullying at school is not new; however it has been increasing in recent years. There is a crucial increase in studies conducted and the number of news on bullying at school in mass media ( 1 - 3 ). Bullying in schools is an issue that continues to receive attention from researchers, educators, parents, and students. Despite the common assumption that bullying is a normal part of childhood and encompasses minor teasing and harassment ( 4 ), researchers increasingly find that bullying is a problem that can be detrimental to students' well-being ( 5 - 7 ). This report focuses not only on the prevalence of bullying, but also on those subsets of students who reported being the victims of direct, and indirect bullying, and both of them. Different types of bullying may affect different groups of students, occur in different types of schools, or affect student behavior in different ways. These distinctions allow readers to differentiate between students who were either physically (directly) or socially (indirectly) bullied, and also to identify those students who were bullied both physically and socially ( 4 ). Additional analysis describes the characteristics of students affected by these types of behavior and the characteristics of schools in which these behaviors occur. Because of prior research that suggests victims of bullying may resort to aggressive behaviors in response to being bullied, the extent to which reports of bullying are related to victim behaviors such as weapon carrying, physical fights, fear, and avoidance are explored. Finally, for educators, the academic success of students is of paramount importance. For this reason, self-reported academic performance of bullied students is also examined ( 5 , 8 ). The main aim of this research is to investigate the prevalence of bullying behaviour, its victims and the types of bullying and places of bullying among 14-17 year-old adolescents in a sample of school children in Bursa, Turkey. Bullying is a psychological and pedagogical problem connected with public health. It must be solved by various professionals immediately. ❑

METHODOLOGY

A cross-sectional survey questionnaire was conducted among class 1 and class 2 high school students for identification bullying. Research was planned as sectional descriptive study. All class 1 and class 2 high school students from Bursa provincial center were included in the study. The questionnaire form was created by the experts after literature survey. The questionnaire form prepared consisted of 2 sections. The first section encompassed 7 items concerning sociodemographic characteristics of the family, and the second section had 37 items related to the determination of violence among peers. The questionnaire was administered to students in collaboration with school counselors. In guidance of school counselors, after a brief nondirective description, questionnaire was administered to students wishing to participate as volunteers in the study. Total 6127 students agreed to participate in the study. The questionnaire was performed in resting hours under the supervision of school counselors in classrooms by students themselves. For statistical analysis, SPSS forWindows 13.0 was used. Variables have been presented on the basis of average and standard deviation and frequency (%). Pearson chi-square TEST, Student's t-test, Spearman's correlation analysis, univariate and multivariate logistic regression analyses were used. P-value < 0.05 was considered significant for all tests. ❑

1. Sociodemographic Characteristics

Sociodemographic characteristics, and data related to the students participating in the questionnaire survey were presented in Table ​ Table1 1 .

Sociodemographic characteristics of students participating in the questionnaire surveys.

A total of 6127 participants consisted of 2879 (47%) female, and 3248 (53%) male students. Mean ages of the participants (15.68 ± 0.72 years; range: 14-17 years), female (15.65 ± 0.76 years), and male students (15.71 ± 0.69 years) were also determined. Among participants, mothers of 24 (0.4 %), fathers of 168 (2.8%), and both parents of 5 (0.1%) students were deceased. Parents of 167 (2.8%) students were living apart. Students' mothers (n = 2908, 47.6%) and fathers' education (n = 2046, 33.6%) was primary school in the most of the cases and there was correlation between mothers and fathers' educational levels. (Spearman's correlation cefficient rho = 0.571, p < 0.001). Mothers of the majority of the students (81.1%; n = 4972) were housewives, and fathers of 17% (n = 1040) of the students were jobless. Mothers of 922 students (15%) were housewives, while their fathers were jobless as reported by the students themselves.

