quantitative research topics about bullying

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Bullying in children: impact on child health

Richard armitage.

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Correspondence to Dr Richard Armitage; [email protected]

Corresponding author.

Received 2020 Dec 4; Revised 2021 Feb 24; Accepted 2021 Mar 2; Collection date 2021.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

Bullying in childhood is a major public health problem that increases the risk of poor health, social and educational outcomes in childhood and adolescence. These consequences are felt by all those involved in bullying (bullies, victims and bully–victims) and are now recognised to propagate deep into adulthood. Cyberbullying is a relatively new type of bullying in addition to the traditional forms of direct physical, direct verbal and indirect bullying. Children who are perceived as being ‘different’ in any way are at greater risk of victimisation, with physical appearance being the most frequent trigger of childhood bullying. Globally, one in three children have been bullied in the past 30 days, although there is substantial regional variation in the prevalence and type of bullying experienced. The consequences of childhood bullying can be categorised into three broad categories: educational consequences during childhood, health consequences during childhood and all consequences during adulthood. Many dose–response relationships exist between the frequency and intensity of bullying experienced and the severity of negative health consequence reported. The majority of victims of cyberbullying are also victims of traditional bullying, meaning cyberbullying creates very few additional victims. Overall, adverse mental health outcomes due to bullying in childhood most severely impact on bully–victims. Bullying prevention is vital for the achievement of the Sustainable Development Goals, with whole-school cooperative learning interventions having the strongest evidence base for successful outcomes. Clear management and referral pathways for health professionals dealing with childhood bullying are lacking in both primary and secondary care, although specialist services are available locally and online.

Keywords: adolescent health, child psychiatry, psychology

Key messages.

Bullying in childhood is a global public health problem that impacts on child, adolescent and adult health.

Bullying exists in its traditional, sexual and cyber forms, all of which impact on the physical, mental and social health of victims, bullies and bully–victims.

Children perceived as ‘different’ in any way are at greater risk of victimisation.

Bullying is extremely prevalent: one in three children globally has been victimised in the preceding month.

Existing bullying prevention interventions are rarely evidence-based and alternative approaches are urgently needed.

Introduction

Bullying in childhood has been classified by the WHO as a major public health problem 1 and for decades has been known to increase the risk of poor health, social and educational outcomes in childhood and adolescence. 2 Characterised by repeated victimisation within a power-imbalanced relationship, bullying encompasses a wide range of types, frequencies and aggression levels, ranging from teasing and name calling to physical, verbal and social abuse. 3 The dynamics within such relationships become consolidated with repeated and sustained episodes of bullying: bullies accrue compounding power while victims are stripped of their own and become progressively less able to defend themselves and increasingly vulnerable to psychological distress. 4

However, only in the last decade have prospective studies been published that reveal the far-reaching effects of childhood bullying that extend into adulthood. There is now substantial evidence that being bullied as a child or adolescent has a causal relationship to the development of mental health issues beyond the early years of life, including depression, anxiety and suicidality. 5 As such, addressing the global public health problem of bullying in childhood has received increasing international attention and is vital for the achievement of Sustainable Development Goal 4. 6 The impact of the COVID-19 pandemic on child health and education has focused further attention on bullying in its digital form, so-called ‘cyberbullying’, the prevalence of which is feared to be increasing. 7

Types of bullying

Participants in childhood bullying take up one of three roles: the victim, the bully (or perpetrator) or the bully–victim (who is both a perpetrator and a victim of bullying). 5 Victims and bullies either belong to the same peer group (peer bullying) or the same family unit (sibling bullying), 8 although bullying frequently occurs in multiple settings simultaneously, such as at school (peer bullying) and in the home (sibling bullying), representing a ubiquitous ecology of bullying that permeates the child’s life.

Three main types of bullying are observed, the typical characteristics of which are illustrated in table 1 .

