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
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
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
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
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
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
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,
"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
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