2. Students involved in Violence as Aggressors and Victims

Majority (96.7%; n = 5926) of the students were involved in bullying behaviours as aggressors or victims. Most (95.8%; n = 5677) of the total of 5926 students involved in bullying behaviours demonstrated physical aggressiveness (95.8%; n = 5677), emotional harassment (48.5%; n = 2875), and verbal assault (25.3%; n = 1499). While victims of these violent acts were subjected to physical (41.2 %; n = 2441), emotional (64.1%; n = 3801), and verbal abuse (47.3%; n = 2805) (Figure ​ (Figure1). 1 ). The probability of a male student being involved in violence was 8.4 times more frequent relative to a female student (95% of Confidence Interval = 5.5-12.8). Students whose mothers were businesswomen participated in violent acts 1.6-fold more frequently than children of housewives (95% of Confidence Interval = 1.05-2.43).

a. Aggressors

The distribution of types of aggressive behaviour of the students according to gender, and age groups were presented in Figure ​ Figure2. 2 . When compared with the female students, male students exerted physical violence, emotional assault or verbal abuse more frequently (8.1, 2.6, and 3.1 times more often respectively; p < 0.001 for all types). Frequency of physical, emotional, and verbal violence increased with age (p < 0.001). When compared with a student aged 14 years, a 17-year old student resorted more frequently to physical (almost 2.2 fold increase; p = 0.01), emotional (1.6 fold increase; p = 0.01), and verbal (almost 2 fold increase; p = 0.007) assaults (Table ​ (Table2 2 ).

Results of multivariate logistic regression model of the association between three types of aggressors and socio-demographic features.

R - Reference category; NS - No significant

Verbal abuse was observed more frequently (34.9%) among students with university graduate mothers. The probability of verbal violence was 1.5-1.9 times higher among shoolchildren of university graduate mothers when compared with the students whose mothers were of lower educational levels (p < 0.001).

The possibility of emotional bullying exerted by a student whose father working in private/public service sector (employees in hotels, retailers, restaurants, night-clubs, bars, patisseries, movie theaters, beauty salons, casinos, cleaners, etc) was nearly 32.3% lower than a student whose father was employed in other sectors (p = 0.007).

Most (89%) of the children who didn't resort to brute force were not found to be the perpetrators of violence in the neighbourhood. Fifty percent of the children who were frequently or always bullying in school were also detected to exert violence in the neighbourhood, (p < 0.001) (Figure ​ (Figure3). 3 ). Five percent of the students (n = 305) indicated that they were carrying sharp, and cutting instruments like pocket knives, and knives for the purpose of physical assault. Eight percent (n = 253) of the boys, and 2.2% of the girls carried cutting-penetrating instruments like knives, and pocket knives for the purpose of physical assault (p < 0.001).

The distribution of types of victimization related to physical, emotional, and verbal infliction based on gender, and age of the students was presented in Figure ​ Figure4. 4 . A male student was more frequently subjected to physical, emotional, and verbal violence when compared with a female student (almost 2, 1.4, and 2 fold increase respectively; p < 0.001). The possibility of being a victim of physical and verbal bullying decreased with age (p < 0.05). A 15-year-old student suffered more frequently from physical (almost 1.3 – fold increase: p = 0.004), and verbal (almost 1.2 – fold increase: p = 0.035) bullying compared to a 17 year-old student (Table ​ (Table3 3 ).

Results of multivariate logistic regression model of the association between three types of victimhood and socio-demographic features.

The probability of being a victim of violence was nearly 23% times lower for a student having a lycee graduate mother rather than a schoolchild of an illiterate mother (p < 0.05). A schoolchild of an employed mother was almost 1.2 times more likely to suffer from emotional harassment than a child of a housewife (p = 0.001).

Illiterate fathers of 54.9% of schoolaged children were unemployed, while jobless fathers of 30% of the students had dropped out during primary education. Schoolchild of an unemployed father was almost 1.2 times more prone to be victimized emotionally relative to a child of an employed father (p < 0.05).

Both Victimized and Aggresive students

A 41.7% of the physically aggressive students were also victims of physical bullying, while 79.9% of emotionally offensive students were also suffered from emotional harassment. Still 80.7% of the students who exerted verbal violence also suffered from verbal abuse (Figure ​ (Figure5). 5 ). As compared with a female student, male students were almost 2,2 times more likely to be both victim and perpetrator of physical violence (95% Confidence Interval = 1.9-2.4), 2,3 times more likely to be both victim and perpetrator of emotional assault (95% Confidence Interval = 2.1-2.6) and 3 times more likely to be both victim and perpetrator of verbal abuse (95% Confidence Interval = 2.5-3.4). As compared with a 17-year-old student, a 15-year old student was almost 1.3 times more likely to be both victim, and perpetrator of physical violence (95% Confidence Interval = 1.1-1.6). As observed in our investigation, the probability of being both victims and perpetrators of physical aggression among schoolchildren of the mothers with a lycée (35%) or university (37.1%) education was at a minimal level. A student raised by a mother graduated from a lycée was 30.4% less likely to be both executers, and victims of physical violence relative to those of illiterate mothers (p < 0.05). ❑

Bullying in schools is an issue that continues to receive attention from researchers, educators, parents, and students ( 4 ). This study focuses not only on the prevalence of bullying, but also on those subsets of students who reported being the victims of physical, verbal and/or emotional bullying.