Typical characteristics of the main types of childhood bullying

While traditional bullying has been recognised and studied for many decades 9 and is often accepted as an inevitable aspect of a normal childhood, 3 cyberbullying represents a relatively new phenomenon in which childhood bullying now takes place through digital modalities. The widespread uptake of electronic devices has reached almost complete saturation among adolescents in high-income countries, with users checking their devices hundreds of times and for hours each day. 10 While providing beneficial access to information and social support, this large and growing online exposure of young people renders them vulnerable to exploitation, gambling, and grooming by criminals and sexual abusers, as well as cyberbullying. 11 Due to the increased potential for large audiences, anonymous attacks and the permanence of posted messages, coupled with lower levels of direct feedback, reduced time and space limits, and decreased adult supervision, it is feared that cyberbullying may pose a greater threat to child and adolescent health than traditional bullying modalities. 12

Factors that influence bullying

Two large-scale international surveys regularly conducted by the WHO—the Global School-based Student Health Survey (GSHS) 13 and the Health Behaviour in School-aged Children (HBSC) study 14 —provide data from 144 countries and territories in all regions of the world. These data identify specific factors that strongly influence the type, frequency and severity of bullying experienced by children and adolescents globally. These factors, which are briefly described in table 2 , suggest that children who are perceived as being ‘different’ in any way are at greater risk of victimisation.

Summary of factors that influence child and adolescent bullying 15

Prevalence of bullying

A 2019 report from the United Nations Educational, Scientific and Cultural Organisation (UNESCO) 15 examined the global prevalence of bullying in childhood and adolescence using data from the GSHS and HBSC studies along with addition data from the Progress in International Reading Literacy Study 16 and the Programme for International Students Assessment. 17 It found that almost one in three (32%) children globally has been the victim of bullying on one or more days in the preceding month, and that 1 in 13 (7.3%) has been bullied on six or more days over the same period. 15 However, there is substantial regional variation in the prevalence of bullying across the world, ranging from 22.8% of children being victimised in Central America, through 25.0% and 31.7% in Europe and North America, respectively, to 48.2% in sub-Saharan Africa. There is also significant geographical variation in the type of bullying reported, with direct physical and sexual bullying being dominant in low-income and middle-income countries, and indirect bullying being the most frequent type in high-income regions. Nevertheless, bullying is a sizeable public health problem of truly global importance.

Encouragingly, there has been a decrease in the prevalence of bullying in half (50.0%) of countries since 2002, while 31.4% have seen no significant change over this time frame. 15 However, 18.6% of countries have witnessed an increase in childhood bullying, primarily among members of one sex or the other, although in both girls and boys in North Africa, sub-Saharan Africa, Myanmar, the Philippines, and United Arab Emirates. 15

Since its appearance, cyberbullying has received substantial media attention claiming that the near-ubiquitous uptake of social media among adolescents has induced a tidal wave of online victimisation and triggered multiple high-profile suicides among adolescents after being bullied online. 18 19 However, a recent meta-analysis suggests that cyberbullying is far less prevalent than bullying in its traditional forms, with rates of online victimisation less than half of those offline. 20 The study also found relatively strong correlations between bullying in its traditional and cyber varieties, suggesting victims of online bullying are also likely to be bullied offline, and that that these different forms of victimisation reflect alternative methods of enacting the same perpetrator behaviour. Recent evidence from England also indicates a difference between sexes, with 1 in 20 adolescent girls and 1 in 50 adolescent boys reporting cyberbully victimisation over the previous 2 months. 21

Consequences of bullying

There is a vast range of possible consequences of bullying in childhood, determined by multiple factors including the frequency, severity and type of bullying, the role of the participant (victim, bully or bully–victim) and the timing at which the consequences are observed (during childhood, adolescence or adulthood). The consequences can be grouped into three broad categories: educational consequences during childhood and adolescence, health consequences during childhood and adolescence, and all consequences during adulthood. Each will now be discussed individually.

Educational consequences during childhood and adolescence

Children who are frequently bullied are more likely to feel like an outsider at school, 17 while indirect bullying specifically has been shown to have a negative effect on socialisation and feelings of acceptance among children in schools. 22 Accordingly, a child’s sense of belonging at school increases as bullying decreases. 22 In addition, being bullied can affect continued engagement in education. Compared with those who are not bullied, children who are frequently bullied are nearly twice as likely to regularly skip school and are more likely to want to leave school after finishing secondary education. 16 The effect of frequent bullying on these educational consequences is illustrated in table 3 .

