International News
Bullying's Sequelae Know No Borders
Psychiatric News
Volume 39 Number 23 page 19-44

Cruelty and power plays—better known as bullying—are problems for youth throughout the world, a new study reveals.

The study was headed by Tonja Nansel, Ph.D., an investigator at the National Institute of Child Health and Human Development in Bethesda, Md. Results appeared in the August Archives of Pediatrics and Adolescent Medicine.

Involvement in bullying at school—as bully, victim, or both—varies dramatically across countries, from as low as 9 percent of youth in Sweden to 54 percent of youth in Lithuania, with an average across countries of 11 percent of youth. (Some 25 percent of young people in the United States are involved.) But the consistency of findings regarding the link between bullying and poor psychosocial adjustment and poor health is striking.

Specifically, youths involved in bullying—as bully, victim, or both—reported significantly poorer emotional and school adjustment and significantly higher levels of health problems than did noninvolved youth in nearly all the countries surveyed. Health problems included headaches, stomachaches, backaches, irritability, nervousness, sleeping difficulties, and dizziness. Further, victims of bullying reported significantly more problems in relationships with classmates than did noninvolved youth in all 25 countries surveyed, and bullies reported significantly more problems in relationships with classmates than did noninvolved youth in 15 out of the 25 countries surveyed.

Thus, being a victim of bullying seems to have an adverse effect on youths' psychological and social development and health regardless of the country in which they live. But so does being a perpetrator of bullying.


In fact, youth who are both bullies and victims of bullying—so-called" bully-victims"—may experience the worst physical and mental health consequences of all, the study revealed. Bully-victims reported levels of emotional adjustment, relationships with classmates, and health problems similar to those of bullying victims and levels of school adjustment and alcohol use similar to those of bullies. What's more, in some cases, their school adjustment and health scores were significantly worse than those of either bullies or victims.

The researchers offered some possible explanations for this finding. For example, being bullied may lead to poor emotional adjustment by negatively shaping a youngster's self-image; this explanation is supported by other studies conducted in several countries. The stress of being bullied may lead to health problems, although only a few studies have examined the relationship between bullying and health. For both bullies and victims, problematic peer relationships may interfere with learning. And bullies may experience further school-related troubles because they often use alcohol. In this study, bullies were found to use more alcohol than noninvolved youth in all of the 25 countries surveyed.

All in all, Nansel and her colleagues concluded in their study report," Bullying is a critical issue for the health of youth internationally.... Bullying is not only a problem that influences individuals; it transcends peer groups, communities, and countries and as such is a significant international public health issue that warrants attention."

Indeed, research published during the past 15 years has shown that bullying is prevalent across countries. However, studies have varied regarding their definitions of bullying and measurements of bullying. So "this is the first study, to our knowledge, assessing the relationship between bullying and psychosocial adjustment across countries in nationally representative samples by standard measures and methods," Nansel and her team pointed out in their report.

The data they used for their study came from a 1997-98 international investigation called the Health Behavior in School-Aged Children Study, performed in collaboration with the World Health Organization. During this investigation, information about youth's health-related behaviors, including bullying, was gathered from some 113,000 students between the ages of 12 and 16 years in 25 countries during the 1997-98 academic year.


"These results reinforce the findings of the American Medical Association's Council on Scientific Affairs on the importance of prevention and early intervention in limiting bullying behaviors in school children," Carolyn Robinowitz, M.D., said in an interview. Robinowitz is a member of the AMA's Council on Scientific Affairs and a coauthor of a landmark AMA report on bullying (Psychiatric News, August 2, 2002).

"I noted that Sweden, which has adopted comprehensive programs to address bullying in school, had the lowest reported bullying," she added. "This certainly suggests that programs work and is a message for us in this country to employ more resources in the prevention of bullying and in the treatment of bullies and their victims."

The finding that the prevalence of bullying varies considerably from country to country is "very interesting and suggests that social and cultural factors are very important," Lois Flaherty, M.D., chair of the APA Council on Children, Adolescents, and Their Families, told Psychiatric News.

Studies such as this, she said, may also help psychiatrists "convince schools of the importance of developing and implementing effective programs to reduce bullying.... Many psychiatrists see children who are victims and/or perpetrators of bullying and realize they are limited in what they can do in working with the child and parents alone.... We have come a long way from seeing bullying as normal, but we have a long way to go to make all our schools free of it."

The American Health Behavior in School-Aged Children Study was funded by the National Institute of Child Health and Human Development. Each country involved in the study obtained its own funding.

An abstract of the study, "Cross-National Consistency in the Relationship Between Bullying Behaviors and Psychosocial Adjustment," is posted online at<http://archpedi.ama-assn.org/cgi/content/abstract/158/8/730.

Arch Pediatr Adolesc Med2004158730

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