Sociodemographic Characteristics

Our study population consisted of male students with a mean age of 15.68 ± 0.72 years (range: 14-17 years). As for sociodemographic properties, lower educational level, possesion of a job of inferior quality have been revealed to be important factors in the exertion of bullying behaviours (Table ​ (Table1). 1 ). Prevalence of being both aggressors, and victims was reportedly higher among students aged between 8-16 years. In a study conducted on 62 adolescents aged 16 years, 15% of the male, and 7% of the female students demonstrated violent behaviours. Again, 72 adolescents (12%), 13% of boys, and 12% of the girls were detected to be victims of violence, while 13 adolescents were both perpetrators, and victims of violence. Persistency of being both perpetrators, and victims of violence was investigated among adolescents aged between 8-16 years, and 18 of 38 girls at 16, and 27 of 30 girls at 8 years of age were detected to be victims of violence. Educational levels, socioeconomic status, composition of the families, and changes in the marital status (divorce, re-marriage etc) were observed for a period of 8 years, and a correlation between being a victim of violence at 8 years of age, and infliction of violence at age 16 could not be detected ( 9 ). In compliance with our study, studies performed in Turkey have emphasized that demonstration of violence was encountered mostly among adolescents aged 15-16 years ( 2 , 10 ).

Students involved in violence as aggressors or victims

Majority (99.2%; n = 3223) of male, and female (93.9%; n = 2703) students were detected to be involved in one form of bullying behaviours as aggressors or victims at one time of their lives. For a male student, the likelihood of being involved in violent behaviours was detected to be nearly 8.4 times higher when compared with a female student (p < 0.001). A statistically significant correlation was not found between the involvement in violence, and age of the student, familial unity, level of education, and occupation of the parents (p > 0.05). A total of 5926 students involved in violence, demonstrated physical (95.8%; n = 5667), emotional (48.5%; n = 2875), and verbal (25.3%; n = 1499) bullying behaviours. The students involved in violence were also suffered from physical (41.2%; n = 2441), emotional (64.1%; n = 3801), and verbal (47.3%; n = 2805) bullying behaviours (Figure ​ (Figure1). 1 ). A survey conducted in 1994, 1998, and 2002 in Lithuania detected that one in every 3 children were the victims of various types of violence exerted regularly by their peers. (During all three surveys conducted in 1994, 1998 and 2002, about one in three students reported that they had been a victim of regular bullying. A higher percentage of boys (36%) reported being bullied than girls (32%, p < 0.05). This study demonstrated that students living in rural areas were 1.5 times more frequently bullied than those in the cities, and 40% the boys and 28% of the girls inflicted violence on their peers. When incidence rates of bullying in different countries were examined, the highest rate was detected in Lithuania, followed by Austria, Swiss, Germany, and Russia in decreasing frequency ( 11 - 14 ).

The incidence of physical, emotional or verbal violence by a male student was found to be higher (8.1, 2.6, and 3.1 times more frequent, respectively) in comparison with a female student (p < 0.001). Usage of physical, emotional, and verbal violence increased with age (p < 0.001). When compared with a student aged 14 years, a 17-year old student resorted more frequently to physical (almost 2.2 – fold increase; p = 0.01), emotional (1.6 fold increase; p = 0.01), and verbal (almost 2 fold increase; p = 0.007) assaults.