Relationship between being frequently bullied and educational consequences 20

Children who are bullied score lower in tests than those who are not. For example, in 15 Latin American countries, the test scores of bullied children were 2.1% lower in mathematics and 2.5% lower in reading than non-bullied children. 22 Compared with children never or almost never bullied, average learning achievement scores were 2.7% lower in children bullied monthly, and 7.5% lower in children bullied weekly, indicating a dose–response relationship. These findings are globally consistent across both low-income and high-income countries. 17

Health consequences during childhood and adolescence

Numerous meta-analyses, 2 23–26 longitudinal studies 5 27 28 and cross-sectional studies 29–31 have demonstrated strong relationships between childhood bullying and physical, mental and social health outcomes in victims, bullies and bully–victims. Some of these consequences are illustrated in table 4 . Reported physical health outcomes are mostly psychosomatic in nature. Most studies focused on the impacts on victims, although adverse effects on bullies and bully–victims are also recognised. Many studies identified a dose–response relationship between the frequency and intensity of bullying experienced and the severity of negative health consequence reported.

Summary of childhood health consequences of bullying during childhood

While there is significant regional variation, the association between childhood bullying and suicidal ideation and behaviour are recognised globally. 32 Alarmingly, childhood bully victimisation is associated with a risk of mental health problems similar to that experienced by children in public or substitute care. 33 Victimisation in sibling bullying is associated with substantial emotional problems in childhood, including low self-esteem, depression and self-harm, 8 and increases the risk of further victimisation through peer bullying. Overall, adverse mental health outcomes due to bullying in childhood appear to most severely impact on bully–victims, followed by victims and bullies. 34

Nine out of 10 adolescents who report victimisation by cyberbullying are also victims of bullying in its traditional forms, 35 meaning cyberbullying creates very few additional victims, 36 but is another weapon in the bully’s arsenal and has not replaced traditional methods. 37 Cyberbullying victimisation appears to be an independent risk factor for mental health problems only in girls and is not associated with suicidal ideation in either sex. 38 As such, traditional bullying is still the major type of bullying associated with poor mental health outcomes in children and adolescents. 21

Consequences during adulthood

A recent meta-analysis 39 and numerous other prospective longitudinal studies 40 41 that used large, population-based, community samples analysed through quantitative methods suggest that childhood bullying can lead to three main negative outcomes in adulthood for victims, bullies and bully–victims: psychopathology, suicidality and criminality. Some of these consequences are illustrated in table 5 .

Summary of adulthood consequences of bullying during childhood

A strong dose–response relationship exists between frequency of peer victimisation in childhood and adolescence and the risk of adulthood adversities. 39 For example, frequently bullied adolescents are twice as likely to develop depression in early adulthood compared with non-victimised peers, and is seen in both men and women. 41 Startlingly, the effects of this dose–response relationship seems to persist until at least 50 years of age. 33

The impact of childhood bully victimisation on adulthood mental health outcomes is staggering. Approximately 29% of the adulthood depression burden could be attributed to victimisation by peers in adolescence, 41 and bully victimisation by peers is thought to have a greater impact on adult mental health than maltreatment by adults, including sexual and physical abuse. 42 Finally, these consequences reach beyond the realm of health, as childhood bullying victimisation is associated with a lack of social relationships, economic hardship and poor perceived quality of life at age 50. 33

Bullying prevention

Until not long ago, being bullied was considered a normal rite of passage through which children must simply persevere. 3 However, the size and scale of its impact on child health, and later on adulthood health, are now clearly understood and render it a significant public health problem warranting urgent attention. 1 While parental and peer support are known to be protective against victimisation, regardless of global location, cultural norms or socioeconomic status, 43 structured programmes have been deployed at scale to prevent victimisation and its associated problems.

School-based interventions have been shown to significantly reduce bullying behaviour in children and adolescents. Whole-school approaches incorporating multiple disciplines and high levels of staff engagement provide the greatest potential for successful outcomes, while curriculum-based and targeted social skills training are less effective methods that may even worsen victimisation. 44 The most widely adopted approach is the Olweus Bullying Prevention Programme (OBPP), a comprehensive, school-wide programme designed to reduce bullying and achieve better peer relations among school-aged children. 9 However, despite its broad global uptake, meta-analyses of studies examining the effectiveness of the OBPP have shown mixed results across different cultures. 45–47

Cooperative learning, in which teachers increase opportunities for positive peer interaction through carefully structured, group-based learning activities in schools, is an alternative approach to bullying prevention that has recently gained traction and been shown to significantly reduce bullying and its associated emotional problems while enhancing student engagement and educational achievement. 48 Also housed within the educational environment, school-based health centres became popular in the USA in the 1990s and provided medical, mental health, behavioural, dental and vision care for children directly in schools, and have had some positive impacts on mitigating the prevalence and impact of bullying. 49 In the UK, school nurses act as liaisons between primary care and education systems, and are often the first to identify victims of bullying, although their numbers in the UK fell by 30% between 2010 and 2019. 50

Due to the link between sibling and peer bullying, there have been calls for bullying prevention interventions to be developed and made available to start in the home, and for general practitioners and paediatricians to routinely enquire about sibling bullying. 8

While countless cyberbullying prevention programmes, both offline and online, are marketed to educational institutions, only a small proportion have been rigorously evaluated. 51 Furthermore, as cyberbullying rarely induces negative impacts on child health independently, interventions to tackle these effects must also target traditional forms of bullying to have meaningful impact.

Addressing the global public health problem of bullying in childhood and adolescence is vital for the achievement of the Sustainable Development Goals. In recognition of this, UNESCO recently launched its first International Day Against Violence and Bullying at School, an annual event which aims to build global awareness about the problem’s scale, severity and need for collaborative action. 52 Meaningful progress on this problem is urgently needed to increase mental well-being and reduce the burden of mental illness in both children and adults globally. Suggestions for immediate action are briefly described in box 1 .

Box 1. Actions needed to improve child health through the prevention of bullying.

Promote the importance of parental and peer support in the prevention of bully victimisation across families and schools.

Educate health professionals about the consequences of childhood bullying and provide training and resources to allow identification, appropriate management and timely referral of such cases (see further).

Develop and make widely available bullying prevention interventions that tackle sibling bullying in the home.

Create and deploy whole-school cooperative learning approaches to reduce bullying within educational institutions.

Address cyberbullying with evidence-based interventions that also tackle traditional forms of bullying.

Increase awareness of the presentation and impacts of bullying on child health among primary care professionals.

What to do if you suspect childhood bullying

GPs should be prepared to consider bullying as a potential contributory factor in presentations of non-specific physical and mental health complaints from children. While GPs recognise their responsibility to deal with disclosures of childhood bullying and its associated health consequences, they often feel unable to adequately do so due to the constraints of time-pressured primary care consultations, and uncertainty around the specialist services to which such children can be appropriately referred. 53

Clear management and referral pathways for health professionals dealing with childhood bullying are lacking in both primary and secondary care. Local, national and online antibullying organisations, such as Ditch the Label 54 and the Anti-Bullying Alliance, 55 provide free advice for children affected by bullying, and their parents, teachers and health professionals, along with free online certified CPD training for anyone working with children. School nurses continue to act as liaisons between primary care and education systems 56 and should be central to the multidisciplinary management of childhood bullying. Finally, if bullying is considered to be contributory to childhood depression, child and adolescent mental health services, along with primary care practitioners and educational professionals, should work collaboratively to foster effective antibullying approaches. 57

Supplementary Material

Contributors: RA was the sole contributor to the work.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: No, there are no competing interests.

Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Patient consent for publication: Not required.

Provenance and peer review: Commissioned; externally peer reviewed.

Data availability statement: Data sharing is not applicable as no datasets have been generated and/or analysed for this study.