A concordance was detected between lower educational level of the family, and verbal, physical, and emotional aggression. Students with employed parents were found to be more prone to resort to physical bullying. In a study, 5% (n = 305) of the students reported that they had carried cutting, and penetrating instruments such as pocket knives, and knives with the intention of bullying. An 8% (n = 253) of the boys, and 2.2% (n = 52) of the girls using physical violence carried cutting, and penetrating instruments such as pocket knives, and knives for the intention of bullying (p < 0.001). A survey among 500 children detected evidence of bullying in 31.4% of the cases. In schools for girls, the incidence of bullying was detected to be 18%, while it was 38.2% in coeducational mixed schools. The incidence of bullying increased with age, and higher grades. Bullying was mostly encountered in the form of verbal violence such as nicknaming, followed by abusive language, rumoring, insult, and isolation Infliction of physical harm was seen at a rate of 16 percent. Feeling oneself badly, desiring to be left alone, and tearing his/her clothes etc. were also observed. School phobia, vomiting, and sleeping disorders were seen in these children. Frequently, headache was seen to be a cardinal symptom of girls, and boys subjected to bullying behaviours ( 15 ).

Statistically significant correlations were seen between types of physical, emotional, and verbal bullying and gender, and age of the students. The likelihood of being a victim of physical, emotional, and verbal bullying was higher among male students rather than female students (almost 2, 1.4, and 2 fold increase respectively; p < 0.001). A study demonstrated that physical and verbal victimization decreases with age (p < 0.05). Minimal degree of physical victimization was observed among students whose mothers were lycée (36.3%), or university (38.8%) graduates. The student whose parents had a lower level of education carries a higher potential of being a victim of bullying. In the study group where male students with a mean age of 13 consisted 50 % of the study population, cases were attending primary (40%), secondary (26%) , and higher levels of (34%) education These students were subjected to violence at least once for a duration of one year. This incidence was 3 times higher than those found in other studies. Male students were more frequently involved in bullying behaviours. In higher education male students were more frequently involved in bullying behaviours, while in primary, and secondary education there was no difference between genders. The frequency of bullying behaviours decreased in higher grades. Bullying was more frequently observed in families with separated parents or in the absence of two biologic parents ( 16 ).

Students both as victims and perpetrators of violence

Many students were detected to be both victims, and perpetrators of physical (41.7%), emotional (79.9%), and verbal (80.7%) violence (Figure 6).

Compared with a female student, the probability of being both perpetrator, and victim of a physical, emotional, and verbal bullying for a male student was increased by 2.2 (p < 0.01), 2.3 (p < 0.001) and 2.3 (p < 0.001) times, respectively. The incidence of being a victim decreased with age. Among students whose parents were lycée (35%) or university (37.1%) graduates, physical aggressiveness, and victimhood have been observedly at a minimal level. Compared with a schoolchild of an unemployed father, and a housewife mother, the child of employed parents was 1.6-fold more likely to be both victim, and a perpetrator of a verbal bullying (p = 0.001). According to investigations conducted in Italy, boys were resorting to bullying more frequently than girls, while both genders were becoming victims of violence with a similar incidence. Boys were more likely to inflict direct physical aggression with the intent of causing physical harm, whereas girls were more likely to inflict indirect forms of aggression with the intent of causing psychological harm. However, there were no significant gender differences in direct verbal aggression. Researches have indicated that bullying is often exerted in the classrooms, but it is also encountered in other parts of the school, like corridors, and rest rooms, as well. Overall, 56.7% of all students had never been bullied in the last 3 months, 13.9% were bullied once or twice, 14.7% sometimes and 14.7% once a week or more often. Girls tended to be victimized more than boys; 34_5% of girls, and 24_8% of boys, had been victimized sometimes or more often. Boys were significantly more likely to suffer from various types of direct bullying, whereas girls were slightly more likely to suffer from indirect forms of bullying (e.g. being rejected, rumours spread about them). Significant differences emerged as for types of direct bullying, especially for being threatened and marginally for being physically hurt. There were no significant gender differences between direct verbal and indirect bullying; boys were almost as likely as girls to suffer from indirect bullying. An 18.5 % of the girls, and 20.4 % of the boys were subjected to bullying behaviours exerted by both girls, and boys. Over half of all students had bullied others, and nearly half had been bullied in Italy. Boys bullied more than girls, and girls were somewhat more likely than boys to be bullied sometimes or more often ( 17 ).

In conclusion, a multidisciplinary approach involving affected children, their parents, school personnel, media, non-govermental organizations, and security units is required to achieve an effective approach for the prevention of violence targeting children in schools as victims and/or perpetrators. In consideration of the impact of child's familial, and environmental cultural factors, and school ambiance on violence as well, educational efforts should be exerted both to eliminate potential adversities and also prevent bullying behaviours in schools.

CONFLICT OF INTEREST

none declared.

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