1. World Health Organization . Social determinants of health and well-being among young people. health behaviour in school-aged children (HBSC) study: international report from the 2009/2010 survey. health policy for children and adolescents, no. 6, 2012. Available: https://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf [Accessed 28 Nov 2020].
2. Hawker DS, Boulton MJ. Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. J Child Psychol Psychiatry 2000;41:441–55. 10.1111/1469-7610.00629 [ DOI ] [ PubMed ] [ Google Scholar ]
3. Lancet Psychiatry . Why be happy when you could be normal? Lancet Psychiatry 2015;2:851. 10.1016/S2215-0366(15)00420-4 [ DOI ] [ PubMed ] [ Google Scholar ]
4. Olweus D. Bully/victim problems among school children: some basic facts and effects of a school-based intervention program. : Pepler D, Rubin K K, . The development and treatment of childhood aggression. Hillsdale, NJ, Erlbaum, 1991: 411–48. [ Google Scholar ]
5. Copeland WE, Wolke D, Angold A, et al. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry 2013;70:419–26. 10.1001/jamapsychiatry.2013.504 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
6. UNESCO . TCG4: development of SDG thematic indicator 4.a.2, 2018. Available: http://tcg.uis.unesco.org/wp-content/uploads/sites/4/2018/08/TCG4-41-Development-of-Indicator-4.a.2.pdf [Accessed 28 Nov 2020].
7. UN News . Violence and bullying affect one in three students, education experts warn, 2020. Available: https://news.un.org/en/story/2020/11/1076932 [Accessed 29 Nov 2020].
8. Wolke D, Tippett N, Dantchev S. Bullying in the family: sibling bullying. Lancet Psychiatry 2015;2:917–29. 10.1016/S2215-0366(15)00262-X [ DOI ] [ PubMed ] [ Google Scholar ]
9. Olweus D. Bullying at school: what we know and what we can do. Oxford, UK: Blackwell, 1993. [ Google Scholar ]
10. Haug S, Castro RP, Kwon M, et al. Smartphone use and smartphone addiction among young people in Switzerland. J Behav Addict 2015;4:299–307. 10.1556/2006.4.2015.037 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
11. Clark H, Coll-Seck AM, Banerjee A, et al. A future for the world’s children? A WHO–UNICEF–Lancet Commission. The Lancet 2020;395:605–58. 10.1016/S0140-6736(19)32540-1 [ DOI ] [ PubMed ] [ Google Scholar ]
12. Sticca F, Perren S. Is cyberbullying worse than traditional bullying? examining the differential roles of medium, publicity, and anonymity for the perceived severity of bullying. J Youth Adolesc 2013;42:739–50. 10.1007/s10964-012-9867-3 [ DOI ] [ PubMed ] [ Google Scholar ]
13. World Health Organization . global school-based student health survey (GSHS). Available: https://www.who.int/ncds/surveillance/gshs/en/ [Accessed 29 Nov 2020].
14. World Health Organization Regional Office for Europe . Health behaviour in school-aged children (HBSC). Available: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/health-behaviour-in-school-aged-children-hbsc [Accessed 29 Nov 2020].
15. UNESCO . Behind the numbers: ending school violence and bullying, 2019. Available: https://unesdoc.unesco.org/ark:/48223/pf0000366483 [Accessed 27 Nov 2020].
16. International Association for the Evaluation of Educational Achievement . Progress in international reading literacy study. Available: https://www.iea.nl/studies/iea/pirls [Accessed 29 Nov 2020].
17. Organisation for Economic Co-operation and Development . Programme for international student assessment. Available: https://www.oecd.org/pisa/ [Accessed 29 Nov 2020].
18. Harrison A. Cyber-bullying: horror in the home. BBC news online, 2013. Available: https://www.bbc.co.uk/news/education-23727673 [Accessed 02 Dec 2020].
19. McGraw P. It’s time to stop the cyberbullying epidemic. Huffington Post, 2015. Available: http://www.huffingtonpost.com/dr-phil/stop-cyberbullying_b_6647990.html [Accessed 02 Dec 2020].
20. Modecki KL, Minchin J, Harbaugh AG, et al. Bullying prevalence across contexts: a meta-analysis measuring cyber and traditional bullying. J Adolesc Health 2014;55:602–11. 10.1016/j.jadohealth.2014.06.007 [ DOI ] [ PubMed ] [ Google Scholar ]
21. Przybylski AK, Bowes L. Cyberbullying and adolescent well-being in England: a population-based cross-sectional study. Lancet Child Adolesc Health 2017;1:19–26. 10.1016/S2352-4642(17)30011-1 [ DOI ] [ PubMed ] [ Google Scholar ]
22. UNESCO . Third regional comparative and explanatory study on education quality (TERCE), 2015. Available: http://www.unesco.org/new/en/media-services/single-view/news/third_regional_comparative_and_explanatory_study_on_educatio/ [Accessed 30 Nov 2020].
23. Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics 2009;123:1059–65. 10.1542/peds.2008-1215 [ DOI ] [ PubMed ] [ Google Scholar ]
24. Moore SE, Norman RE, Suetani S, et al. Consequences of bullying victimization in childhood and adolescence: a systematic review and meta-analysis. World J Psychiatry 2017;7:60–76. 10.5498/wjp.v7.i1.60 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
25. Holt MK, Vivolo-Kantor AM, Polanin JR, et al. Bullying and suicidal ideation and behaviors: a meta-analysis. Pediatrics 2015;135:e496–509. 10.1542/peds.2014-1864 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
26. van Geel M, Vedder P, Tanilon J. Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatr 2014;168:435–42. 10.1001/jamapediatrics.2013.4143 [ DOI ] [ PubMed ] [ Google Scholar ]
27. Fisher HL, Moffitt TE, Houts RM, et al. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ 2012;344:e2683. 10.1136/bmj.e2683 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
28. Catone G, Marwaha S, Kuipers E, et al. Bullying victimisation and risk of psychotic phenomena: analyses of British national survey data. Lancet Psychiatry 2015;2:618–24. 10.1016/S2215-0366(15)00055-3 [ DOI ] [ PubMed ] [ Google Scholar ]
29. Nansel TR, Overpeck M, Pilla RS, et al. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA 2001;285:2094–100. 10.1001/jama.285.16.2094 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
30. Nansel TR, Overpeck MD, Haynie DL, et al. Relationships between bullying and violence among US youth. Arch Pediatr Adolesc Med 2003;157:348–53. 10.1001/archpedi.157.4.348 [ DOI ] [ PubMed ] [ Google Scholar ]
31. Harel Y. A cross-national study of youth violence in Europe. Int J Adolesc Med Health 1999;11:121–34. 10.1515/IJAMH.1999.11.3-4.121 [ DOI ] [ PubMed ] [ Google Scholar ]
32. Tang JJ, Yu Y, Wilcox HC, et al. Global risks of suicidal behaviours and being bullied and their association in adolescents: school-based health survey in 83 countries. EClinicalMedicine 2020;19:100253. 10.1016/j.eclinm.2019.100253 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
33. Takizawa R, Maughan B, Arseneault L. Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. Am J Psychiatry 2014;171:777–84. 10.1176/appi.ajp.2014.13101401 [ DOI ] [ PubMed ] [ Google Scholar ]
34. Juvonen J, Graham S, Schuster MA. Bullying among young adolescents: the strong, the weak, and the troubled. Pediatrics 2003;112:1231–7. 10.1542/peds.112.6.1231 [ DOI ] [ PubMed ] [ Google Scholar ]
35. Kowalski RM, Limber SP. Psychological, physical, and academic correlates of cyberbullying and traditional bullying. J Adolesc Health 2013;53:S13–20. 10.1016/j.jadohealth.2012.09.018 [ DOI ] [ PubMed ] [ Google Scholar ]
36. Wolke D, Lee K, Guy A. Cyberbullying: a storm in a teacup? Eur Child Adolesc Psychiatry 2017;26:899–908. 10.1007/s00787-017-0954-6 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
37. Wolke D. Cyberbullying: how big a deal is it? Lancet Child Adolesc Health 2017;1:2–3. 10.1016/S2352-4642(17)30020-2 [ DOI ] [ PubMed ] [ Google Scholar ]
38. Bannink R, Broeren S, van de Looij-Jansen PM, et al. Cyber and traditional bullying victimization as a risk factor for mental health problems and suicidal ideation in adolescents. PLoS One 2014;9:e94026. 10.1371/journal.pone.0094026 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
39. Klomek AB, Sourander A, Elonheimo H. Bullying by peers in childhood and effects on psychopathology, suicidality, and criminality in adulthood. Lancet Psychiatry 2015;2:930–41. 10.1016/S2215-0366(15)00223-0 [ DOI ] [ PubMed ] [ Google Scholar ]
40. Sigurdson JF, Undheim AM, Wallander JL, et al. The long-term effects of being bullied or a bully in adolescence on externalizing and internalizing mental health problems in adulthood. Child Adolesc Psychiatry Ment Health 2015;9:42. 10.1186/s13034-015-0075-2 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
41. Bowes L, Joinson C, Wolke D, et al. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ 2015;350:h2469. 10.1136/bmj.h2469 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
42. Lereya ST, Copeland WE, Costello EJ, et al. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry 2015;2:524–31. 10.1016/S2215-0366(15)00165-0 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
43. Biswas T, Scott JG, Munir K, et al. Global variation in the prevalence of bullying victimisation amongst adolescents: role of peer and parental supports. EClinicalMedicine 2020;20:100276. 10.1016/j.eclinm.2020.100276 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
44. Vreeman RC, Carroll AE. A systematic review of school-based interventions to prevent bullying. Arch Pediatr Adolesc Med 2007;161:78–88. 10.1001/archpedi.161.1.78 [ DOI ] [ PubMed ] [ Google Scholar ]
45. Olweus D, Limber SP. Bullying in school: evaluation and dissemination of the Olweus bullying prevention program. Am J Orthopsychiatry 2010;80:124–34. 10.1111/j.1939-0025.2010.01015.x [ DOI ] [ PubMed ] [ Google Scholar ]
46. Ferguson CJ, Miguel CS, Kilburn JC. The effectiveness of school-based anti-bullying programs: a meta-analytic review. Criminal Justice Review 2007;32:401–14. [ Google Scholar ]
47. Merrell KW, Gueldner BA, Ross SW, et al. How effective are school bullying intervention programs? A meta-analysis of intervention research. School Psychology Quarterly 2008;23:26–42. 10.1037/1045-3830.23.1.26 [ DOI ] [ Google Scholar ]
48. Van Ryzin MJ, Roseth CJ. Cooperative learning in middle school: a means to improve peer relations and reduce victimization, bullying, and related outcomes. J Educ Psychol 2018;110:1192–201. 10.1037/edu0000265 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
49. Arenson M, Hudson PJ, Lee N, et al. The evidence on school-based health centers: a review. Glob Pediatr Health 2019;6:2333794X1982874. 10.1177/2333794X19828745 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
50. Nursing Standard . School nurse numbers in UK fall by 30% since 2010, 2019. Available: https://rcni.com/nursing-standard/newsroom/news/school-nurse-numbers-uk-fall-30-2010-152546 [Accessed 24 Feb 2021].
51. Della Cioppa V, O'Neil A, Craig W. Learning from traditional bullying interventions: a review of research on cyberbullying and best practice. Aggress Violent Behav 2015;23:61–8. 10.1016/j.avb.2015.05.009 [ DOI ] [ Google Scholar ]
52. UNESCO . International day against violence and bullying at school including cyberbullying 2020.
53. Condon L, Prasad V. GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care. British Journal of General Practice 2019;69:e752–9. 10.3399/bjgp19X706013 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
54. Ditch the label. Available: https://www.ditchthelabel.org [Accessed 03 Dec 2020].
55. Anti-Bullying alliance. Available: https://www.anti-bullyingalliance.org.uk/ [Accessed 03 Dec 2020].
56. Royal College of Nursing . The Best Start: The Future of Children’s Health – One Year on. Valuing school nurses and health visitors in England, 2018. Available: https://www.rcn.org.uk/professional-development/publications/pdf-007000 [Accessed 03 Dec 2020].
57. National Institute for Health and Care Excellence . Depression in children and young people: identification and management. NICE guideline [NG134], 2019. Available: https://www.nice.org.uk/guidance/ng134/chapter/Recommendations#step-3-managing-mild-depression [Accessed 03 Dec 2020]. [ PubMed ]
58. Rivers I, Smith PK. Types of bullying behaviour and their correlates. Aggress Behav 1994;20:359–68. [ DOI ] [ Google Scholar ]
59. McMaster LE, Connolly J, Pepler D, et al. Peer to peer sexual harassment in early adolescence: a developmental perspective. Dev Psychopathol 2002;14:91–105. 10.1017/S0954579402001050 [ DOI ] [ PubMed ] [ Google Scholar ]
60. Slonje R, Smith PK. Cyberbullying: another main type of bullying? Scand J Psychol 2008;49:147–54. 10.1111/j.1467-9450.2007.00611.x [ DOI ] [ PubMed ] [ Google Scholar ]